Symptoms And Diagnosis Of Metastatic Breast Cancer
The most common parts of the body where breast cancer tends to spread are the bones, lungs, brain, and liver. But metastatic breast cancer can affect other parts of the body, as well.
Metastatic breast cancer symptoms can be very different depending on the cancers location, but may include:
biopsy of any suspicious area
a tap, removal of fluid from the area with symptoms to check for cancer cells a pleural tap removes fluid between the lung and chest wall a spinal tap removes fluid from around the spinal cord and a tap of fluid in the abdomen removes fluid in the abdominal cavity
These tests may also be used if you have no history of breast cancer and your doctor is having trouble determining the cause of your symptoms.
When breast cancer spreads to other parts of the body, its important to confirm whether the cancer has certain characteristics that may influence your treatment options, such as HER2 status and hormone receptor status. If you have been diagnosed with metastatic breast cancer years after an early-stage breast cancer diagnosis, it may seem logical to assume that the hormone receptor status and HER2 status are the same. But research has shown that the hormone receptor status and HER2 status of early-stage breast cancer can be different than that of a metastatic recurrence.
A biopsy may be done to determine these factors that can influence your treatment, which will be listed in your pathology report.
What Does Skin Metastases Look Like
Metastatic malignant melanomas that appear black or blue and nodular, resembling harmless blue nevi on the skin, are frequently seen as skin metastases. In contrast to the more common amelanotic form, the amelanotic form causes a darkened, pink, or red rash.
Diagnosing And Treating Cutaneous Metastases
In general, the diagnosis of cutaneous metastases is based on the clinical features and histologic evidence. Inflammation of the skin is the most common cause of cutaneous metastasis, which can be distinguished from a painless lesions buildup. Lesions that appear ulcerated can be diffuse erythematous, as well as ulcerated rash. When lesions progress to the more advanced stages, they can lose their overlying epidermis and form metastases in the skins dermis or subdermal tissue. Symptomatic treatment is typically provided in addition to treating cutaneous metastases based on their stage of disease. Antibiotics and topical creams are typically used to treat early-stage lesions, whereas surgical removal is required for more advanced ones.
Treatment For Metastatic Cancer
There are treatments for most types of metastatic cancer. Often, the goal of treating metastatic cancer is to control it by stopping or slowing its growth. Some people can live for years with metastatic cancer that is well controlled. Other treatments may improve the quality of life by relieving symptoms. This type of care is called palliative care. It can be given at any point during treatment for cancer.
The treatment that you may have depends on your type of primary cancer, where it has spread, treatments youve had in the past, and your general health. To learn about treatment options, including clinical trials, find your type of cancer among the PDQ® Cancer Information Summaries for Adult Treatment and Pediatric Treatment.
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What Is Metastatic Breast Cancer
Metastasis is the process by which cancer cells spread. In the case of metastatic breast cancer, the cancer originated in breast tissue, then spread to other parts of the body.
Metastatic cancer is further described as local, regional or distant, depending on the location of the cancer cells in relation to the original tumor.
- Localized metastatic breast cancer often means the breast cancer has spread to nearby lymph nodes.
- The more distant locations include the bones, lungs, skin, liver and brain, although its possible for other parts of the body to be affected.
Its important to remember that every cancer is unique and that your experience may not necessarily be the same as that of another breast cancer patient. With a personalized treatment plan, metastatic breast cancer is typically treatable. A recent National Cancer Institute study found that the number of U.S. women living longer with distant metastatic breast cancer is growing, thanks to advances in treatments.
Its also important to prepare yourself with information about the disease, its symptoms and how its detected and treated.
This article will cover:
Symptoms Of Metastasis May Vary Depending On Where The Cancer Has Spread To
Here are some symptoms that vary by locations commonly associated with breast cancer metastasis.
Metastasis in the bone may cause:
- Severe, progressive pain
- Bones that are more easily fractured or broken
Metastasis to the brain may cause:
- Persistent, progressively worsening headache or pressure to the head
- Vision disturbances
- Behavioral changes or personality changes
Metastasis to the liver may cause:
- Abnormally high enzymes in the liver
- Abdominal pain, appetite loss, nausea, and vomiting
Metastasis to the lungs may cause:
- Chronic cough or inability to get a full breath
- Abnormal chest X-ray
- Other nonspecific systemic symptoms of metastatic breast cancer can include fatigue, weight loss, and poor appetite, but its important to remember these can also be caused by medication or depression.
If you notice these symptoms, be sure you talk with your physician. They could be important for getting the treatment you need.
Interested in learning more? i3Health is hosting an upcoming webinar Metastatic Triple-Negative Breast Cancer: Applying Treatment Advances to Personalized Care. Learn more here.
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Stage Iv Or Metastatic Breast Cancer
Although seldom curable, advanced breast cancer is a highly treatable illness. Palliation or prevention of symptoms without excess toxicity is the primary goal of treatment. The median survival after diagnosis of metastatic breast cancer is 2 to 3 years, although the range is great, and a small cadre of long-term survivors has been described. Several recent clinical trials have documented small improvements in survival with some of the newer therapies.
Most women with metastatic breast cancer present with symptoms or abnormalities on physical examination. Less than 10% of women present initially with metastatic disease rather, advanced disease is normally diagnosed in women with a previous diagnosis of early breast cancer for which they received treatment. Common sites for metastases include bone, soft tissues, lung, liver, and brain. If metastatic disease is suspected, relevant hematologic, biochemical, and radiographic evaluation is indicated to assess location and severity of involvement. Because of the import of the diagnosis, pathologic confirmation is preferred. This permits verification of recurrent disease, exclusion of other diagnoses, and reassessment of biologic features such as estrogen receptor, progesterone receptor, and HER2 expression. Elevation of tumor markers or the presence of circulating tumor cells is not diagnostic of recurrent disease, although these markers may be useful adjuncts in the assessment of the effects of therapy.
Talk To Your Care Team
Whether youve already been diagnosed with metastatic breast cancer or you’re concerned about it due to a past early-stagediagnosis, its important to talk to your care team if you have a new symptom that is unusual for you.
Many of the symptoms we talk about on this page can have other causes besides metastatic breast cancer. Headaches, body aches, or a cough are fairly common and can be caused by non-cancerous conditions. Also, if youre currently receiving cancer treatments or finished them recently, you could still be experiencing side effects from those. Still, if you have a new symptom, share it with your care team and ask if an exam or testing makes sense.
It can be helpful to track any symptoms over time, either by writing them down or creating a file on your computer or phone. This way, you and your doctor can understand more about what youre experiencing, such as when it happens and if it happens during or after a specific activity.
If your symptom is sudden, severe, or way out of the ordinary for you, your care team may decide to investigate right away. If its milder and comes and goes, your team might ask you to track your symptom for several days to a couple of weeks to see if it improves on its own. Remember that you know the most about what does feel normal for you.
Pallav Mehta, MD
Two to three weeks is my personal cutoff, since most things tend to resolve on their own in a few weeks, Dr. Mehta says.
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What Are The Signs That Breast Cancer Has Spread
Metastatic breast cancer is a secondary cancer the cancerous cells originate in breast tissue and then travel to other parts of the body. The most common areas of breast cancer metastasis are the bones, lungs and liver.
Following an initial breast cancer diagnosis, a patient will receive a personalized monitoring plan for metastatic reoccurrence from their care team. Depending on the specific parts of the body affected, the symptoms of metastatic breast cancer can vary.
Metastatic Breast Cancer Symptoms
- Medical Review: Pallav K. Mehta MD
Metastatic breast cancer can cause a range of symptoms, and not every person experiences them in exactly the same way.
There are some symptoms that can happen no matter where metastatic breast cancer is in the body, including: Vomiting Generally not feeling well
Other symptoms of metastatic breast cancer are directly related to where in the body the cancer has spread such as the bones, lungs, liver, or brain. Usually, the symptoms depend on where the new areas of cancer are and their size.
It can be hard to tell the difference between symptoms caused by breast cancer itself and side effects caused by ongoing or past treatments. It can also be hard to tell if a symptom is due to something else entirely. Thats why its important get any new symptoms checked out.
It’s normal to feel concern when something seems off in your body. Its also important to know that just because you have a symptom, it doesnt always mean metastatic breast cancer. On this page, you can learn about common metastatic breast cancer symptoms, and well share links to more detailed information.
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Family History Of Breast Cancer
A positive family history of breast cancer is the most widely recognized risk factor for breast cancer. The lifetime risk is up to 4 times higher if a mother and sister are affected, and it is about 5 times greater in women who have two or more first-degree relatives with breast cancer. The risk is also greater among women with breast cancer in a single first-degree relative, particularly if the relative was diagnosed at an early age .
Despite a history indicating increased risk, many of these families have normal results on genetic testing. However, identification of additional genetic variants associated with increased risk may prove valuable. Michailidou et al conducted a controlled genome-wide association study of breast cancer that included 122,977 cases of European ancestry and 14,068 cases of East Asian ancestry, and identified 65 new loci associated with overall breast cancer risk. A GWAS by Milne et al identified 10 variants at 9 new loci that are associated with risk of estrogen receptornegative breast cancer.
A family history of ovarian cancer in a first-degree relative, especially if the disease occurred at an early age , has been associated with a doubling of breast cancer risk. This often reflects inheritance of a pathogenic mutation in the BRCA1 or BRCA2 gene.
The family history characteristics that suggest increased risk of cancer are summarized as follows:
- Ontario Family History Assessment Tool
Direct-to-consumer genetic testing
Whats The Difference Between Metastatic And Recurring Breast Cancer
Recurrent cancer is cancer that comes back after your initial treatment. This can happen when treatment doesnt completely destroy all of the cancer cells in a tumor. As time passes, these remaining cancer cells can begin to grow into detectable tumors.
Like metastasis, recurrence can happen with almost every type of cancer. As well see below, some types of recurrent cancer can happen distantly and therefore also fall under the umbrella of metastatic cancer.
Breast cancer may recur locally, regionally, or distantly:
- Local recurring breast cancer occurs when a new tumor develops in the breast that was originally affected. If the breast has been removed, the tumor may grow in the chest wall or nearby skin.
- Regional recurring breast cancer happens in the same region as the original cancer. In the case of breast cancer, this may be the lymph nodes above the collarbone or in the armpit.
- Distant recurring breast cancer happens when cancer cells travel to a different part of the body. This new location is far away from the original cancer. When cancer recurs distantly, its considered metastatic cancer.
, the most common metastasis locations for breast cancer are the:
The frequency that breast cancer metastasizes to each of these sites can vary based off of the population studied. A in Scientific Reports included a group of 4,932 people with metastatic breast cancer. Researchers determined the metastatic site for each person and found that:
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Symptoms Based On Location Of Metastasis
If breast cancer travels beyond the breast, it can spread to organs including the bones, brain, liver, or lung. As the cancer grows, it causes symptoms specific to that area of the body. Here, well talk about some of the most common symptoms.
Keep in mind that many of these symptoms can have less serious causes. A headache can result from eye strain or too much time on the computer. Back, neck, or leg pain can occur after a strain during exercise, sitting for too long, or even sleeping in a strange position. Stress and anxiety can cause physical symptoms, too. Your care team can help you figure out if any unusual or persistent symptom needs to be more closely examined with tests.
Treatments For Bone Metastases
To understand how treatments for bone metastasis work, it can help to first understand how breast cancer cells behave in the bones.
A bone can function like a storage tank that traps and holds breast cancer cells. For some time, those cells may not cause any problems. Eventually, though, the cancer cells can hijack the normal, healthy process through which bone tissue regenerates itself.
Your bones are constantly breaking down and clearing away old cells and stimulating new cells to grow. Breast cancer cells in the bone can speed up the breakdown of normal bone tissue and weaken the bones. This is called osteolytic metastasis. Breast cancer cells also can overstimulate the production of new bone, leading to large, rigid growths. This is called osteoblastic metastasis.
Its possible to have osteolytic metastasis, osteoblastic metastasis, or a combination of both. Treatment helps slow or stop these bone metastasis cycles to reduce the risk of whats called a skeletal-related event .
hypercalcemia of malignancy, or an excessive amount of calcium in the blood
Its important to address any potential symptoms of bone metastases quickly. In addition to controlling the growth of the cancer, the goals of treatment for bone metastasis are to relieve pain, preserve function, and prevent SREs. Doctors can often stabilize bone metastases and help people manage it for long periods of time.
the cancer is growing quickly
Xgeva is given monthly as an injection under the skin.
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What Can I Expect While Living With Metastatic Breast Cancer
Your care team will monitor you every few months to check if the cancer is responding to treatment, and also to see if you are having any side effects. The process of restaging the cancer includes:
- History/physical exam.
- Imaging tests, including CTs and bone scan or PET scan.
Before your scans or tests, its normal to feel anxiety. It may help to bring a friend or family member to the appointment with you.
Myth #: If Youre Diagnosed With Metastatic Breast Cancer You Did Something Wrong Or Didnt Get The Right Treatment The First Time
When some people hear stage IV breast cancer, they assume something must have been missed along the way to let the cancer get that far. There is a misconception that breast cancer always develops in orderly steps from stages I to II, III, and then IV and that theres plenty of time to catch it early. People with MBC can face misguided assumptions that they must have skipped mammograms or self-exams, or they didnt control risk factors such as not exercising enough, watching their weight, or eating healthy. But a person can do everything right and still get MBC. Although regular screenings increase the odds of diagnosing breast cancer at an earlier stage, they cant guarantee it.
Another major misconception: If youre diagnosed with metastatic cancer after being treated for an early-stage breast cancer, you must have chosen the wrong treatment regimen or it wasnt aggressive enough. But between 20% and 30% of people with an earlier-stage breast cancer will eventually go on to develop MBC and theres often no good explanation as to why. And it can happen to anyone. Treatments can reduce the risk of recurrence, but they cant eliminate it.
As Illimae of Houston notes: that a stage IV diagnosis equals negligence on the part of the patient. In my case, it had spread before I ever felt a lump. I felt it Saturday and saw my doc on Monday, I ignored nothing, sometimes it just happens that fast.
Why Does My Provider Need To Test The Metastatic Tumor
Your care team will test the metastases to figure out the biology of the tumor, which can help guide your treatment plan. Providers may test tumors for:
- Hormone receptor status: If the cancer is hormone receptor-positive, hormonal therapy may be your first treatment.
- HER2 status: Human epidermal growth factor receptor 2 is a protein that is overexpressed on some breast cancer cells. HER2-positive cancer responds to specific HER2-targeted therapies.
- PIK3CA gene mutation: If a tumor is hormone receptor-positive and HER2-negative, your provider may test for this gene mutation. Specific targeted therapies can be used to treat tumors with this mutation.
- PD-L1 status: Tumors that are hormone receptive-negative and HER2-negative may be tested for PD-L1 status. If the PD-L1 test is positive, you may be recommended to receive a combination of immunotherapy and chemotherapy.