How We Can Manage Breast Cancer That Spreads To The Bones
by Robert Henshaw, MD, Professor and Director, Orthopedic Oncology, MedStar Orthopaedic InstituteApril 6, 2018
Has my cancer spread? After a woman has had the time she needs to process a cancer diagnosis, this tends to be one of her first questions.
The process of a cancer spreading is called metastasis. When breast cancer spreads, the bones are one of the most common places it goes. One study noted that 70 percent of breast cancer patients had a cancer that spread to at least one bone. As an orthopedic surgical oncologist, I care for women whose cancer has spread to the bones and who need surgery to reduce pain and improve their quality of life. My colleagues and I work closely with our breast oncology team to provide advanced therapies and to advocate for women who are being treated for breast cancer or who have been treated for it in the past. Unfortunately, breast cancer can come back years after beating the disease, and its vital that women recognize the subtle signs that a cancer has spread to the bones.
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Positron Emission Tomography Scan
This is another nuclear scanning technique sometimes used to detect metastases by creating a 3-dimensional picture of your body, with the use of radio waves that show up after an injection. PET scans are not routinely used to look for bone metastases. If your doctor recommends that you have a PET scan you should speak to your doctor about possible costs as it is not usually covered by Medicare.
Additional Tools For Diagnosing Advanced Breast Cancer
The additional tools below are often used specifically for diagnosing advanced cancer:
Sentinel lymph node biopsy: This procedure removes sentinel lymph node cells during surgery for examination. When breast cancer spreads, it often heads first to the lymph nodes.
Chest X-ray: This detailed image of the chest may help doctors see whether cancer has spread to the bones.
Computed tomography scan: Also known as a CAT scan, this procedure takes detailed pictures of internal areas of the body using a computer linked to an X-ray machine. A dye may be used to help the organs show up more clearly in the images.
Bone scan: This procedure looks for bone metastasis, or cancer cells that have spread to the bone. A small amount of radioactive material is injected into the blood, then detected with a scanner.
Positron emission tomography scan: A PET scan is a detailed imaging tool that uses a radioactive drug, known as a tracer, to search for cancer cells within your body.
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Symptoms If Cancer Has Spread To The Lymph Nodes
Lymph nodes are part of a system of tubes and glands in the body that filters body fluids and fights infection.
The most common symptom if cancer has spread to the lymph nodes is that they feel hard or swollen. You might have any of the following symptoms if your cancer has spread to the lymph nodes:
- a lump or swelling under your armpit
- swelling in your arm or hand
- a lump or swelling in your breast bone or collar bone area
One of the first places breast cancer can spread to is the lymph nodes under the arm on the same side as the breast cancer. This is not a secondary cancer.
What Is A Metastasis
Metastasis is a word that describes the spread of cancer from its original site to another part of the body. Metastasis happens when cells break away from the original cancer site and travel to other areas of the body through the bloodstream or the lymph system. Cancer cells then settle in different tissues or organs, where they grow and form a new tumour . When breast cancer is found in parts of the body other than the breast it is called metastatic breast cancer.
A bone metastasis from breast cancer is made up of breast cancer cells. Bone is one of the most common places for breast cancer to spread.
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Managing Your Feelings About Metastatic Breast Cancer
Regardless of whether metastatic breast cancer is a first diagnosis or a recurrence, its normal for people to feel angry, scared, stressed, outraged, depressed, or calm. You may question the treatments youve had, feel mad at your doctors, or be prepared to deal with the diagnosis in a matter-of-fact way. There is no right or wrong way to come to terms with a metastatic breast cancer diagnosis.
Many people find it helps to concentrate on understanding the diagnosis, learning all they can about different treatment options, and taking the time to get second opinions. Information can give people a feeling of control, which can help them manage any fears they may have.
Loss of control is a huge issue for women diagnosed with metastatic breast cancer, said Musa Mayer, author of Advanced Breast Cancer: A Guide to Living with Metastatic Disease and patient advocate. The process of gathering information and learning about the disease and treatment can be very stabilizing and help women feel more in control.
Some people with metastatic breast cancer may feel the urge to withdraw from social connection. But in interviews and publications, many people who are living with metastatic breast cancer have said that distancing themselves from loved ones wasnt very helpful in dealing with their diagnosis.
Still, its important to remember that everyone deals with fear and stress differently. Coming to terms with the diagnosis takes time and is different for everyone.
What Is Secondary Breast Cancer In The Bone
When cancer that started in the breast has spread to the bones, its called secondary or metastatic breast cancer in the bone.
Some people also refer to it as bone metastases or bone mets.
The bones most commonly affected are the:
- Spine
- Pelvis
- Upper bones of the arms and legs
The cells that have spread to the bone are breast cancer cells. Its not the same as having cancer that starts in the bone.
Breast cancer cells can spread to the bone through the lymphatic system or the blood.
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How Long Does It Take Breast Cancer To Grow
Every type of breast cancer varies based on individual factors and subtypes, says Dr. Roesch.
Different types of breast cancer tend to behave differently, and because every cancer is different and every person is too its hard to say exactly how quickly breast cancer can grow and spread. Still, experts understand that some types of breast cancer tend to be more aggressive and fast moving, while other types typically move slower.
Speed of breast cancer growth can be influenced by these factors:
Your cancer team will determine how likely or fast your breast cancer may spread based on your breast cancer subtype, stage and individual factors. Although breast cancer experts can hypothesis and estimate the speed of cancer growth, every breast cancer is different and distinctive to that person.
When Cancer Goes Beyond Your Breast
If your doctor told you that your breast cancer has spread to other parts of your body, it’s at a more advanced stage than if it’s only in your breasts. How far it has spread is one of the things your doctor will consider when they tell you the “stage” of your cancer. It’s considered “metastatic” if it has spread far from your breasts. Every case is different. For some women, it becomes something they live with for a long time. For others, focusing on pain management and quality of life is the main goal.
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How Will I Know If My Breast Cancer Spreads
Your doctor will use specific kinds of tests to find out if your cancer has gone to other places in your body. First, your doctor will want to know how youâre feeling. They will ask you about any symptoms youâre having and your overall health. They might also look at the size of your tumor and check your lymph nodes.
After that, the doctor may give you:
Blood tests. They look for signs of anything abnormal thatâs happening in your body. For example, results from a liver function test can let your doctor know that breast cancer may have gone to your liver. High levels of some substances in your blood hint that the cancer has spread to your bones.
Imaging scans. These tests make detailed pictures of the inside of your body. They help your doctor pinpoint any cancer spread. These tests include:
- X-ray
Is Cancer In Lymph Nodes Fatal
When cancer cells break away from a tumor, they can travel to other areas through either the bloodstream or the lymph system. If they travel through the lymph system, the cancer cells may end up in lymph nodes. Most of the escaped cancer cells die or are killed before they can start growing somewhere else.
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Symptoms Point To Cancer’s Spread
Bone metastasis may not have any symptoms. But often, you’ll feel pain in your bones. The ache may come and go and first, often worsening at night and easing up when you’re active. Eventually it can become more intense and flare during activity.
If you have , you may have other symptoms as well, including:
Sometimes a fracture in your arms, legs, or spine is the first sign that your cancer has spread. You may break a bone when you fall, or incur what appears to be a trivial injury during your regular daily activities. The nature of the injury could be minor, and seem insufficient to fracture healthy bone. If occurs, you’ll feel sudden, severe pain. Get immediate treatmentespecially if the pain strikes in your back, a sign of a broken bone in your spine.
Investigations For Stages Of Breast Cancer
The following procedures may be necessary to check for metastasis:-
- bone scan
- MRI scan
- blood tests
So, after a breast cancer diagnosis, while in general, the outlook is favorable , it should really be considered a chronic condition.
But the progression is not going to be the same for everyone, even for patients with similar stages of breast cancer presentation. It is SO important to remember that each case is individual. Indeed breast cancer has been known to return even 20 years after a mastectomy, whilst in others, the progression and systemic development of the disease may be rapid.
Are you considering having NO treatment?
Anxiety, fear, panic, anger and sadness are all common emotions following a breast cancer diagnosis. If you are in the middle of a combination of these feelings, today is not a good day to make important decisions.
Here is my quick imagine a way this all gets better line of reasoning, to help you. Firstly, treatments are so effective nowadays and very well organized. Cancer research and treatments are improving all the time and the people who treat breast cancer are experienced experts.
Give the team some trust and time to explain things properly and accept the treatments. Do one step at a time, one day at a time, and you will be amazed at the results.
Add onto that the following self-help methods:-
- lots of sleep
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How Long Does It Take Breast Cancer To Spread
According to the Robert W. Franz Cancer Research Center at Providence Portland Medical Center, breast cancer cells need to divide at least 30 times before they are detectable by physical exam. Each division takes about 1 to 2 months, so a detectable tumor has likely been growing in the body for 2 to 5 years.
Origin And Characterization Of Cafs In The Tumor Microenvironment
The origin of CAFs in the tumor microenvironment remains to be elucidated, but they might be derived from resident fibroblasts , actively recruited bone marrow-derived cells or cells that undergo epithelial-mesenchymal transition .
Due to the phenotypical and functional heterogeneity of CAFs there are no unique markers to identify them but commonly used ones include SMA, fibroblast-specific protein1 , fibroblast activation protein , platelet derived growth factor receptors , vimentin, and tenascin C . Several in vitro studies demonstrate that MSCs can differentiate into SMA -expressing myofibroblasts upon cancer cell stimulation . For instance, studies by Mishra and colleagues show that human bone marrow-derived MSCs can acquire a CAF-like, myofibroblastic phenotype upon prolonged stimulation with conditioned medium from MDA-MB-231 breast cancer cells. Importantly, these cells expressed CAF markers including SMA, SDF-1, vimentin, and FSP as determined by immunofluorescence staining. Gene expression analysis revealed that cancer-conditioned medium upregulated the expression of CAF-associated genes including SDF-1, platelet derived growth factor and MMP9, suggesting that exposure to cancer cells induces hMSC differentiation into a CAF-resembling state .
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Breast Cancer: Why Metastasis Spreads To The Bone
Nature Communications
When cancer cells break away from a primary tumor and migrate to other organs, this is called “metastatic cancer.” The organs affected by these metastases, however, depend in part on their tissue of origin. In the case of breast cancer, they usually form in the bones. In an attempt to identify what determines the organs affected by metastasis, a team from the University of Geneva , in collaboration with researchers from ETH Zurich, has identified a protein involved in this phenomenon. This discovery could lead to the development of therapeutic approaches to suppress metastasis. This work can be read in the journal Nature Communications.
From the primary site of a tumor, cancer cells can invade their microenvironment and then circulate via blood and lymphatic vessels to distant healthy tissue to form metastases. In the case of metastatic breast cancer, the cancer cells primarily colonize the bones, but can also be found in other organs such as the liver, lungs or brain.
Plasticity of tumor cells
Although the molecular and cellular mechanisms responsible for the different stages of the metastatic process are not yet fully understood, studies show that cellular plasticity plays an important role. This term refers to the ability of cells to change function and/or form. Thus, tumor cells that become metastatic change their shape and become mobile.
Directing metastasis to bone
Explore further
Signs That Breast Cancer Has Spread To The Bone
Most aches and pains arent cancer, stresses Huston. But its important to keep an open and honest dialogue with your doctor about any unusual or persistent discomfort you may be having. He or she can determine if getting images is appropriate to rule out bone metastasis. Here are the symptoms of bone metastasis to look out for:
If you report any of the above symptoms to your doctor, he or she may want to do a thorough physical exam, blood tests, and a bone scan to check for bone metastasis. Depending on the results and where or how severe the bone pain is, he or she may also order an X-ray, PET scan, or CT scan. In some cases, a tissue biopsy is also done to confirm the diagnosis.
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Metastatic Breast Cancer In Bones
Like any cancer, breast cancer can spread to other parts of the body. Breast cancer that has invaded bone can have a significant effect on quality of life, but there are treatments to help manage symptoms and slow disease progression.
Read on to learn more about metastatic breast cancer in bones, including symptoms and what you can expect of treatment.
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Survival Rates Of Bone Metastases
Survival rates for people with bone metastases vary greatly by cancer type and stage. Your general health condition and the type of treatment you received for the primary cancer are additional factors.
Discuss your particular situation with your doctor. Remember that survival rates are averages gathered from large numbers of people. Also, survival data may reflect statistics from a period before the most recent treatment advances.
A large-scale 2017 study of the 10 most common cancers with bone metastasis found:
- Lung cancer had the lowest 1-year survival rate after bone metastasis .
- Breast cancer had the highest 1-year survival rate after bone metastasis .
- Having metastases in bone and also in other sites was found to decrease the survival rate.
Here are some typical figures from a 2018 study of common cancers and bone metastasis:
| Type of cancer |
Youre likely to have a combination of therapies that may include:
- radiation to slow metastasis growth and reduce pain
- chemotherapy to kill cancer cells and reduce tumor size
- hormone therapy to reduce the hormones known to be involved with breast and prostate cancer
- painkillers and steroids for pain relief
- drugs that specifically target bones
- surgery if necessary to stabilize your bone, fix a break, and help with pain
- physical therapy to strengthen your muscles and help you with mobility
- extreme heat or cold that targets cancer cells and may relieve pain
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Living With Secondary Breast Cancer
You will see your cancer doctor or specialist nurse regularly during and after treatment. This means that any symptoms or problems can be managed early on. You may have regular scans to check how the cancer has responded to treatment.
You may need treatment at different times or have ongoing treatment with hormone therapy. There may be long periods when the cancer is controlled and you are getting on with day-to-day life.
We have more about well-being and coping in our information about living with secondary breast cancer.
You may get anxious between appointments. This is natural. It may help to get support from family, friends or a support organisation. Macmillan is also here to support you. If you would like to talk, you can:
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