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When Does Breast Cancer Metastasis

How Does Distant Recurrence Occur

Breast Cancer Metastasis, When Can It Happen?

Many patients find it hard to understand how they can be apparently cancer free one day and be diagnosed with recurrent cancer the next. If surgery got all of the cancer out and chemotherapy and radiation were supposed to have mopped up the rest, how can recurrence even happen?

In most cases, even the smallest breast cancer detected has been growing for some time before it was caught. During this period of growth, the cancer cells multiplied and divided over and over again, and some cancer cells may splinter off from the main tumour and escaped into the surrounding blood and lymphatic vessels. Cells that spread to lymph nodes can certainly be trapped in those lymph nodes and removed at the time of surgery, but cells can also go into the circulatory system. Even early-stage cancers that originally had no lymph node involvement can recur and develop metastatic disease.

While its less common, cancer cells can bypass lymphatics and lymph nodes and travel via surrounding blood vessels. Cancer cells can continue to circulate and go anywhere the blood vessels will take them, or they can home in on other organs in the body, where they take up residence and continue to grow and divide in that one particular spot.

If and when cancer comes back, the cancer cells that escaped the breast are to blame. Obviously if your recurrence is ten years after your diagnosis, we assume that the cells have been dormant all that time and missed the treatments aimed at dividing cells.

What Are Skin Metastases

Skin metastases are secondary breast cancers that form on or just below the skin.

Secondary breast cancer happens when cancer cells spread from the breast to other parts of the body. Sometimes breast cancer cells can spread to the skin. This can happen through the blood or lymphatic system.

The most common sites affected are the areas near where the original breast cancer was for example the skin of the chest wall or around the surgical scar. Less commonly, skin metastases can occur on other areas of skin, such as on the scalp, neck, abdomen, back and upper limbs.

About a fifth of people with secondary breast cancer will develop skin metastases.

This is not the same as having cancer that starts in the skin. The cells that have spread to the skin are breast cancer cells.

Its also different to local recurrence, which is when primary breast cancer has come back in the chest or breast area, or in the skin near the original site or scar.

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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Symptoms Of Skin Metastases

Symptoms of skin metastases include:

  • a change in the colour of the skin
  • a lasting rash
  • a firm, painless nodule or a number of nodules of different sizes

Sometimes the symptoms of skin metastases, such as redness and inflammation, may look like an infection of the skin called cellulitis.

Skin metastases can also cause lymphoedema, which is swelling of the arm, hand or breast area.

Other possible symptoms include:

  • odour

When Does Breast Cancer Appear

Cancers Spread to Bone

Ana Rosa had almost two decades on television and becoming one of the best known personalities in Spain, but this situation has forced him to take a break: Normally, and except holidays I have not missed my appointment with you not even when the Covid lurked around every corner and confined us at home .

Breast cancer can start in different parts of the breast

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The breast cancer It is a disease that occurs when the cells of the breast are multiply without brake. Most of the cancers take place in the ducts or lobulillos . Cancer can spread outside the breast due to blood vessels and the lymphatic vessels.

In case the cancer spreads to other parts of the body, we are talking about the metastasis, a situation that Ana Rosa has assured that she is not suffering fortunately. Next, we explain what types of cancer breast are the most common.

Also Check: Breast Cancer Metastasis Prognosis

The Tumor Microenvironment: Creating A Pre

TNBC exhibits numerous CSC-like traits and is more likely to lead to BM. The short time to BM occurrence in TNBC and the short survival time after BM diagnosis may be indicative of an innate ability of TNBC cells to adapt to the brain microenvironment.67 The vascular basement membrane presents the soil in BM. Although more than 95% of early brain micrometastases were shown to coexist with blood vessels, there is little evidence for isolated neurogenic growth.68 When TNBC cells invade the brain parenchyma, an adequate blood supply is needed to provide the nutrients necessary for tumor growth and proliferation. Tumor angiogenesis depends on the balance between pro- and anti-angiogenic factors at the local tissue level and is regulated by the local microenvironment.69

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.

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When Can Metastatic Breast Cancer Occur

Some people have metastatic breast cancer when they are first diagnosed with breast cancer . This is called de novo metastatic breast cancer.

Most often, metastatic breast cancer arises years after a person has completed treatment for early or locally advanced breast cancer. This may be called a distant recurrence.

A diagnosis of metastatic breast cancer is not your fault. You did nothing to cause the cancer to spread.

Metastatic breast cancers come from breast cancer cells that remained in the body after treatment for early breast cancer. The breast cancer cells were always there but were dormant and could not be detected. For some unknown reason, the cancer cells began to grow again. This process is not well-understood.

Relieving Symptoms Of Advanced Breast Cancer

What Does Metastatic Breast Cancer Mean To You?

Treatment to relieve symptoms depends on where the cancer has spread. For example, pain from bone metastases may be treated with radiation therapy, drugs called bisphosphonates such as pamidronate or zoledronic acid , or the drug denosumab . For more, see our information about the treatment of bone metastases.

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How Long Does It Take For Metastatic Breast Cancer To Spread

According to the Robert W. Franz Cancer Research Center at Providence Portland Medical Center, breast cancer cells need to divide at least 30 times before they are detectable by physical exam. Each division takes about 1 to 2 months, so a detectable tumor has likely been growing in the body for 2 to 5 years.

What Is The Prognosis For Those With Metastatic Cancer

While there is no cure for metastatic breast cancer, there are treatments that slow the cancer, extending the patients life while also improving the quality of life, Henry says. Many patients now live 10 years or more after a metastatic diagnosis.

“We are seeing improvements in how long people are living. The new types of medicines that are being approved treat the cancer and help with other symptoms. People are not only living longer, but they are also feeling better longer for the most part, which is very encouraging.”

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Breast Cancer Is A Heterogeneous Disease

Based on the presence or absence of the oestrogen receptor and progesterone receptor , and the expression and amplification of the human epidermal growth factor receptor type 2 , breast cancer can be divided into three clinical subtypes: hormone-receptor -positive , HER2-positive and triple-negative ., In the United States, 71% of breast cancers are HR+, 17% are HER2+ and 12% are TN. Following the discovery of five intrinsic molecular subgroups of the disease based on a 50-gene expression classifier luminal A, luminal B, HER2-enriched, basal-like and normal-likeit became apparent that a large degree of unappreciated molecular heterogeneity exists across and within each subtype of breast cancer. While TN and HER2+ patients often present with basal-like and HER2-enriched cancers, respectively, HR+ women are usually diagnosed with luminal A or luminal B tumours. However, despite sharing some common traits, luminal A cancers are generally ER+, PR high and Ki67 low, resulting in low-grade, slow-proliferating neoplasms, whereas luminal B tumours are typically ER+, PR variable and Ki67 variable, translating into more aggressive cancers with a higher proliferative rate.

What Is Metastatic Breast Cancer

Department of Surgery

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:

  • Bones.
  • Liver.
  • Lungs.

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.

Also Check: What Organs Does Breast Cancer Affect

Emotional And Spiritual Care

End-of-life care also includes emotional, mental, and spiritual therapy. A personâs healthcare team may include social workers, counselors, mental health professionals, and religious or spiritual advisors.

According to the Anxiety and Depression Association of America, up to 40 percent of people with cancer experience serious mental distress. This may include anxiety, depression, panic attacks, and post-traumatic stress disorder .

Medications, therapy, religious or spiritual rituals, and support groups can help a person cope with mental health issues and stress during this difficult time.

Caregivers may also need help with stress, anxiety, and depression. The palliative care team can usually also provide support and advice to caregivers for their emotional needs.

The Breast Cancer Healthline app provides people with access to an online breast cancer community, where users can connect with others and gain advice and support through group discussions.

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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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:

Factors Associated With More Rapid Spread

Metastatic Bone Cancer: Bone Pain When Breast & Prostate Cancer Spreads

Some types of breast cancer, as well as molecular subtypes, are more likely to spread and spread earlier than other types. Ductal carcinoma is more likely to spread than lobular carcinoma, among tumors that are the same size and stage.

While many breast cancers do not spread to lymph nodes until the tumor is at least 2 cm to 3 cm in diameter, some types may spread very early, even when a tumor is less than 1 cm in size.

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Disseminated Tumour Cells As Culprits For Metastatic Recurrence

Metastatic relapse is attributed to the outgrowth of cancer cells that have escaped from the primary tumour and take up residence in secondary sites. Cancer cells that physically detach from a primary source and seed distant sites are known as disseminated tumour cells . The process whereby DTCs transform a localised cancer into a systemic disease is called the metastatic cascade . In the next few sections, the seven key steps comprising this complex biological process are discussed with the goal to shed light on the when and how of DTC dissemination. Importantly, while depicting the metastatic cascade as an orderly series of sequential eventsstarting from the primary tumour and ending in a distant metastatic siteit should be noted that DTC spread can take place through multiple routes and different directions. Accordingly, clinical evidence of self-seedingwhereby a metastatic cell re-infiltrates its primary tumourand of metastasis-to-metastasis spread, has been documented, with one such study in HR+ breast cancer patients reporting a common origin between lymph node and distant metastases in up to 25% of cases.

Fig. 2: Tumour cell dissemination: the route to metastatic success or failure.

Types Of Recurring Breast Cancer

Breast cancer may recur locally, regionally, or distantly:

Local recurring breast cancer occurs when a new tumor develops in the breast that was originally affected. If the breast has been removed, the tumor may grow in the chest wall or nearby skin.

Regional recurring breast cancer happens in the same region as the original cancer. In the case of breast cancer, this may be the lymph nodes above the collarbone or in the armpit.

Distant recurring breast cancer happens when cancer cells travel to a different part of the body. This new location is far away from the original cancer. When cancer recurs distantly, its considered metastatic cancer.

Not everyone with metastatic breast cancer experiences symptoms. When symptoms do occur, they can vary. Symptoms depend on the location of the metastasis and its severity.

Also Check: What Is Stage 2 Cancer Of The Breast

Risk Factors And Epidemiologic Features

In addition to a distinct molecular and pathologic profile, the epidemiology and risk factors associated with triple-negative breast cancer are distinct, especially when compared with endocrine-sensitive luminal breast tumors. The Carolina Breast Cancer Study, a population-based, case-control study aimed at determining clinical associations and distributions across distinct breast cancer subtypes, has refined our understanding of the epidemiologic and risk factors associated with triple-negative breast cancer. In the initial study of women diagnosed with invasive breast cancer, the prevalence of breast cancer subtypes within racial and menopausal subsets were determined. Immunohistochemical staining was used to classify specific subtypes in approximately 500 tumors, and basal-like tumors were defined as triple negative and cytokeratin 5/6 positive and/or HER1 positive. Results indicated that those with basal-like tumors were more likely to be African American compared with nonAfrican American and premenopausal compared with postmenopausal . There was a particularly high prevalence of basal-like tumors among premenopausal African American women compared with postmenopausal African American women and nonAfrican American women of any age . The observation that triple-negative breast cancers more commonly arise in younger African American women has been confirmed in several additional studies, although the exact cause for this association is not yet fully understood.,

Treating Metastatic Breast Cancer

Common Symptoms of Metastatic Breast Cancer

There isnt a cure for metastatic breast cancer. There are treatments aimed at preventing further progression, reducing symptoms, and improving the quality and length of life. Treatments are individualized.

They depend on the type and extent of recurrence, the type of cancer, previous treatment received, and your overall health. Treatment options may include:

  • hormone therapy for estrogen receptor-positive breast cancer, which is the most common type of breast cancer
  • chemotherapy
  • medications that target specific proteins on cancer cells to stop growth, sometimes called targeted therapy
  • bone-building drugs to reduce bone pain and increase bone strength
  • radiation therapy
  • surgery

The US Food and Drug Administration approved the drug palbociclib in 2015 for use in conjunction with an aromatase inhibitor. This combination is used to treat ER-positive, HER2-negative metastatic breast cancer in postmenopausal women.

Other therapies used in hormone-positive breast cancer include:

  • selective estrogen receptor modulators

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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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