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Where Does Breast Cancer Metastasis To First

What Are The Stages Of Breast Cancer

Breast Cancer Metastasis, When Can It Happen?

Breast cancers are staged by the size of the tumor and extent of spread. Breast cancers are also graded from one to three, based on how abnormal the cancer cells look and how fast they grow. One is low grade and three is a high grade cancer that is more likely to grow rapidly and spread. In addition, breast cancer may be staged as noted below.

The four stages of breast cancer are:

  • Stage I: The tumor is relatively small and localized to the original site with possible spread to the sentinel lymph nodes.
  • Stage II: The tumor has grown and spread to a few nearby lymph nodes.
  • Stage III: The tumor has grown into many lymph nodes and other tissue in the breast.
  • Stage IV: The cancer has spread to distant parts of the body such as bone, brain, lungs or liver.

Other staging systems state there are 5 stages with Stage 0 representing non-invasive cancer cells. Another classification that is highly detailed is the TNM system, based on tumor size, lymph node involvement and metastatic spread.

Treatment Options For Metastatic Breast Cancer

Treatment for metastatic breast cancer often is based on systemic therapies, which use drugs rather than surgery or radiation. Metastases treatments are designed to shrink tumors and slow their growth, help ease symptoms and improve quality of life. Treatment may change, such as when one therapy stops working, or the side effects become too uncomfortable. Rather than having only one treatment, most patients undergo several treatments combined to help fight the cancer.

The four broad categories of drug-based treatments are:

What Is A Breast Cancer Recurrence

Breast cancer recurrence means that the cancer was diagnosed when limited to the breast and/or armpit lymph nodes, then treated, and at some time later has come back.

This can occur in several ways:

  • Local and/or regional recurrence: the breast cancer that was previously treated returns within the breast, chest wall or regional lymph nodes.
  • New primary breast cancer: an unrelated new breast cancer occurs in one or the other breast. This actually isnt a local recurrence at allits a new cancer in the breast . This typically occurs many years after the original cancer and in an entirely different area of the breast. Its pathology is often different lobular instead of ductal, for example. Though they are often counted as recurrences in the statistics for breast conservation, they should be treated as completely new cancers, much as with new cancers in the opposite breast.
  • Distant or systemic recurrence or metastasis is much more serious than local recurrence and is synonymous with stage 4 disease. For breast cancer patients, the most common areas of spread are the bone, liver, lungs and brain

Breast cancer recurrence occurs if:

  • Cells from the original breast cancer diagnosis break away and hide nearby in the breast or spread elsewhere in the body
  • Treatment, including surgery, chemotherapy, radiotherapy and/or hormone therapy have not gotten rid of all these cancer cells from the body.

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Cellular And Tumour Mass Dormancy

Two different models of tumour dormancycellular and tumour mass dormancyhave been proposed. Cellular dormancy refers to the presence of solitary or small cell clusters of DTCs that exist in a G0/G1 growth-arrested state and result from quiescence, senescence or differentiation. An inability to properly adhere to the ECM,, reduced signalling through the phosphatidylinositol 3-kinase /AKT pathway and a low ratio of the extracellular signal-regulated kinase to the stress-induced kinase p38, are some of the plethoras of predominantly cell-intrinsic mechanisms that have been reported to induce cellular dormancy. On the other hand, escape from cellular dormancy has been shown to occur upon increased matrix stiffness through TGF1 expression, following the release of neutrophil extracellular traps by inflammatory neutrophils, and as a result of aberrant activation of the adhesion protein vascular cell adhesion protein 1 in indolent breast DTCs lodged in the bone marrow via engaging 41-expressing osteoclasts.

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What Are The Types Of Breast Cancer

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Breast cancers are classified by the types of cells in which they develop, and whether they are invasive or noninvasive. Invasive cancers grow into nearby tissue while noninvasive tumors are slow-growing and remain localized.

Breast cancers are also grouped by the presence of mutations in certain genes such as HER2 and BRCA1 and whether they grow in response to estrogen and progesterone, the female hormones. Breast cancers that grow in response to hormones have proteins known as hormone receptors on them.

Breasts consist of milk glands and ducts, connective and fat tissue. Most breast cancers start in the milk-producing glands and ducts in the breast. The types of breast cancers include:

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Where Does Breast Cancer Metastasize To

    Sometimes, breast cancer spreads to other parts of the body. This does not always happen, but when it does, it is known as metastatic breast cancer.

    Metastatic breast cancer is treated differently than localized breast cancer. As a result, oncologists typically check for evidence of metastasis during the diagnostic/staging process. Additionally, breast cancer can spread after a patient has been diagnosed. To watch for potential signs of metastasis, patients are typically scheduled for frequent imaging scans during and after treatment.

    Treatment Of Stage Iv Breast Cancer

    Stage IV cancers have spread beyond the breast and nearby lymph nodes to other parts of the body. When breast cancer spreads, it most commonly goes to the bones, liver, and lungs. It may also spread to the brain or other organs.

    For women with stage IV breast cancer, systemic drug therapies are the main treatments. These may include:

    • Some combination of these

    Surgery and/or radiation therapy may be useful in certain situations .

    Treatment can often shrink tumors , improve symptoms, and help some women live longer. These cancers are considered incurable.

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    Treatment Of Local Recurrence After Previous Mastectomy

    Most commonly the lesion is removed surgically and followed by radiation to the chest wall if the woman has not previously had radiation Treatment of local recurrence after mastectomy can involve a variety of different approaches, including surgery to remove the recurrence if it is confined to a limited area. Other options for treatment include radiation, chemotherapy, and endocrine therapy, or a combination of these.

    Despite aggressive local treatment, many women with an isolated local recurrence following mastectomy eventually develop distant metastases. This is not because the local recurrence spreads, but rather because it is a sign that things have changed and dormant cells in other organs may also be waking up.

    What Are The Chances Of Breast Cancer Recurring

    Metastatic Breast Cancer — An Introduction

    Despite huge advancements in breast cancer screening, early detection and treatment, a percentage of breast cancers will recur and spread to distant sites.

    Although at the moment, it is almost impossible to say which cancers will recur and at what time period from diagnosis, there are a few factors that are known to increase the risk for recurrence.

    These risk factors include:-

    • Lymph node involvement and number of lymph nodes affected at the time of diagnosis
    • Tumor Size at the time of diagnosis
    • A subtype of Breast Cancer and hormonal receptor Status
    • The time span from the initial diagnosis to recurrence of breast cancer

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    Recurrent Breast Cancer: Facts And Figures

    Breast cancer can return at any point after the initial diagnosis and treatment. This is one of the most anxiety-provoking factors for many women after breast cancer diagnosis and treatment.

    There are 3 types of cancer recurrence:-

  • Localized: The cancer returns to the original site where it started.
  • Regional: The cancer has spread to nearby lymph nodes, tissues or organs
  • Distant: The cancer has spread to distant body sites such as the bone, brain, liver or lungs.
  • It is very difficult to predict how many breast cancers of all stages recur, at local, regional and distant sites.

    Indeed, breast cancer incidence and mortality rates are documented over the years. However, data on most cancer registries do not document the incidence of recurrence.

    Furthermore, a local or regional recurrence does not have the same prognostic impact as distant metastasis. Even more difficult to handle, is that cancer can recur at any given point in time.

    What Treatments Are Used For Metastatic Cancer

    Metastatic cancer may be treated with chemotherapy, biological therapy, targeted therapy, hormonal therapy, radiation therapy, surgery, or a combination of these treatments.

    The choice of treatment generally depends on the type of primary cancer the size, location, and the number of metastatic tumors. Also, the patients age and general health and the types of treatment the patient has had in the past.

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    Additional Tools For Diagnosing Advanced Breast Cancer

    The additional tools below are often used specifically for diagnosing advanced cancer:

    Sentinel lymph node biopsy: This procedure removes sentinel lymph node cells during surgery for examination. When breast cancer spreads, it often heads first to the lymph nodes.

    Chest X-ray: This detailed image of the chest may help doctors see whether cancer has spread to the bones.

    Computed tomography scan: Also known as a CAT scan, this procedure takes detailed pictures of internal areas of the body using a computer linked to an X-ray machine. A dye may be used to help the organs show up more clearly in the images.

    Bone scan: This procedure looks for bone metastasis, or cancer cells that have spread to the bone. A small amount of radioactive material is injected into the blood, then detected with a scanner.

    Positron emission tomography scan: A PET scan is a detailed imaging tool that uses a radioactive drug, known as a tracer, to search for cancer cells within your body.

    Are There Any Statistics On Recurrence Rates Or Incidence Of Metastasis

    LIVING WITH STAGE IV BREAST CANCER â Medicals Plan

    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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    Breast Cancer Subtypes Hormonal And Her2 Status And Survival Rates

    Many research studies over the years have shown that Estrogen-positive breast cancers have better survival rates than all of the Estrogen-negative subtypes.

    Progesterone-positive breast cancer also appears to have improved survival rates in comparison to progesterone-negative cases.

    A recent research study combines hormone receptivity, HER2 status and stage and found some interesting results:-

    For ER+ sub-types survival rates were significantly better than all other subtypes. For example, at stage 1b,

    ER+ PR+ HER2- 5-year survival rates were 98.6%ER+ PR- HER2+ 5-year survival rates were 97.3%

    The subtype triple negative breast cancer had the worst survival rates over all three stages. At stage I the 5-year survival rate was 92.9% and at stage III 48.9%.

    Why Does My Provider Need To Test The Metastatic Tumor

    Your care team will test the metastases to figure out the biology of the tumor, which can help guide your treatment plan. Providers may test tumors for:

    • Hormone receptor status: If the cancer is hormone receptor-positive, hormonal therapy may be your first treatment.
    • HER2 status: Human epidermal growth factor receptor 2 is a protein that is overexpressed on some breast cancer cells. HER2-positive cancer responds to specific HER2-targeted therapies.
    • PIK3CA gene mutation: If a tumor is hormone receptor-positive and HER2-negative, your provider may test for this gene mutation. Specific targeted therapies can be used to treat tumors with this mutation.
    • PD-L1 status: Tumors that are hormone receptive-negative and HER2-negative may be tested for PD-L1 status. If the PD-L1 test is positive, you may be recommended to receive a combination of immunotherapy and chemotherapy.

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    Symptoms Of Metastatic Breast Cancer

    The symptoms of metastatic breast cancer may be different than those of early-stage breast cancer, but not always. Sometimes, there are no symptoms at all.

    You should always speak with your doctor if you experience any new signs or symptoms, but here are some of the most common signs that breast cancer has spread:

    • Bone pain or bone fractures due to tumor cells spreading to the bones or spinal cord
    • Headaches or dizziness when cancer has spread to the brain
    • Shortness of breath or chest pain, caused by lung cancer
    • Jaundice or stomach swelling

    The symptoms of breast cancer metastasis may also vary depending on where in the body the cancer has spread. For example:

    • If the breast or chest wall is affected, symptoms may include pain, nipple discharge, or a lump or thickening in the breast or underarm.
    • If the cancer has spread to bones, symptoms may include pain, fractures or decreased alertness due to high calcium levels.
    • If the cancer has spread to the lungs, symptoms may include shortness of breath, difficulty breathing, coughing, chest pain or fatigue.
    • If the cancer has spread to the liver, symptoms may include nausea, fatigue, swelling of the feet and hands or yellowing skin.
    • If cancer has spread to the central nervous system, which includes the brain or spinal cord, symptoms may include pain, memory loss, headache, blurred or double vision, difficulty with and/or movement or seizures.

    Symptoms Of Metastatic Cancer

    Metastasis: How Cancer Spreads

    Metastatic cancer does not always cause symptoms. When symptoms do occur, what they are like and how often you have them will depend on the size and location of the metastatic tumors. Some common signs of metastatic cancer include:

    • pain and fractures, when cancer has spread to the bone
    • headache, seizures, or dizziness, when cancer has spread to the brain
    • shortness of breath, when cancer has spread to the lung
    • jaundice or swelling in the belly, when cancer has spread to the liver

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    Where Does Breast Cancer Spread To

    Metastatic breast cancer also called advanced or stage IV breast cancer is cancer that spreads to other parts of the body. Even when the breast cancer spreads to other organs of the body, it is still called and treated as breast cancer. Metastatic cancer can arise several months and even years after you have successfully treated early or locally advanced breast cancer. This often makes cancer patients wonder where breast cancer spreads to. Letâs find out more about it.

    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.

    3

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    How Breast Cancer Spreads

    Breast cancer can spread through the lymphatic system, the bloodstream, or by local invasionfor instance, when cancer cells actually invade nearby tissues, such as the chest wall or ribs.

    When breast cancers spread and enter the lymphatic system, they usually first arrive at nearby lymph nodes and may still be early-stage.

    Metastatic breast cancer is the same thing as stage 4 breast cancer and is considered the most advanced stage. It refers to breast cancers that have spread beyond the breast and nearby lymph nodes to other regions of the body, which are called distant metastases.

    While treatment options for metastatic breast cancer are similar no matter where cancer has spread, some treatments are used for specific sites of metastasis as well .

    Rare Sites Of Breast Cancer Metastasis: A Review

    Metastatic Cancer: When Cancer Spreads

    Rosa Di Micco1,2, Letizia Santurro1, Maria Luisa Gasparri1, Veronica Zuber1, Enrico Fiacco1, Guglielmo Gazzetta1, Chanel Elisha Smart1, Alice Valentini1, Oreste Davide Gentilini1

    1 Breast Surgery Unit, Breast Unit , Department of Clinical Medicine and Surgery , University of Naples Federico II , , Italy

    Contributions: Conception and design: R Di Micco, OD Gentilini Administrative support: V Zuber, E Fiacco, CE Smart Provision of study materials or patients: ML Gasparri Collection and assembly of data: L Santurro, G Gazzetta Data analysis and interpretation: R Di Micco Manuscript writing: All authors Final approval of manuscript: All authors.

    Correspondence to:

    Keywords: Breast cancer rare metastasis unusual site metastatic disease

    Submitted Jun 30, 2019. Accepted for publication Jul 12, 2019.

    doi: 10.21037/tcr.2019.07.24

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    Why Cancer Cells Tend To Spread To The Parts Of The Body They Do

    Where a cancer starts is linked to where it will spread. Most cancer cells that break free from the primary tumor are carried in the blood or lymph system until they get trapped in the next downstream organ or set of lymph nodes. This explains why breast cancer often spreads to underarm lymph nodes, but rarely to lymph nodes in the belly. Likewise, there are many cancers that commonly spread to the lungs. This is because the heart pumps blood from the rest of the body through the lungs blood vessels before sending it elsewhere.

    What Is Metastatic Cancer

    Metastatic cancer is a cancer that has spread from the part of the body where it started to other parts of the body. When cancer cells break away from a tumor, they can travel to other parts of the body through the bloodstream or the lymph system.

    This image shows some parts of the lymph system, like lymph nodes and lymph vessels, as well as organs and tissues that contain many lymphocytes .

    If the cells travel through the lymph system, they could end up in nearby lymph nodes or they could spread to other organs. More often, cancer cells that break off from the main tumor travel through the bloodstream. Once in the blood, they can go to any part of the body. Many of these cells die, but some may settle in a new area and start to grow.

    Cancer cells must go through several steps to spread to new parts of the body:

    • They must find ways to break away from the original tumor and enter the bloodstream or lymph system.
    • They need to attach to the wall of a blood or lymph vessel and move into a new body part.
    • They need to find ways to grow and thrive in their new location.
    • They must be able to avoid attacks from the bodys immune system.

    Sometimes the metastatic tumors have already begun to grow when the cancer is first found. And sometimes, a metastasis may be found before the original tumor is found. If a cancer has already spread to other parts of the body before its first diagnosed, it may be hard to figure out where it started.

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