Treatment Options For Metastatic Breast Cancer
Treatment for metastatic breast cancer often is based on systemic therapies, which use drugs rather than surgery or radiation. Metastases treatments are designed to shrink tumors and slow their growth, help ease symptoms and improve quality of life. Treatment may change, such as when one therapy stops working, or the side effects become too uncomfortable. Rather than having only one treatment, most patients undergo several treatments combined to help fight the cancer.
The four broad categories of drug-based treatments are:
Lymphangiogenesis And Lymphatic Metastasis
While the promoting effect of angiogenesis and vascularization of the tumor in the progression of the disease is well documented, there is little information with regard to lymphangiogenesis and its function in metastasis. Certain studies have indicated that the tumors are devoid of lymphatic vessels, while others have suggested that tumors invade and destroy lymphatic vessels . Furthermore, other studies have indicated that tumor cells may induce lymphangiogenesis, some form of lymphatic sprouting, or hyperplasia in close proximity to the periphery of the tumors . Therefore, the pertinent question is whether lymphangiogenesis is necessary for lymphatic metastasis. Although it is possible for lymphatic metastasis to occur via preexisting vessels that were incorporated into the tumors, there is evidence to suggest that increased lymphatic vessel density due to lymphangiogenesis significantly improves metastasis .
What Is Metastatic Breast Cancer
Metastatic breast cancer is the most advanced stage of breast cancer. Breast cancer develops when abnormal cells in the breast start to divide uncontrollably. A tumor is a mass or collection of these abnormal cells.
Metastasis refers to cancer cells that have spread to a new area of the body. In metastatic breast cancer, cells may spread to the:
Healthcare providers name cancer based on its primary origin. That means breast cancer that spreads to other body parts is still considered breast cancer. The cancer cells are still breast cancer cells. Your care team will use breast cancer therapies, even if the cancer cells are in other areas.
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Can Metastatic Breast Cancer Be Cured
There is no cure for metastatic breast cancer. Once the cancer cells have spread to another distant area of the body, its impossible to get rid of them all. However, the right treatment plan can help extend your life and improve its quality.
Metastatic breast cancer treatment aims to shrink tumors, slow their growth and improve your symptoms.
How Is Cancer In Lymph Nodes Found
Normal lymph nodes are tiny and can be hard to find, but when theres infection, inflammation, or cancer, the nodes can get larger. Those near the bodys surface often get big enough to feel with your fingers, and some can even be seen. But if there are only a few cancer cells in a lymph node, it may look and feel normal. Lymph nodes deep in the body cannot be felt or seen. So doctors may use scans or other imaging tests to look for enlarged nodes that are deep in the body. Often, enlarged lymph nodes near a cancer are assumed to contain cancer.
The only way to know whether there is cancer in a lymph node is to do a biopsy. Doctors may remove lymph nodes or take samples of one or more nodes using needles. The tissue thats removed is looked at under the microscope by a pathologist to find out if there are cancer cells in it. The pathologist prepares a report, which details what was found. If a node has cancer in it, the report describes what it looks like and how much was seen.
When a surgeon operates to remove a primary cancer, they may remove one or more of the nearby lymph nodes as well. Removal of one lymph node is considered a biopsy, but when many lymph nodes are removed, its called lymph node dissection. When cancer has spread to lymph nodes, theres a higher risk that the cancer might come back after surgery. This information helps the doctor decide whether more treatment, like chemo,immunotherapy, targeted therapy or radiation, might be needed after surgery.
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Diagnosis Of Secondary Breast Cancer
You may be diagnosed with secondary breast cancer after having tests to check a new symptom. This could be through your GP or at a breast cancer follow-up clinic. Sometimes there may be no obvious symptoms and the diagnosis is made after routine follow-up tests.
Some women who have just been diagnosed with primary breast cancer have tests that show the cancer has already spread to other parts of the body. Sometimes the secondary breast cancer is diagnosed first and tests show that it first started in the breast.
Your cancer doctor or nurse will ask you about your symptoms and general health. You may need some of the following tests:
What Is The Treatment For Metastatic Breast Cancer
Treatments include many of the same treatments as other stages of breast cancer:
- Radiation therapy
- Hormone therapy For patients diagnosed with Stage IV breast cancer that is hormone receptor positive, hormonal therapy may be the first line of defense against the disease. As long as the drugs are keeping the cancer from progressing, the patient may be kept on the medication for some time. If scans show the progression of the cancer, the medical oncologist may switch to another form of hormonal therapy or possibly stop this therapy and pursue a different line of systemic treatment, such as chemotherapy or biologic targeted therapy.
- Biologic targeted therapy
- Breast surgery It is controversial whether surgery should be done on the breast in the presence of known metastatic disease. In most cases, however, the knowledge of metastasis is discovered after the breast cancer surgery and other treatment has been performed. The cancer returns as a distant recurrence.
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How Long Do People Live With Secondary Breast Cancer
One of the first things many people with secondary breast cancer want to know is how long theyve got to live.
Life expectancy is difficult to predict as each persons case is different and no two cancers progress in the same way. However, as treatments have improved, more and more people are living longer after a diagnosis of secondary breast cancer.
Your specialist will have an understanding of the likely progression of your secondary breast cancer and can talk to you about what you might expect. You may worry if their answers are vague but it isnt possible to accurately predict how each persons cancer will respond to treatment.
Will I Need More Than One Treatment For Metastatic Breast Cancer
Medications are important for metastatic breast cancer to help control its spread. Resistance to therapies may develop, which can lead your care team to recommend a change in treatment.
When you start a treatment regimen, you and your care team will see how:
- The cancer responds to the therapy.
- The side effects impact you.
If the treatment isnt working or the side effects are unbearable, your care team can discuss switching the treatment method. They may recommend a different drug, dosage or schedule.
There are many treatments available. If one therapy isnt working for you for whatever reason, there is usually another one you can try.
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Treating Breast Cancer In People Age 70 And Up
Older age increases the risk of several types of breast cancer. But advancements in diagnosis and highly individualized treatment plans are increasing the odds of recovery for older patients and making it possible for many to live longer, healthier lives.
Breast surgeon Hanh-Tam Tran, M.D., explains what people age 70 and older should know about being diagnosed with breast cancer and why theres reason for hope.
Where In The Body Does Breast Cancer Spread
In theory, breast cancer can spread to any part of the body, but it most commonly spreads to the lymph nodes, lungs, liver, bones and sometimes the brain. Keep in mind though, that even if your breast cancer spreads to other areas of your body, its still considered breast cancer. For example, if breast cancer spreads to your lungs, it does not mean that you now have lung cancer too.
If your breast cancer has moved to other parts of your body, you might experience symptoms relating to the area it has spread to, but not always.
Here Dr. Roesch explains how metastatic breast cancer can affect different parts of the body:
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Support When You Have Secondary Breast Cancer
Secondary breast cancer occurs when breast cancer cells spread from the first cancer in the breast through the lymphatic or blood system to other parts of the body. Read more about diagnosis, treatments and living with secondary breast cancer, and find support.
Metastatic Breast Cancer Treatment And Planning
After a diagnosis of metastatic breast cancer, its helpful to take all the time you need to gather information and make decisions about your treatment. Learn about the medical specialists that may be involved in your care, treatment options, genetic testing, taking a break from treatment, and more.
SurgeryDoctors sometimes recommend surgery for metastatic breast cancer in order, for example, to prevent broken bones or cancer cell blockages in the liver. Learn more.
ChemotherapyChemotherapy is used in the treatment of metastatic breast cancer to damage or destroy the cancer cells as much as possible. Learn more.
Radiation TherapyYour doctor may suggest radiation therapy if youre having symptoms for reasons such as easing pain and controlling the cancer in a specific area. Learn more.
Hormonal TherapyHormonal therapy medicines are used to help shrink or slow the growth of hormone-receptor-positive metastatic breast cancer. Learn more.
Targeted TherapyTargeted therapies target specific characteristics of cancer cells, such as a protein that allows the cancer cells to grow in a rapid or abnormal way. Learn more.
Local Treatments for Distant Areas of MetastasisLocal treatments are directed specifically to the new locations of the breast cancer such as the bones or liver. These treatments may be recommended if, for example, the metastatic breast cancer is causing pain. Learn more.
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Local And Regional Recurrence Of Breast Cancer
Breast cancer that comes back in the breast, chest, scar or lymph nodes nearby is called a local or regional recurrence. This is not secondary breast cancer. If you have a local or regional recurrence, you may have tests to check the cancer has not spread to other parts of the body.
We have more information about breast cancer recurrence.
Symptoms Of Metastatic Cancer
Metastatic cancer does not always cause symptoms. When symptoms do occur, what they are like and how often you have them will depend on the size and location of the metastatic tumors. Some common signs of metastatic cancer include:
- pain and fractures, when cancer has spread to the bone
- headache, seizures, or dizziness, when cancer has spread to the brain
- shortness of breath, when cancer has spread to the lung
- jaundice or swelling in the belly, when cancer has spread to the liver
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Breast Cancer Progression Tends To Be Consistent And Predictable
There are many ways that breast cancer can develop but most of the time it starts in the breast ducts.
While cancer is still confined to the breast ducts, specialists refer to it as ductal carcinoma in situ, or DCIS. The good news is that if breast screening detects cancer at this in-situ stage, the chance of survival is close to 100%.
As cancer moves into the breast duct wall and finally begins to affect the surrounding breast tissue, specialists call it infiltrative or invasive breast cancer.
If treatment does not occur, breast cancer will usually spread to other areas of the body . Very often the first area that cancer usually spreads to is the lymph nodes in the underarm area .
Once cancer enters the lymphatic system, it can and usually does spread to other areas of the body. Sometimes this is called distant metastasis.
Not all breast cancers spread first to the axillary lymph nodes and then to the rest of the body. If the breast tumor occurs near the nipple, cancer may spread first to the internal mammary nodes beneath the sternum. And in some cases, the breast cancer can spread via the bloodstream without involving the lymphatic system.
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If Breast Cancer Has Spread To My Lymph Nodes Do They All Have To Be Removed
Not always, says Tran. We are performing fewer axillary lymph node removal surgeries now. Just a few years ago, if you came to me with breast cancer that had spread to the lymph nodes, those nodes would all have to come out, which raises the risk of lymphedema.
Recent studies have found that for some patients with cancer in their lymph nodes, radiation to the remaining lymph nodes may control local cancer as well as axillary lymph node dissection removing all of your lymph nodes.
Another way to avoid axillary dissection is to shrink the cancer with a course of chemotherapy first. If there is a good response, we can remove fewer lymph nodes.
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If Your Breast Cancer Has Spread
Even if your breast cancer has spread to other parts of your body, it does not necessarily mean its not treatable. If the cancer cannot be removed, the goal of treatment is to improve symptoms, improve quality of life and extend survival.
Some women live with breast cancer for several years as they learn to adjust and accept that theyll be on treatment for an indefinite period of time, explains Dr. Roesch. Your cancer team will help you learn and cope with what you can expect on this journey.
What Treatments May I Be Offered
Treatment for secondary breast cancer in the lung aims to relieve symptoms and slow down the growth of the cancer.
Treatments can be given on their own or in combination.
When making decisions about how best to treat you, your treatment team will consider factors such as:
- How extensive the cancer is within the lung
- Whether the cancer has spread to other organs
- Any symptoms you have
- What treatment youve had in the past
- The features of the cancer
- Whether youve been through the menopause
- Your general health
Your specialist should discuss any recommendations for treatment with you and take into account your wishes. They will talk with you about your options, explain what the aim of your treatment will be and help you weigh up the potential benefits against the possible side effects you may have.
You may also be referred to the respiratory team, which specialises in treating people with breathing difficulties. They can help plan your treatment or manage your symptoms. Your care will continue under your usual breast oncologist, but with involvement or advice from the other team.
If you had a biopsy or surgery for primary breast cancer, the tissue removed will have been tested to see if it is ER+. However, in some people the oestrogen receptors change during the development of secondary breast cancer. Because of this, your doctor may discuss having a biopsy to retest for hormone receptors.
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Diagnosis When Breast Cancer Has Spread
A number of tests are used to diagnose breast cancer that has spread outside the breast area to other parts of the body.
Test results will be summarised in a pathology report and in imaging reports. The treating doctor can explain what the test results mean and whether other tests will be needed in future. Some women find it helpful to keep a copy of their reports so that they can refer to them later.
The words used in the pathology report to describe breast cancer that has spread outside the breast area will depend on the parts of the body affected.
- Locally advanced breast cancer is breast cancer that has spread to areas near the breast. The stages used to describe locally advanced breast cancer are Stage IIB and Stage III.
- Metastatic breast cancer is breast cancer that has spread to other parts of the body. The stage used to describe metastatic or advanced breast cancer is Stage IV.
How Is A Local Recurrence After Lumpectomy Diagnosed
After a diagnosis of early stage breast cancer, any remaining breast tissue should be evaluated annually with scans .
Most local recurrences within the breast after lumpectomy are detected on routine annual breast imaging, which usually takes the form of mammography and ultrasound, and on occasions MRI.
If you have a local recurrence or new primary breast cancer, you may find symptoms similar to an initial breast cancer. This includes:
- A new lump in the breast, armpit area or around the collarbone
- A change in breast size or shape
- Changes to the nipple, such as sores or crusting, an ulcer or inverted nipple
- Clear or bloody nipple discharge
- Changes to the skin including redness, puckering or dimpling
- Breast tenderness or pain
Once a local recurrence has been diagnosed, we do tests to see whether there are signs of cancer elsewhere in the body. These may include a chest X-ray, CT scan, bone scan or PET scan, and blood tests , then we have to figure out how best to treat the tumour in the breast. Usually in these cases we do a mastectomy, as the prior less drastic surgery and radiation didnt take care of it.
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