Breast Cancer Metastasis: Secondary Sites
Over the years there have been significant improvements and advancements in the diagnosis and treatment of breast cancer. Indeed, breast cancer is now considered to be a manageable disease.
However, there are still over half a million deaths worldwide from breast cancer and over 90% of these women die of metastasis. Consequently, research into metastasis is of vital importance in overcoming deaths from metastatic breast cancers.
Stage IV or metastatic breast cancer, as mentioned earlier, are cancer cells that have spread from the breast to distant sites around the body. Common secondary sites are:-
- Bone: .
- Lungs
- Liver
How Can I Take Care Of Myself While Living With Metastatic Breast Cancer
Living with metastatic breast cancer can be challenging. Your care team can help provide physical and emotional support. Talk to them about how you can:
- Eat the most nutritious diet for your needs.
- Exercise regularly.
- Get emotional support, including finding support groups.
- Reach out for help from friends, family and loved ones.
- Find mental health services.
- Find complementary therapies.
Treatment Options For Stage 4 Cancer
Stage 4 cancer is challenging to treat, but treatment options may help control the cancer and improve pain, other symptoms and quality of life. Systemic drug treatments, such as targeted therapy or chemotherapy, are common for stage 4 cancers.
Often, a clinical trial may be an option, offering new treatments to help you fight stage 4 cancer.
Below are the prevailing treatment options for the five most common cancers.
Treatment of stage 4 breast cancer: For cancer that has spread beyond the breast and nearby lymph nodes, systemic drug treatments are typically used. These include:
- Hormone therapy
- Chemotherapy
- Immunotherapy
They may be used alone or in combination, and they may also be determined by the hormone receptor and the HER2 status of the cancer.
Surgery and radiation may be treatment options in specific cases to help improve symptoms caused by a growing tumor, not to get rid of the cancer. The tumor may be removed with surgery or shrunk by radiation therapy if, for example, its:
- Blocking a blood vessel
- Causing a wound
- Affecting the spinal cord
Treatment of stage 4 lung cancer: In general, stage 4 lung cancer is also treated with systemic drug therapies.
Stage 4 lung cancer that has spread to one distant area tends to be treated differently than lung cancer that has spread more widely. For stage 4A cancers, treatment tends to focus on the one site where the cancer has spread.
There may also be clinical trials assessing new treatments for stage 4 melanoma.
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Are New Treatments For Metastatic Cancer Being Developed
Yes. Researchers are now studying new ways to kill or stop the growth of primary cancer cells and metastatic cancer cells. One new area of research includes ways to boost the strength of the immune response against tumors.
Regulatory T-cells and RANKL proteins may play a role in breast cancer metastasisRecent breast cancer research suggests that the bodys regulatory T cells, which are an integral part of the immune response system, may play a key role in metastasis.
It is speculated that the T cells produce a protein which seems to accelerate the spread of breast cancer cells to other areas of the body. The inflammatory protein RANKL seems to influence the T-cells ability to spread cancer cells to distant areas of the body.
It is believed that by interfering with RANKLs ability to interact with the T-cells, the early metastasis of breast cancer cells can be significantly inhibited
Are There Any Statistics On Recurrence Rates Or Incidence Of Metastasis
As mentioned, it is very difficult to find statistics on metastatic breast cancer that has recurred after initial diagnosis. However, these cases represent a large proportion of Stage IV breast cancer cases and overall deaths.
Most of the statistical data on Stage IV or metastatic breast cancer is from those women presenting at diagnosis. According to the Metastatic Breast Cancer Network in 2012 new cases of Stage IV breast cancer were between 13,776 to 22,096.
The number of breast cancer recurrences at Stage IV is estimated to be between 20% and 30% of all breast cancer diagnoses.
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Metastatic Breast Cancer Symptoms And Diagnosis
The symptoms of metastatic breast cancer can vary greatly depending on the location of the cancer. This section covers the symptoms of breast cancer that has spread to the bone, lung, brain, and liver, and the tests used to diagnose metastatic breast cancer.
Bone Metastasis: Symptoms and DiagnosisThe most common symptom of breast cancer that has spread to the bone is a sudden, noticeable new pain. Breast cancer can spread to any bone, but most often spreads to the ribs, spine, pelvis, or the long bones in the arms and legs. Learn more.
Lung Metastasis: Symptoms and DiagnosisWhen breast cancer moves into the lung, it often doesnt cause symptoms. If a lung metastasis does cause symptoms, they may include pain or discomfort in the lung, shortness of breath, persistent cough, and others. Learn more.
Brain Metastasis: Symptoms and DiagnosisSymptoms of breast cancer that has spread to the brain can include headache, changes in speech or vision, memory problems, and others. Learn more.
Liver Metastasis: Symptoms and DiagnosisWhen breast cancer spreads to the liver, it often doesnt cause symptoms. If a liver metastasis does cause symptoms, they can include pain or discomfort in the mid-section, fatigue and weakness, weight loss or poor appetite, fever, and others. Learn more.
Survival Rates For Stage Iv Breast Cancer
Stage of breast cancer at diagnosis is one of the most important prognostic factors. Above is a bar chart from the National Cancer Institute statistics for 2012. As we can see, the 5-year survival rate for women diagnosed with Stage IV breast cancer was 22%.
Remember, these figures are still quite dated as it takes 5 years to determine survival rates and treatment is improving all the time.
A recent study found that 37% of women survived for three years after a Stage IV breast cancer diagnosis, although some women do survive longer.
However, although the 5-year survival rates are much higher for earlier stages of breast cancer at diagnosis, there is no predicting which cases will progress to metastatic breast cancer in the future.
Although it is important to be realistic regarding the survival of metastatic breast cancer, each individual situation is unique and ultimately, statistics are meaningless.
There is a small subcategory of people with Stage IV breast cancer who beat the odds and live for years. However, it is difficult to predict who will fall into this group.
All that is known is that people in this group have secondary spread to the bones. Furthermore, cancer is often estrogen positive and responds to hormone treatments.
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De Novo Stage Iv Breast Cancer
We identified eight studies that assessed survival improvement in exclusively de novo stage IV disease . These included registry-based studies and single- or multi-institution studies . Meta-regression found no statistically significant improvement from 1980 to 1990 but statistically significant improvement thereafter . We estimated median unadjusted survival to have been 19 months in 1980, 20 months in 1990, 23 months in 2000, and 31 months in 2010 . Only one of these studies reported survival separately for ER-positive and ER-negative disease and showed improvement for ER-positive disease but not ER-negative disease from 1987 to 2000. Multivariable analysis was performed in four of the six studies: the association between time period of diagnosis and survival persisted after multivariable analysis in three of the four studies .
Life Expectancy Of Stage 4 Liver Cancer
Life Expectancy of Stage 4 Liver Cancer is not very impressing at all. The stage is concerned as one of the most critical Liver Cancer. The impact of the Liver Cancer Stage 4 is very bad, and the condition gets worse with time. On average patient may survive for 6 months. However, if the complexity of Liver is less then, people may survive for even couple of years. However, the life expectancy of Stage 4 depends upon the condition of the people.
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From Cured To Stage 4
Others, like Teri Pollastro, a 54-year-old stage 4 patient from Seattle, respond surprisingly well.
Diagnosed with early stage ductal carcinoma in situ in 1999, Pollastro underwent a mastectomy but did not receive chemotherapy, radiation or tamoxifen, since her cancer was ER negative.
âThey used the C-word with me, they told me I was cured,â she said. âEvery time I went back to my oncologist, he would roll his eyes at me when I had questions.â
In 2003, Pollastro switched to Seattle Cancer Care Alliance where she saw Dr. Julie Gralow, a breast cancer oncologist and clinical researcher at Fred Hutchinson Cancer Research Center. Gralow discovered Pollastroâs cancer had metastasized to her liver.
âMy husband and I were in shock,â said Pollastro of her mets diagnosis. âYou donât go from being cured to stage 4.â
Pollastro went on Herceptin, a type of immunotherapy for women with HER2-positive metastatic breast cancer, and did six months of chemotherapy.
âI felt better right away with the treatment,â she said. âBut the problem is, it stopped . Thatâs what you can expect with mets. And thereâs always some residual cancer. And that starts percolating.â
And along with mets, she also had to deal with many misconceptions regarding her disease.
The Mercer Island, Washington, mother of two, who often counsels newly diagnosed patients, sometimes even found it difficult to relate to early stage breast cancer survivors.
Being Your Own Advocate
While there aren’t currently any studies looking at self-advocacy and survival, being your own advocate can’t hurt in maximizing your survival. Oncology is changing rapidly and it’s difficult for any oncologisteven those who specialize in breast cancerto stay aware of all of the latest research and clinical trials taking place.
It can be helpful to research your cancer yourself. Becoming involved via social media such as Twitter is also an excellent way to learn about the latest research, using the hashtag #bcsm, which stands for breast cancer social media.
Getting a second opinion can be helpful as well, especially from one of the larger cancer centers such as a National Cancer Institute-designated cancer center.
There are ways to learn about opportunities, however, that don’t require traveling for opinions. There are now clinical trial matching services in which a nurse navigator can help to match your particular tumor and characteristics with clinical trials in progress all over the world.
Several of the larger cancer centers are now also offering remote second opinions, in which an oncology team can review your medical information and talk to you on the phone about whether there are any opportunities for treatment for you that may not be available elsewhere.
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Treatment For Physical Symptoms
The American Cancer Society urge that a person should not have to endure pain in the final months and days of life.
Many people find relief with opioid medications, but these can cause side effects such as fatigue and constipation. A person may use opioids in combination with other pain relief medications, such as acetaminophen or ibuprofen.
Other drugs, such as antidepressants and antiseizure medications, can also treat certain types of pain.
Doctors can also prescribe medications for nausea and vomiting. Some drugs for treating nausea can make a person drowsy. However, these drugs may help people eat and drink more or simply make it easier for them to function and interact with other people.
Disease Free Intervals And Prognosis In Metastasis
The time that passes between the primary diagnosis and treatment of breast cancer and a diagnosis of metastasis is also of prognostic significance.
A 2015 medical study from the Netherlands looked at 815 patients with metastatic breast cancer between 2007 and 2009 in eight hospitals.
Of these 815 patients, 154 had metastatic spread at diagnosis. 176 patients had a metastatic free interval of less than 2 years and 485 patients had been metastasis-free for longer than 2 years.
The ladies presenting with metastatic breast cancer at diagnosis had a longer survival rate than those who experienced a recurrence at distant sites in under 2 years from the initial diagnosis of breast cancer.
However, there were no differences in survival rates between those diagnosed at Stage IV and those women who had metastatic spread over 2 years after an original breast cancer diagnosis and treatment.
Furthermore, some medical studies show that survival rates vary for different types and subtypes of breast tumors according to the time intervals of recurrence. So, for example, breast cancer survival rates comparing two cancers may be better at a 5-year interval for some cancers but even out over 15 years.
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Demographic And Clinical Variables
The relationship between metastatic sites and clinical characteristics, including age at diagnosis, year of diagnosis, race, marital status, tumor grade, tumor size, nodal status, subtype, and treatment was analyzed. Initial metastatic sites were registered as single or multiple and were categorized as bone-only, lung-only, liver-only, brain-only, other-only and multiple metastasis . Overall survival was calculated from the date of diagnosis to the date of death due to any cause, the date of last follow-up, or December 31, 2015. Breast cancer specific survival was measured as the time from the date of diagnosis to the date of death attributed to breast cancer. Both overall survival and breast cancer specific survival were used as endpoints.
For Family And Friends
Caring for a loved one with stage 4 breast cancer has special challenges as well. Fortunately, organizations such as CancerCare now offer support groups design for loved ones who are caring for someone with cancer. In addition to caring for yourself , it’s helpful to learn about metastatic breast cancer.
Common things that people learn about cancer usually refer to an early-stage disease, and myths about metastatic breast cancer can be painful for those living with advanced disease. For example, one of the things not to say to someone with metastatic breast cancer is, “When will you be done with treatment?”
For the most part, people with metastatic breast cancer will require some type of treatment for the rest of their lives.
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Life Expectancy Of Stage 4 Breast Cancer
According to the American Cancer Society, 22% of the patients live five years after being diagnosed of stage 4 breast cancer. Compared to earlier stages of the cancer, this rate is considerably lower. At stage two, the five year survival rate is at 90% and at stage three, it is 72%. This shows that an early diagnosis is important for better chances of survival.
Predicting survival rates for patients are never really accurate. Your age, general health, hormone receptors on cells with cancer, the type of tissue the cancer has affected and your general outlook on life all affect your stage 4 breast cancer life expectancy.
About 50% percent of women who are diagnosed with stage four breast cancer are still alive 18 months after their diagnosis. Over the years, life expectancy for stage four cancer has been steadily and slowly improving. This has been mainly due to combination treatment of surgery, radiation, multiple medications, and a much more positive support network.
Database And Patient Selection
Data were extracted from the recently released SEER database containing information of cancer patients diagnosed from 1975 to 2016. SEER*Stat software version 8.3.6 was used to access the database with permission from the SEER program office. A total of 17446 patients met the criteria of metastatic breast cancer who were diagnosed from 2010 to 2015 were screened out from the database. Subsequently, patients who met the following criteria were excluded: unknown race unknown histological grade stage T0, TX or NX breast cancer unknown specific surgery type unknown estrogen receptor , progesterone receptor , or HER2 status unknown information of distant metastasis unknown radiation information patients with incomplete follow-up patients with multiple primary cancer. Finally, 8097 metastatic breast cancer patients were included in this study. Of these patients, 5173 patients who were diagnosed from 2010 to 2013 were chosen as the training set, while 2924 patients diagnosed from 2014 to 2015 were used as the validation cohort. Subsequently, each cohort was further divided into two subgroups based on whether they had undergone locoregional surgical treatment or not. The flowchart of patient selection was shown in Figure 1.
Figure 1. Flowchart of data selection. SEER, Surveillance, Epidemiology, and End Results Program.
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What Is Metastatic Cancer
Cancer that spreads from where it started to a distant part of the body is called metastatic cancer. For many types of cancer, it is also called stage IV cancer. The process by which cancer cells spread to other parts of the body is called metastasis.
When observed under a microscope and tested in other ways, metastatic cancer cells have features like that of the primary cancer and not like the cells in the place where the metastatic cancer is found. This is how doctors can tell that it is cancer that has spread from another part of the body.
Metastatic cancer has the same name as the primary cancer. For example, breast cancer that spreads to the lung is called metastatic breast cancer, not lung cancer. It is treated as stage IV breast cancer, not as lung cancer.
Sometimes when people are diagnosed with metastatic cancer, doctors cannot tell where it started. This type of cancer is called cancer of unknown primary origin, or CUP. See the Carcinoma of Unknown Primary page for more information.
Progression During Hormone Therapy
For hormone receptor-positive cancers that were being treated with hormone therapy, switching to another type of hormone therapy sometimes helps. For example, if either letrozole or anastrozole were given, using exemestane, possibly with everolimus , may be an option. Another option might be using fulvestrant or a different aromatase inhibitor, along with a CDK inhibitor. If the cancer has a PIK3CA mutation and has grown while being treated with an aromatase inhibitor, fulvestrant with alpelisib might be considered. If the cancer is no longer responding to any hormone drugs, chemotherapy immunotherapy, or PARP inhibitors might be options depending on specific features of the cancer or any gene changes that might be present.
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