Treatment By Breast Cancer Type
Most patients underwent oncologic breast surgery, including surgical evaluation of the axilla . Mastectomy was more commonly used in the metaplastic BC group , as was SLND . Regional nodal irradiation was more often used as a part of treatment for other BC than for metaplastic BC and TNBC , respectively.
With regard to systemic therapy, neoadjuvant chemotherapy was used nearly twice as often for metaplastic BC and TNBC than for other BC , and approximately one quarter of all women did not receive any chemotherapy. Hormone therapy was used the least often for TNBC but was part of the treatment paradigm for 11% of metaplastic BC and 55% of other BC cases.
End Of Life Concerns With Metastatic Breast Cancer
Despite encouraging advances in breast cancer treatment that have dramatically prolonged survival even when diagnosed at a metastatic stage, there still is a significant group of less fortunate patients that die from this condition every year.
The usual scenario goes like this: People with metastatic breast cancer want to talk about these concerns, but are afraid to upset their loved onesso they stay quiet. On the other side, loved ones are afraid of upsetting you by talking about the end of life issuesso they say nothing.
The same holds true even for patients and oncologists, and studies tell us that these conversations take place much less often than they should.
Many people fear these discussions are a sign of giving up. However, talking about your wishes does not mean you are giving up at all. It does not mean that you have lost hope that you will be one of the people who live for decades with stage 4 breast cancer. What it means, instead, is that you want your decisions to be thought out, and not left to chance. It’s a way to communicate your wishes before circumstances may force you to do so.
The best place to start is with the most important step. How can you begin these discussions with your loved ones?
What Is Metaplastic Carcinoma Of The Breast
Metaplastic carcinoma of the breast is a subtype of invasive breast cancer. Metaplastic breast cancer is a very rare form of breast cancer, accounting for less than 1% of cases. Like invasive , metaplastic carcinoma starts in the milk ducts. Since it is invasive, it has grown through the wall of the milk duct into other breast tissues or beyond the breast.
Doctors call it metaplastic because of the way the cells look under a microscope. Instead of looking like ductal cells, metaplastic tumor cells look very abnormal. In fact, they look more like other tissues in the breast, such as connective tissue. This has lead scientists to believe the ductal cells went through some kind of unexplained changeor metaplasia.
Because the cells look so different, metaplastic breast cancer can be hard to diagnose. If your results suggest this cancer, consider getting a second opinion. You can do this by asking your doctor to send your biopsy specimen slides to a different pathologist. Consider sending the slides to a cancer center with experience diagnosing metaplastic breast and other rare breast cancers.
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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.
What Is The Relative Survival Rate For Breast Cancer
A relative survival rate compares women with the same type and stage of breast cancer to women in the overall population. For example, if the 5-year relative survival rate for a specific stage of breast cancer is 90%, it means that women who have that cancer are, on average, about 90% as likely as women who dont have that cancer to live for
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Metaplastic Breast Carcinoma: Update On Histopathology And Molecular Alterations
Emily R. McMullen, Nicholas A. Zoumberos, Celina G. Kleer Metaplastic Breast Carcinoma: Update on Histopathology and Molecular Alterations. Arch Pathol Lab Med 1 December 2019 143 : 14921496. doi:
Metaplastic carcinoma is a rare, triple-negative carcinoma of the breast that exhibits transformation of part or all of its glandular carcinomatous component into a nonglandular, or metaplastic, component. The World Health Organization currently recognizes 5 variants of metaplastic carcinoma based on their histologic appearance.
To review the histologic classifications, differential diagnosis, prognosis, and recent laboratory studies of metaplastic breast carcinoma.
We reviewed recently published studies that collectively examine metaplastic carcinomas, including results from our own research.
Metaplastic breast carcinoma has a broad spectrum of histologic patterns, often leading to a broad differential diagnosis. Diagnosis can typically be rendered by a combination of morphology and immunohistochemical staining for high-molecular-weight cytokeratins and p63. Recent studies elucidate new genes and pathways involved in the pathogenesis of metaplastic carcinoma, including the downregulation of CCN6 and WNT pathway gene mutations, and provide a novel MMTV-Cre Ccn6fl/fl knockout disease-relevant mouse model to test new therapies.
What Are The Potential Complications Of Metaplastic Breast Cancer
Metastasis or cancer spread is the main complication of breast cancer. This is more likely to happen with metaplastic breast cancer than other more common forms. Metaplastic breast cancer is also more likely to recur after treatment.
Metaplastic breast cancer prognosis depends on the stage and grade of the tumor. Less aggressive and lower stage cancers generally have a better outlook. Metaplastic breast cancer is usually at a higher stage and grade at diagnosis than other invasive breast cancers. However, there are other factors that can influence prognosis and survival, such as your age, your general health, and the cancers response to treatment. Ask your doctor how these factors affect your prognosis.
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Mpbc Pathology And Presentation
The clinical features of MpBC are similar to other high-grade cancers of no special type , however, they often present at a more advanced stage. They tend to be large in size, with dimensions ranging from 1.2 to > 10 cm and often present as a palpable breast mass, with ill-defined borders on mammography, ultrasonography, and magnetic resonance imaging. MpBC represents 0.21% of all breast cancers the rates vary due to the differing definitions and classification systems used over time.
MpBC do not have any distinctive macroscopic features, with the tumor varying from well-circumscribed to having an irregular border. Microscopically, they comprise a heterogenous group with differing outcomes. In the absence of sufficient molecular and outcome data, the current WHO Classification of Tumours of the Breast1,2 has maintained a descriptive morphological classification system, based on the type of the metaplastic elements present. MpBC are classified monophasic or biphasic . Further, MpBC can also be classified into epithelial-only carcinomas , pure sarcomatoid carcinomas, and biphasic epithelial and sarcomatoid carcinomas.
What Is Metaplastic Breast Cancer
Metaplastic breast cancer is a very rare form of cancer. Whereas most types of breast cancer involve one type of breast tissue, metaplastic breast cancer first develops in one tissue then the cells change characteristics to resemble cells of another tissue type. Due largely to this characteristic, metaplastic breast cancer is very likely to spread to other parts of the body.
Most cases of breast cancer involve the cancer cells spreading and developing tumors within the main structures that are responsible for the transport of milk. These structures, both the ducts and the lobules, are where the majority of tumors are located, whether they are benign or malignant. In metaplastic breast cancer, the disease begins in the epithelial cells.
The epithelial cells, also known as surface cells, are where most forms of cancer begin. Cancers that start in these cells are called carcinomas another name for metaplastic breast cancer is metaplastic breast carcinoma. From these surface cells, the cancer begins to spread.
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Precision Oncology For Mpbc
In the absence of indications for hormone and anti-HER2 therapies, and given their typically large size at presentation, MpBC are managed with chemotherapeutics in addition to surgery . However, early studies showed that systemic therapy was less effective in MpBC12 and this data has held true over time and is supported by the overall poor outcomes of MpBC patients.27 In fact, while 90% of diagnoses of MpBC are for localized disease, half of these patients will progress to advanced BC over time.28,29 Treatment in the neoadjuvant setting appears to afford little advantage, with a 1017% pathological complete response rate reported for American studies, while studies in Japan and Turkey reported no complete responders.34,35 It is clear that efficacious treatments for MpBC are an unmet clinical need, and while some clinical trials specifically for MpBC are being initiated, the potential for novel therapeutic interventions must be capitalized upon.
Genomic Biomarkers And Targeted Therapy For Mpbc
MpBC are characteristically triple-negative BC, thus eliminating these patients from current tailored therapeutic options of hormone therapy and anti-HER2 therapy. This triple-negativity, does however make them eligible for a multitude of trials currently recruiting, including those assessing benefit of immune checkpoint inhibitors a non-exhaustive list of open trials is presented in Table 2.
Table 2 Active Trials Open to Metaplastic Breast Cancer Patients
CDK4/6 inhibitors are now approved as standard of care for advanced, hormone receptor positive breast cancers, however this proliferation check-point may also be a useful target in TNBC, and trials are underway to determine the efficacy of this approach , including in combination with immune checkpoint inhibitors . A recent case report demonstrated a dramatic but short-term benefit from combined dabrafenib and trametinib in an advanced MpBC patient.43 Dabrafenib and trametinib target BRAF and MEK signalling, respectively, and their application in MpBC has not previously been reported.
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What Is Spindle Cell Breast Cancer
Doctors also refer to spindle cell breast cancer as:-
- sarcomatoid carcinoma
This is in itself evidence of the ambiguous and varied presentation of this sub-type of breast cancer.
Researchers think that spindle cells generally evolve from mesenchymal cells, which are the building blocks of connective and muscle tissue. Whereas epithelial cells generally are in the membranes and linings.
Myo-epithelial cells are more-or-less a combination of the two and give strength and resilience to the breast duct lining. But more and more evidence suggests that spindle-cell breast cancer is a unique subcategory of metaplastic breast cancer.
So spindle cell breast cancer has its own differential diagnosis, prognosis and treatment strategies. A clinical finding of a large and well-circumscribed tumor, especially with accompanying cyst formation, would be strongly suggestive of spindle cell.
What Causes Metaplastic Breast Cancer
All cancers develop in the same basic way. Normal processes that control cell growth stop working the way they should. Gene mutations are the underlying cause. Mutations in key genes involved in normal cell growth can cause normal cells to multiply and grow unchecked. Scientists and researchers continue to study cancer to try to understand why this happens. Family history, environmental exposures, and lifestyle factors can affect the risk of developing metaplastic breast cancer.
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When Should You Ask For Hospice Care
Very often we hear people say they wish they had opted for hospice care earlier on, so how can you know when it is time?
In order to receive hospice care, you usually need a physicians note saying that you are expected to live six months or less. If you live longer, that’s not a problem and there’s no penalty. Your care can either be renewed for another six months or discontinued. You can also change your mind at any time if you decide you would rather pursue treatments designed to treat your cancer.
What Type Of Cancer Is Breast Cancer
Invasive ductal carcinoma , sometimes called infiltrating ductal carcinoma, is the most common type of breast cancer. The abnormal cancer cells that began forming in the milk ducts have spread beyond the ducts into other parts of the breast tissue. Invasive cancer cells can also spread to other parts of the body.
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Metaplastic Breast Cancer Diagnosis
Metaplastic breast cancer is a rare form of breast cancer, accounting for fewer than 1% of all breast cancers. It differs from the more common kinds of breast cancer in both its makeup and in the way it behaves.
Like invasive ductal cancer, metaplastic breast cancer begins in the milk duct of the breast before spreading to the tissue around the duct. What makes a metaplastic tumor different is the kinds of cells that make up the tumor.
When the cells of an invasive ductal tumor are examined under a microscope, they appear abnormal, but still look like ductal cells. Metaplastic tumors may contain some of these breast cells, too, but they also contain cells that look like the soft tissue and connective tissue in the breast. It is thought that the ductal cells have undergone a change in form to become completely different cells, though it is not known exactly how or why this occurs.
Metaplastic breast cancers can also behave more aggressively than other kinds of breast cancers.
- Metaplastic tumors are often, though not always, triple-negative, which means that they test negative for estrogen and progesterone receptors, as well as for the HER2/neu protein.
- Metaplastic tumor cells are often found to be high grade, which means that they look very different from normal cells and are dividing rapidly.
- Metaplastic tumors are, on average, larger at diagnosis.
Why Prepare These Documents
There are two very important reasons to prepare these documents. One reason is for yourself so that your wishes are honored. They give you a chance to dictate what will happen if you are unable to speak for yourself.
Another reason is for your family. Decisions near the end of life are difficult to begin with, but are even more challenging if family members second guess themselves wondering if they are truly abiding by your wishes. This can become even more of an issue if family members disagree, and can lead to hurt feelings and family friction. Taking the time to spell out your wishes may prevent painful disagreements as your family members argue over what they believe you would have wanted.
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Metaplastic Carcinoma Of The Breast
Metaplastic carcinoma of the breast
Support and advocacy groups can help you connect with other patients and families, and they can provide valuable services. Many develop patient-centered information and are the driving force behind research for better treatments and possible cures. They can direct you to research, resources, and services. Many organizations also have experts who serve as medical advisors or provide lists of doctors/clinics. Visit the groups website or contact them to learn about the services they offer. Inclusion on this list is not an endorsement by GARD.
Outcomes After Treatment Of Metaplastic Versus Other Breast Cancer Subtypes
Amy C. Moreno1, Yan Heather Lin2, Isabelle Bedrosian3, Yu Shen2, Gildy V. Babiera3, Simona F. Shaitelman1
1. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.2. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX.3. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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The Ratio Of Spindle Cell Vs Epithelial Cell Elements Is Variable
The ratio of the spindle cell component to the ductal-carcinomatous component is variable. Sometimes they are in a 1:1 ratio, ranging right up to an 8:1 ratio or higher.
However, if the ductal carcinoma element is higher than 50%, the tumor might be named differently. Even though elements of ductal, lobular and squamous patterns are often present, sometimes there is a pure spindle cell pattern in spindle cell carcinoma tumors.
When this is the case, differential diagnosis become more difficult and more important. Pure spindle-cell presentations must be differentiated from:-
- primary sarcoma