Metastasis Is A Highly Inefficient Yet Lethal Process
In the next few sections, we introduce the concept of tumour dormancy and discuss its ties with DTC dissemination in order to highlight how its reversible nature might alter the equilibrium between unsuccessful and successful metastases, thus possibly dictating the timing of metastatic relapse, or whether relapse occurs at all. We then focus on two key determinants of relapse in HR+ breast cancer: the extrinsic effect of targeted therapy, and the consequences of intrinsic HR function modulation.
Types Of Bone Metastases
Normally your bones are constantly changing. New bone tissue is being formed and old bone tissue is breaking down into minerals that circulate in your blood. This process is called remodeling.
Cancer cells upset the normal process of bone remodeling, causing bones to become weak or too dense, depending on the type of bone cells affected.
Your bone metastases may be:
- osteoblastic, if there are too many new bone cells
- osteolytic, if too much bone is destroyed
In some cases, your bones may have both types of metastases.
How Fast Can Breast Cancer Spread
Metastasis occurs when breast cancer cells begin to grow in another body part.
It is hard to say exactly how quickly breast cancer can grow, including the timeframe, as the disease affects each person differently.
Cancer occurs due to mutations in human cells. Mutations do not follow normal, predictable patterns of cell division, so it is difficult to predict the progression.
Tumors appear when damaged cells replicate over and over to form a clump of abnormal cells. Breast cancer cells can break off and move through the lymph or blood vessels to other areas of the body.
If breast cancer cells begin to grow in another body part, this is called metastasis. Breast cancer is most likely to metastasize to the lymph nodes, lungs, and bones.
Regardless of the location of the new tumor, doctors still consider it to be breast cancer.
Breast cancer growth and its chances of spreading depend on the following:
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Limited Arm And Shoulder Movement
You might also have limited movement in your arm and shoulder after surgery. This is more common after ALND than SLNB. Your doctor may advise exercises to help keep you from having permanent problems .
Some women notice a rope-like structure that begins under the arm and can extend down toward the elbow. This is sometimes called axillary web syndrome or lymphatic cording. It is more common after ALND than SLNB. Symptoms may not appear for weeks or even months after surgery. It can cause pain and limit movement of the arm and shoulder. This often goes away without treatment, although some women may find physical therapy helpful.
Myth #: When Breast Cancer Travels To The Bone Brain Or Lungs It Then Becomes Bone Cancer Brain Cancer Or Lung Cancer
Not true. Breast cancer is still breast cancer, wherever it travels in the body. However, the characteristics of the cells can change over time. For example, a breast cancer that tested negative for hormone receptors or an abnormal HER2 gene might test positive when it moves to another part of the body, or vice versa . Keep in mind that the cancer cells are trying to survive in the body, so they can change, says Dr. Gupta. We always emphasize rechecking the biology.
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Can Earlier Detection Of Recurrence Improve Breast Cancer Outcomes
The risk of metastatic relapse weighs heavily on the minds of patients, physicians and caregivers for years, sometimes decades, after treatment of the primary tumour is complete. Nearly 17 million cancer survivors are living in the United States, 3.9 million of whom are breast;cancer survivors, and repeated monitoring for cancer recurrence in these individuals presents a significant challenge to healthcare;delivery systems. For breast;cancer patients, current American Society of Clinical Oncology and National Comprehensive Cancer Network guidelines limit follow-up care to mammography, medical history and physical exam, stating that in the absence of clinical signs and symptoms suggestive of recurrent disease, there is no indication for laboratory or imaging studies for metastases screening., Despite these guidelines, however, many patients receive high-cost imaging analysis and tumour marker blood tests during routine follow-up exams, exposing them to radiation and increasing healthcare costs.,,, So, what has led to the current precarious balance between the desire to detect recurrence early and clinical guidelines that limit the use of diagnostic tests?
Table 1 Exploiting tumour dormancy as a window of therapeutic opportunity to target MRD.
Coping With Advanced Breast Cancer
Being told that you have advanced or metastatic breast cancer may be very confronting or overwhelming. Some women also find the news that their cancer has spread or come back is more devastating than their original diagnosis.
There are many resources available online to help you further understand the meaning of your diagnosis and how to manage the emotional, physical and practical issues arising from metastatic breast cancer. Below are some links where these resources can be accessed:
Connecting and speaking with others who have gone through a similar experience can also be helpful. Cancer Council runs support groups all across Australia which can provide support and information for people with cancer and their families. Groups in each state can be accessed here:
Although support groups can provide a safe place for people to express their feelings amongst others who share a similar experience, some people are more comfortable talking one-on-one, such as with a counsellor, therapist or trained volunteer . Your GP can also refer you to a psychologist, social worker or other trained therapist. Every person is different and it is important to find a healthy support system that works for you.
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About The Lymph Nodes
The lymphatic system helps protect us from infection and disease. It also drains lymph fluid from the tissues of the body, before returning it to the blood.
The lymphatic system is made up of fine tubes called lymphatic vessels. They connect to groups of lymph nodes throughout the body.
Lymph nodes are small and bean-shaped. They filter bacteria and disease from the lymph fluid. When you have an infection, lymph nodes often swell as they fight the infection.
The Stages Of Breast Cancer
NOTE: Although a lot of this information is still valid, The American Joint Committee on Cancer has recently updated their classifications for staging breast tumors.
We will be updating all our articles on staging in the near future. In the meantime, please click HERE for a brief summary of the major changes in January 2018.;
If a breast biopsy confirms that breast cancer is indeed the diagnosis, the staging process begins.
The stages of breast cancer are really the extent of breast cancer.; So, in order to choose and begin the best treatment, it is necessary to stage breast cancer.; The staging process shows the progression of breast cancer.
Breast cancer progresses in relatively predictable and consistent ways, so it is possible to categorize breast cancer in terms of; stages.
There are basically five stages of breast cancer, with some subcategories .
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Types Of Breast Cancer
There are several types of breast cancer, and any of them can metastasize. Most breast cancers start in the ducts or lobules and are called ductal carcinomas or lobular carcinomas:
- Ductal carcinoma. These cancers start in the cells lining the milk ducts and make up the majority of breast cancers.
- Lobular carcinoma. This is cancer that starts in the lobules, which are the small, tube-like structures that contain milk glands.
Less common types of breast cancer include:
Inflammatory breast cancer is a faster-growing type of cancer that accounts for about 1% to 5% of all breast cancers.
Pagets disease is a type of cancer that begins in the ducts of the nipple.
Breast cancer can develop in women and men. However, breast cancer in men is rare. Less than 1% of all breast cancers develop in men.
Diagnosing Secondary Cancer In The Lymph Nodes
Secondary cancer in the lymph nodes may be diagnosed at the same time as the primary cancer. It may also be found during routine tests and scans after treatment.
If a lymph node close to the surface of the skin is affected, your doctor may be able to see it or feel it. If an affected lymph node is deep inside the chest, tummy or pelvis, only a scan can find it.
If you have had cancer before, you may only need a scan to make a diagnosis of secondary cancer in the lymph nodes. This may be:
- A CT scan
A CT scan;takes a series of x-rays, which build up a 3D picture of the inside of the body.
- An MRI scan
An MRI scan;uses magnetism to build up a detailed picture of the inside of your body.
- An ultrasound scan
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Most Common Places It Spreads
It’s still breast cancer, even if it’s in another organ. For example, if breast cancer spreads to your lungs, that doesn’t mean you have lung cancer. Although it can spread to any part of your body, there are certain places it’s most likely to go to, including the lymph nodes, bones, liver, lungs, and brain.
What Is Secondary Breast Cancer In The Lung
Secondary breast cancer in the lung happens when breast cancer cells spread to the lung. It can also be known as lung metastases or secondaries in the lung.
Secondary breast cancer in the lung is not the same as cancer that started in the lung.
Usually secondary breast cancer occurs months or years after primary breast cancer. But sometimes its found at the same time as the primary breast cancer, or before the primary breast cancer has been diagnosed.; In this situation, the breast cancer has already spread to the other parts of the body such as the;lung. This is referred to as de novo metastatic breast cancer, meaning the breast cancer is metastatic from the start.
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Types Of Lymph Node Surgery
Even if the nearby lymph nodes are not enlarged, they will;still need to be checked for cancer. This can be done in two different ways.;Sentinel lymph node biopsy might be needed.
Lymph node surgery is often done as part of the main surgery;to remove the breast cancer, but in some cases it might be done as a separate;operation.
What Is Stage Iv Breast Cancer
Stage IV is the most advanced stage of breast cancer. It has spread to nearby lymph nodes and to distant parts of the body beyond the breast. This means it;possibly involves;your organs such as the lungs, liver, or brain or your bones.
Breast cancer may be stage IV when it is first diagnosed, or it can be a recurrence of a previous breast cancer that has spread.;
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Myth #: People With Metastatic Breast Cancer Look Sick And Lose Their Hair
You dont look sick. You look so well. Why do you still have your hair? Are you sure you have cancer? These are comments that people with MBC report hearing. But there are many treatment options besides chemotherapy, and people often appear well while taking them.
As NancyHB comments: Id much rather be a poster child for how sometimes we can live with, rather than die from, MBC at least for a while. Instead, I find myself defending against people who are increasingly becoming impatient with my lack of cancer-patient appearance. Im grateful for this time of feeling good, and theyre harshing my buzz.
Some people with MBC report that they actually look better than they feel while in treatment. So they sometimes have to let family and friends know that even though they appear fine, they dont feel well.
Shetland Pony notes: If she looks good, she is good. Nope. Many of us suffer from the invisible disability of fatigue. I would venture to say every available treatment causes us some level of fatigue. We struggle to keep up. It may look like we are doing the bare minimum when we are really giving it our all.
JoE777 of Texas adds: The new normals advertised about therapies on TV are deceiving about the side effects. They talk about side effects while women are skipping through life. not looking to show the harsh side effects but think there is something wrong with me that my life is not like that.
Breast Cancer In The Spine Understanding Metastatic Breast Cancer
If you are a music fan or hear the news, by this time you must have come across this very disheartening news that Olivia Newton Johns breast cancer has returned in her spine which is why her concerts are being canceled. Ms. Newton John has been an advocate in the breast cancer community and she established the ONJCC in Australia where active research to combat breast cancer is happening . As a woman dealing with metastatic breast cancer for the last year, I wish she hadnt joined this club and I am truly saddened for her. She was first diagnosed with Breast Cancer in 1992 and now 25 years later, she has been found to have breast cancer in her spine. I can imagine how devastating it must be for her and her family as I too live with metastatic breast cancer. I wish her great success in her upcoming treatment and sincerely pray that she will go in remission.
So what is happening when breast cancer is diagnosed in the spine? Is it now bone cancer? The answer is no. There is generally a lack of awareness about breast cancer that has spread to other organs called Metastatic Breast Cancer or MBC . A lot of people unfortunately dont understand the reality of metastatic breast cancer which is the fact that incurable stage 4 of breast cancer . More importantly, although stage 4 breast cancer is incurable, it is treatable and many sub-types of breast cancer respond to treatment for a number of years.
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Blood Tests For Tumor Markers
In some cases, blood tests for tumor markers may be used to help monitor metastatic breast cancer.
For example, you may have blood tests every few months for cancer antigen 15-3 or cancer antigen 27.29 . These tests are similar. Health care providers usually check one, but not both of these blood tests.
Whether the tumor marker test score rises or falls over time may give some information on tumor response to a drug or tumor spread.
Tumor marker tests are not helpful in every case. Some people with rising tumor marker levels dont have tumor growth, and some people with tumor growth have normal or unchanged tumor marker levels.
Health care providers dont make treatment decisions based on serum tumor marker testing alone. They may combine findings from a tumor marker test with information on;symptoms and findings from imaging tests . This combined information can help your health care providers understand if a treatment is working well for your cancer.
Talk with your health care provider about whether tumor marker testing is right for you.
Diagnosing Metastatic Breast Cancer
Getting a clear picture of where breast cancer has spread is essential for creating a personalized treatment plan. Your care team will likely use a combination of the following tests and tools to diagnose both localized and advanced breast cancer:
Ultrasound exam: With this imaging technique, sound waves create a picture of internal areas of the body.
Magnetic resonance imaging : This procedure produces detailed images using magnetic fields and radio waves.
Blood chemistry studies: A blood sample is taken to measure the amounts of certain substances that are released by your organs and tissues. A higher or lower amount of a particular substance may be a sign of disease.
Biopsy: A biopsy is the removal of cells or tissues so a pathologist may view them through a microscope. Your original breast cancer diagnosis was likely confirmed with a biopsy.
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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.
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.
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