Treatment For Metastatic Cancer
There are treatments for most types of metastatic cancer. Often, the goal of treating metastatic cancer is to control it by stopping or slowing its growth. Some people can live for years with metastatic cancer that is well controlled. Other treatments may improve the quality of life by relieving symptoms. This type of care is called palliative care. It can be given at any point during treatment for cancer.
The treatment that you may have depends on your type of primary cancer, where it has spread, treatments youve had in the past, and your general health. To learn about treatment options, including clinical trials, find your type of cancer among the;PDQ® Cancer Information Summaries for Adult Treatment and Pediatric Treatment.
Where Do These Numbers Come From
The American Cancer Society relies on information from the SEER* database, maintained by the National Cancer Institute , to provide survival statistics for different types of cancer.
The SEER database tracks 5-year relative survival rates for breast cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages; . Instead, it groups cancers into localized, regional, and distant stages:
- Localized: There is no sign that the cancer has spread outside of the breast.
- Regional: The cancer has spread outside the breast to nearby structures or lymph nodes.
- Distant: The cancer has spread to distant parts of the body such as the lungs, liver or bones.
What Is Bone Metastasis
The bone is a common site for metastasis. Bone metastasis or “bone mets” occurs when cancer cells from the primary tumor relocate to the bone. Prostate, breast, and lung cancers are most likely to spread to the bone. However, other cancers are not excluded. Bone metastases do not begin from the bones but move there from the primary tumor site. On the other hand, primary bone cancers are rare cancers where the primary tumor actually starts in the bone. Therefore, bone cancer and bone metastases are not the same.
As an example, consider a patient with prostate cancer. Prostate cancer cells from the primary tumor can break away and get into the bloodstream. Once in the blood, the cancer cell can travel to the bone and form a new tumor. It is important to remember that this secondary tumor is made up of abnormal prostate cancer cells, not abnormal bone cells. The result of this process is referred to as prostate cancer that has metastasized to the bone or metastatic prostate cancer. This is otherwise known as bone metastasis.
When cancer cells metastasize to the bone, they can cause changes to the bone. The process by which portions of the bone are damaged is called osteolysis. Oftentimes, small holes result from osteolysis. These holes in the bone are referred to as osteolytic lesions or lytic lesions. Lytic lesions can weaken the bones and increase the risk of breakage or other problems. It is also common for bone metastasis patients to experience pain with lesions.
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Is Metastatic Cancer Curable
As researchers continue to make advances in treatment, certain types of metastatic cancer increasingly can be cured. These include colon cancer and melanoma. More commonly, however, therapies for metastatic cancer are palliative. This means they reduce symptoms and improve a persons quality of life but cannot fully get rid of the cancer.
For many people, palliative treatments can keep the disease under control for many years. Some drugs can hold tumors at bay for a long time if patients continue to take them, although resistance may eventually develop. In this way, cancer can become more like a manageable chronic condition, one that allows people to live with the disease for a long time.
What Are The Symptoms Of Metastatic Cancer
The symptoms of metastatic cancer vary greatly depending on the type of cancer and where it has spread. For cancer that has spread to the brain, common symptoms include headaches, seizures, and vision problems. For cancer that has spread to the liver, people may have jaundice , swelling in the legs, fatigue, weight loss, or loss of appetite.
In some instances, the cancer may spread after a person has already been treated for the original tumor. Metastatic tumors may appear months or even years after first treatments. In other cases, people may not be aware of having cancer at all until they notice symptoms from metastatic tumors.
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Mechanism In Brain Metastasis
The brain is a unique organ for metastasis, since the breast-tumor cells have to pass the bloodâbrain barrier to form micrometastases.
CD44 is a receptor for hyaluronic acid, involved in cell adhesion by binding to specific extracellular matrix components. A proposed mechanism for the function of CD44 is to regulate the adhesion of circulating cancer cells in the brain to the endothelium at the secondary site with the help of a hyaluronate matrix ligand or by its cytoplasmic attachments to actin-associated proteins of the merlin/ezrin/radixin/moesin family.
Cell-surface sialylation has been implicated in cellâto-cell interactions, and over-expression of a brain sialyltransferase in breast-cancer cells is a mechanism highlighting the role of cell-surface glycosylation in organ-specific metastatic interactions. Breast-cancer metastasis to the brain involves mediators of extravasation through non-fenestrated capillaries, complemented by specific enhancers of BBB-crossing and brain colonization.
Central Nervous System Metastases
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Clinically symptomatic CNS metastases are reported in 10â15% of patients with metastatic breast cancer; in large autopsy studies, up to 40% of women who died of metastatic breast cancer were reported to have at least one brain metastasis. CNS metastases are often viewed by patients and doctors as a late complication of metastatic breast cancer for which few effective treatments exist. In most cases, CNS involvement occurs after metastatic dissemination to the bones, liver and/or lungs has already occurred; for that reason, many patients already have refractory, terminal breast cancer by the time they are diagnosed with brain metastases. The diagnosis of brain metastases from breast cancer relies mainly on patient-reported symptoms and neuroimaging. The role of imaging in patients with suspected brain metastases is a very good modality to aid in diagnosis. According to Weil et al., 2005, neuroimaging such as Computed Tomography and Magnetic Resonance Imaging prove to be very effective in the diagnosis of brain and central nervous system metastases.
Symptoms of brain metastases from breast cancer are:
- new-onset headache
- cranial neuropathy, which may cause diplopia and Bell’s palsy
- vomiting and nausea
- deficits in sensation, motor function, and speech
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Alternative And Complementary Therapies
Some patients with metastatic breast cancer opt to try alternative therapies that are claimed to achieve healing effects similar to scientifically-tested medical approaches, but lack scientific evidence to support those claims. Approaches that are considered alternative therapies when applied to cancer treatment include vitamin therapies, homeopathic treatments, extreme diets, chiropractic treatment and acupuncture.
Some alternative treatments are harmful or even life-threatening. Amygdalin, an extract derived from apricot kernels, exposes the patient to cyanide. Bee venom can cause a life-threatening allergic reaction. Severe dietary restrictions such as Macrobiotic diets can disrupt the bodyâs metabolism and cause dangerous weight loss. People should be aware that foods, vitamins, and other treatments may interfere with the effectiveness of surgery, chemotherapy or radiation. It is essential that patients work with their doctors and openly discuss possible effects of any treatment they are considering. Alternative and complementary therapies are not regulated by the U.S. federal government and may lack quality controls.
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.
Are Targeted Therapies And Immunotherapy Used To Treat Metastatic Cancer
The first step in determining whether a targeted therapy may be effective is to find out whether there are any genetic mutations linked to a persons cancer. MSK-IMPACT is a test developed to analyze gene mutations in tumors. It is available to all MSK patients who have metastatic cancer. The test was designed to find the specific in mutations in tumors that can be treated with targeted drugs. These drugs may include FDA-approved medications or experimental treatments that are available through clinical trials.
In addition to the combination treatment Dr. Beal is studying, there are a number of other immunotherapy options for people with metastatic cancer. These include drugs that are designed to boost the bodys immune response and help it fight cancer, such as nivolumab . MSK researchers are also conducting clinical trials with CAR T cell therapy. In one trial, immune cells are engineered to seek out and destroy breast and lung tumors that have metastasized to the chest wall.
When Metastatic Cancer Can No Longer Be Controlled
If you have been told your;cancer can no longer be controlled, you and your loved ones may want to discuss end-of-life care. Whether or not you choose to continue;treatment;to shrink the cancer or control its growth, you can always receive palliative care to control the symptoms of cancer and the side effects of treatment. Information on coping with and planning for end-of-life care is available in the Advanced Cancer section of this site.
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Living With Stage : The Breast Cancer No One Understands
Editor’s note: We’re bringing back this piece from October 2014 for Metastatic Breast Cancer Awareness Day and to honor Jody Schoger, featured in the story. Schoger died of metastatic breast cancer in May. Want to learn more about MBC? Look for our tweets at the Northwest Metastatic Breast Cancer Conference this Saturday at Fred Hutch.
A no-nonsense Texan of 60 years, Jody Schoger* has a very no-nonsense way of educating people about her metastatic breast cancer.
âSomeone will say, âWhen are you done with treatment?â and Iâll tell them, âWhen Iâm dead,ââ said Schoger, a writer and cancer advocate who lives near Houston. âSo many people interpret survivorship as going across the board. That everybody survives cancer now. But everybody does not survive cancer.â
An estimated 155,000-plus women in the U.S. currently live with âmets,â or metastatic breast cancer. This type of cancer, also called stage 4 breast cancer, means the cancer has metastasized, or traveled, through the bloodstream to create tumors in the liver, lungs, brain, bones and/or other parts of the body. Between 20 and 30 percent of women with early stage breast cancer go on to develop metastatic disease. While treatable, metastatic breast cancer cannot be cured. The five-year survival rate for stage 4 breast cancer is 22 percent; median survival is three years. Annually, the disease takes 40,000 lives.
What Causes Metastatic Breast Cancer
Breast cancer treatments are intended to eliminate any cancer cells that may remain after surgery. Potential treatments include radiation, hormone therapy, chemotherapy, and targeted therapy.
In some cases, some cancer cells survive these treatments. These cancer cells may break away from the original tumor. These cells then make their way to other parts of the body via the circulatory or lymphatic systems.
Once the cells settle somewhere in the body, they have the potential to form a new tumor. This can happen quickly or develop years after initial treatment.
Several tests are used to confirm a diagnosis of metastatic breast cancer. These include:
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I Have To Prioritize And Try Not To Sweat The Small Stuff
For Sendelbach, each week begins with a list of her priorities. Obviously, getting to my doctors appointments is very important, she says. But if the clothes arent folded, is that a dire situation? Absolutely not!
Sendelbach has learned to make compromises: If her husband and son have to pick up their clean clothes from the couch, she can live with that.
I have learned, she says, to look at every situation and ask if this is going to truly make a difference in my day or my familys day for better or worse. If the answer is no, then that task might be left undone.
It wasnt always this way for Sendelbach, though. When she was first diagnosed with cancer, her son was just a year old and she had been married for only two and a half years. You know how it is when you first have a baby if everything isnt perfect, then the world is falling apart! she laughs. Now, to us we ate, were all still alive, the house is acceptable if were good, its all okay.
What To Know About Breast Cancer Growth
Breast cancer occurs when normal cells mutate and multiply faster than usual. One cell divides to become two cells, then each of those cells divides to become four cells, and so on. The uncontrolled multiplication of cancer cells creates tumors within the breast tissue.
The speed at which a cancer progresses depends on the growth rate of the cancer cells. It is hard to estimate cancer growth because not all cancer cells multiply and divide at the same speed.
In most cases, breast cancer initially develops in either the milk ducts or the lobules, which are the glands that produce milk, before expanding into the breast tissue.
Breast cancer that develops in ducts or lobules can spread to the connective tissue. From there, it can spread to the surrounding lymph nodes.
Once in the lymph nodes, the cancer cells can enter the lymphatic system or the bloodstream, where they can move to other areas of the body.
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How Does Cancer Spread Or Metastasize
The spread of cancer usually happens through one or more of the following steps:
- Cancer cells invade nearby healthy cells.;When the healthy cell is taken over, it too can replicate more abnormal cells.
- Cancer cells penetrate into the circulatory or lymph system.;Cancer cells travel through the walls of nearby lymph vessels or blood vessels.
- Migration through circulation.;Cancer cells are carried by the lymph system and the bloodstream to other parts of the body.
- Cancer cells lodge in capillaries.;Cancer cells stop moving as they are lodged in capillaries at a distant location and divide and migrate into the surrounding tissue.
- New small tumors grow.;Cancer cells form small;tumors;at the new location
Functional Stratification: A New Way To Look At Breast Cancer
As mentioned above, current breast cancer staging is heavily dependent upon the evaluation of pathology specimens. However, recent findings suggest that functional classification of breast tumours may become an important addition to risk prediction and prognosis. Results from preclinical animal models suggest that it might be possible to classify breast cancers on a functional basis, as determined by their ability to promote outgrowth of micrometastatic tumour populations at distant sites. Of note, as presented at the recent Nobel Conference on Breast Cancer, we have the ability to use human tumour cell lines and fresh surgical specimens in our xenograft model to test their ability to promote systemic instigation and/or respond to a protumorigenic host systemic environment .
The ability to determine whether or not a given tumour has the potential to promote the dissemination of tumour cells from the primary tumour, support the proliferation of otherwise indolent disseminated cells or activate systemic signalling pathways that recruit bone marrow cells to the developing tumour stroma of a metastatic lesion would have significant implications for treatment strategies . The ability to use tumour tissue in functional assays to predict tumour behaviour may enable more accurate identification of patients with a high likelihood of future relapse, thereby allowing for potentially curative treatment during the therapeutic window in which the disease can be controlled.
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Metastatic Breast Cancer Symptoms In The Bones:
The bone is one of the most common places for breast cancer to metastasize60% of metastatic breast cancer patients experience bone or lung metastasis, according to research published in the journal Cancer. The most common symptom is bone or joint pain that progressively gets worse, Dean Tsarwhas, MD, the medical director of cancer services for Northwestern Medicine Lake Forest Hospital, tells Health. Dr. Taiwo adds that the most common areas for bone to be affected are in the hip and lower back.
Identifying bone pain can be challenging for patients who have arthritis or other chronic pain issues, Dr. Taiwo says. “Patients who have arthritis…aren’t that concerned about the pain that they’re having. They think it’s part of the arthritis.” She says that any new pain that feels different than other chronic pain a patient may have experienced is a red flag that their breast cancer may have spread.
In rare cases, Dr. Taiwo says that patients find out they have metastatic breast cancer in their bones after breaking their bone . “In the process, images are done and we find that they have other lesions in the area.” This is known as a pathologic fracture.