Where Does Breast Cancer Metastasize

How Do Breast Cancers Start

The human body is made of countless cells that reproduce, by splitting, to replace or repair other cells. New cells usually work like their parent cells. Sometimes, however, a new cell has an error. Not all cells with errors are bad some are harmless, or benign. Others, however, reproduce rapidly and harm healthy cells. The offensive cells are said to be malignant because they dont function like healthy parent cells.

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Metastatic Ovarian Cancer Symptoms

When ovarian cancer is in the early stages, cancer cells are only located within the pelvis. A persons symptoms may include pain in their pelvis or abdomen, bloating, and bladder symptoms such as needing to urinate often.

As ovarian cancer spreads to other areas, additional symptoms may appear. If cancer has metastasized to organs in the abdomen, a person may experience nausea, vomiting, constipation, back pain, and swelling in the abdomen from ascites .

Other symptoms may depend on the exact location of the cancer:

• Liver Abdominal swelling or jaundice
• Lung Shortness of breath
• Brain Headache, dizziness, or seizures
• Bones Pain or fractures
• Breast Mass in breast or underarm area

If you have been diagnosed with ovarian cancer and are noticing health changes in another part of your body, talk to your oncologist.

Local Or Regional Treatments For Stage Iv Breast Cancer

Although systemic drugs are the main treatment for stage IV breast cancer, local and regional treatments such as surgery, radiation therapy, or regional chemotherapy are sometimes used as well. These can help treat breast cancer in a specific part of the body, but they are very unlikely to get rid of all of the cancer. These treatments are more likely to be used to help prevent or treat symptoms or complications from the cancer.

Radiation therapy and/or surgery may also be used in certain situations, such as:

• When the breast tumor is causing an open or painful wound in the breast
• To treat a small number of metastases in a certain area, such as the brain
• To help prevent or treat bone fractures
• When a cancer is pressing on the spinal cord
• To treat a blood vessel blockage in the liver
• To provide relief of pain or other symptoms anywhere in the body

In some cases, regional chemo may be useful as well.

If your doctor recommends such local or regional treatments, it is important that you understand the goalwhether it is to try to cure the cancer or to prevent or treat symptoms.

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Managing Your Feelings About Metastatic Breast Cancer

Regardless of whether metastatic breast cancer is a first diagnosis or a recurrence, its normal for people to feel angry, scared, stressed, outraged, depressed, or calm. You may question the treatments youve had, feel mad at your doctors, or be prepared to deal with the diagnosis in a matter-of-fact way. There is no right or wrong way to come to terms with a metastatic breast cancer diagnosis.

Many people find it helps to concentrate on understanding the diagnosis, learning all they can about different treatment options, and taking the time to get second opinions. Information can give people a feeling of control, which can help them manage any fears they may have.

Loss of control is a huge issue for women diagnosed with metastatic breast cancer, said Musa Mayer, author of Advanced Breast Cancer: A Guide to Living with Metastatic Disease and patient advocate. The process of gathering information and learning about the disease and treatment can be very stabilizing and help women feel more in control.

Some people with metastatic breast cancer may feel the urge to withdraw from social connection. But in interviews and publications, many people who are living with metastatic breast cancer have said that distancing themselves from loved ones wasnt very helpful in dealing with their diagnosis.

Still, its important to remember that everyone deals with fear and stress differently. Coming to terms with the diagnosis takes time and is different for everyone.

How Does Breast Cancer Spread

Breast cancer can invade and grow into the tissue surrounding the breast or it can travel to other parts of the body and form a new tumor there. Nearly all types of cancer have the ability to spread , but whether or not it will spread is often linked to what type of breast cancer you have.

Breast cancer can spread in three ways:

Every cancer is different, but the type of breast cancer you have typically plays a role in how aggressive or slow moving it is and where its most likely to spread, says Dr. Roesch.

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What Should I Ask My Healthcare Provider About Metastatic Breast Cancer

If youve been diagnosed with metastatic breast cancer, ask your provider:

• What are my treatment options?
• What is my prognosis?
• What side effects can I expect?
• Will complementary therapy help me feel better?
• What if I want to stop treatment?
• How can I feel my best during treatment?

A note from Cleveland Clinic

Metastatic breast cancer is advanced breast cancer. Providers classify it as stage 4 breast cancer. It happens when cancer cells, often left behind after previous breast cancer treatment, start to spread to other parts of the body. While there is no cure for metastatic breast cancer, treatment can prolong your life and help you feel better. There are many medications available, so if one treatment isnt working, your care team can try a different approach. If you notice any symptoms or dont feel your best, especially if youve undergone breast cancer treatment in the past, talk to your healthcare provider.

Last reviewed by a Cleveland Clinic medical professional on 04/14/2021.

References

What Happens When Breast Cancer Spreads To Bone

Breast cancer that spreads to bones can destroy normal bone. Symptoms are pain, compromised mobility, fractures, spinal cord compression, and hypercalcemia, or too much calcium in blood. Hypercalcemia can be life threatening and may cause the following symptoms: headache and fatigue excessive thirst and urination nausea, vomiting, and constipation abnormal heart rhythm muscle cramping and weakness pain and fractures and memory loss, depression, and irritability.

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Where Can Breast Cancer Go

Breast cancer mostly spreads to the bones, lungs, liver, and brain. When it does, you may start to notice symptoms that affect that area of your body.

Bones: swelling, intense pain, bones that break easily, and pain in your bones, back, neck, or joints

Lungs: long-lasting cough, trouble breathing, chest pain

Liver: Jaundice, or skin with a yellow tint, rashes and itchy skin, not feeling hungry, stomach pain

Brain: headaches that wonât go away, problems with your vision, seizures, vomiting and nausea, memory troubles, feeling dizzy

Other, less common, places where breast cancer spreads include:

Let your doctor know as soon as you can if you have any of these symptoms. They donât always mean your cancer has moved to another organ, but your doctor might want you to take some tests to make sure.

What To Expect When Taking Keytruda

Keytruda is given as a 30-minute infusion, every 3 or 6 weeks, depending on the dose given at each infusion. The Keytruda infusion is given before the chemotherapy infusion. If you are receiving Keytruda for metastatic or unresectable locally advanced triple-negative breast cancer, you may continue treatment with Keytruda and chemotherapy for up to 2 years, unless the cancer grows or you develop unacceptable side effects.

Women who are pregnant or planning to get pregnant should not be given Keytruda. Keytruda can cause embryo death and birth defects. Its important that you dont get pregnant while youre getting Keytruda you must use effective birth control.

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Why Does Cancer Spread So Fast After Surgery

Surgery induces increased shedding of cancer cells into the circulation, suppresses anti-tumor immunity allowing circulating cells to survive, upregulates adhesion molecules in target organs, recruits immune cells capable of entrapping tumor cells and induces changes in the target tissue and in the cancer cells …

Regulatory Factors Of The Rankl Pathway

RANKL clearly holds the key to the osteolytic process. In fact, a new drug, denosumab , a fully human monoclonal antibody to RANKL, has been approved by the US Food and Drug Administration for the treatment of postmenopausal women with high risk of osteoporotic fractures, and is under priority review for patients with bone metastases. Osteoblasts and bone stromal cells can respond to a variety of substances that upregulate RANKL. PTH/PTHrP, TNF-, prostaglandins , IL-1, IL-11, FGF-2, and IGF-1 have been reported to increase RANKL production. Cells of the immune system, T cells and dendritic cells can also express RANKL. In this context, RANKL increases in the presence of inflammatory agents from infectious organisms, such as lipopolysaccharide, CpGpDNA and viral double-stranded DNA . Several of these RANKL inducers merit further discussion with respect to metastatic breast cancer-induced osteolysis.

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The Risk Of Metastatic Breast Cancer

The risk of metastasis after breast cancer treatment varies from person to person. It depends on:

• The biology of the tumor
• The stage at the time of the original diagnosis
• The treatments for the original cancer

Modern treatments continue to improve survival for people with metastatic breast cancer. However, survival varies greatly from person to person.

About one-third of women diagnosed with metastatic breast cancer in the U.S. live at least 5 years after diagnosis . Some women may live 10 or more years beyond diagnosis .

Your oncologist can give you some information about your prognosis, but they dont know exactly how long you will live.

Signs That Breast Cancer Has Spread To The Bone

Most aches and pains arent cancer, stresses Huston. But its important to keep an open and honest dialogue with your doctor about any unusual or persistent discomfort you may be having. He or she can determine if getting images is appropriate to rule out bone metastasis. Here are the symptoms of bone metastasis to look out for:

If you report any of the above symptoms to your doctor, he or she may want to do a thorough physical exam, blood tests, and a bone scan to check for bone metastasis. Depending on the results and where or how severe the bone pain is, he or she may also order an X-ray, PET scan, or CT scan. In some cases, a tissue biopsy is also done to confirm the diagnosis.

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The Extrinsic Effect Of Targeted Therapy

Fig. 4: The effects of cell-extrinsic and cell-intrinsic determinants in dictating breast cancer outcomes.

Part I The journey of a breast cancer patient from the development of undetectable disease and its clinical discovery , through its surgical removal and adjuvant ET , to metastatic relapse and death . The presence of tumour lesions across the body is indicated by starsthe smaller referring to the clinically undetectable ones , the bigger ones to the clinically detectable ones . Part II The development of an HR+ breast tumour lesion in the breast , comprising a mixture of ER+/PR+ and ER/PR cells . DTC escape from the primary site can occur early and/or late during tumorigenesis , although the HR phenotype of DTCs at these stages is often unclear. Bones, lungs and liver are represented as common secondary sites for breast cancer metastases, albeit the sequential patterns of DTC spread among these organs are still elusive . Targeted treatment for HR+ breast cancer patients relies on adjuvant ET. Several mechanisms of ET resistance cytostasis, ESR1 mutations and HR function regulationcontribute to DTC outgrowth. DTC disseminated tumour cell, ER oestrogen receptor, ET endocrine therapy, HR hormone receptor, PR progesterone receptor. Figure created with BioRender.com.

What Is Stage Iv Breast Cancer

Stage IV is the most advanced stage of breast cancer. It has spread to nearby lymph nodes and to distant parts of the body beyond the breast. This means it possibly involves your organs such as the lungs, liver, or brain or your bones.

Breast cancer may be stage IV when it is first diagnosed, or it can be a recurrence of a previous breast cancer that has spread.

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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.

Myth #: People With Metastatic Breast Cancer Have A Short Amount Of Time Left

While some people mistakenly think MBC is curable, at the other extreme are those who assume its an immediate death sentence. But there is a big difference between stage IV incurable cancer, which MBC is, and terminal cancer, which can no longer be treated. A person isnt automatically terminal when she or he gets a metastatic diagnosis. Although MBC almost certainly will shorten someones life, it often can be managed for years at a time.

As Illimae of Houston points out: Stage IV is not an immediate death sentence. It feels that way at first but many have months/years of reasonably decent condition. Brain mets are not necessarily the end either. When found early and treated, especially with minimal disease in the body, life can resume to a fairly normal state.

Mermaid007 adds: hen I was diagnosed with bone mets I felt I needed to go home and get my affairs in order when here I am 4 and half years later.

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How Are Bone Metastases Treated

Although it is not possible to cure bone metastases, they are not usually life-threatening. Many women enjoy active lives for many years after bone metastases are diagnosed.

Treatments for bone metastases aim to improve your quality of life by reducing symptoms, such as pain or bone fractures. Treatment will depend on:

• which bones are affected
• whether your bones have been weakened and are in danger of breaking
• characteristics of your original breast cancer, such as type of tumour and the type of receptor the tumour had or HER2 receptor)
• other treatments you have had for primary or secondary breast cancer
• systemic cancer treatments which work on the whole body.

Treatments are often very effective in stopping the growth or decreasing the size of cancerous deposits in the bones. Current treatments are not usually able to completely remove all cancer cells from the bones.

There are three types of treatment for bone metastases:

• treatments to control pain
• local treatments for the bones which are directed at a single bone or area
• systemic cancer treatments (such as
• hormone-blocking therapy, HER2-blocking drugs and chemotherapy) which work on the whole body.

De Novo Metastatic Breast Cancer

If your first breast cancer diagnosis is metastatic stage IV breast cancer to a distant organ, you may hear the term de novo metastatic breast cancer to describe it. Signs of de novo metastatic breast cancer include a breast lump or mass that you can feel, or a symptom such as pain. De novo metastatic stage IV breast cancer is often confirmed on imaging tests that show cancer spread to a distant organ. Learn more about de novo metastatic breast cancer.

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Where Can Breast Cancer Spread

The most common places for breast cancer to spread to are the lymph nodes, bone, liver, lungs and brain. The symptoms you may experience will depend on where in the body the cancer has spread to. You might not have all of the symptoms mentioned here.

Remember other conditions can cause these symptoms. They donât necessarily mean that you have cancer that has spread. But if you have symptoms that you are worried about, discuss them with your GP, cancer specialist, or breast care nurse so that you can be checked.

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What Is Stage Ii Breast Cancer

Stage II describes cancer that is in a limited region of the breast but has grown larger. It reflects how many lymph nodes may contain cancer cells. This stage is divided into two subcategories.

Stage IIA is based on one of the following:

• Either there is no tumor in the breast or there is a breast tumor up to 20 millimeters , plus cancer has spread to the lymph nodes under the arm.
• A tumor of 20 to 50 millimeters is present in the breast, but cancer has not spread to the lymph nodes.

Stage IIB is based on one of these criteria:

• A tumor of 20 to 50 millimeters is present in the breast, along with cancer that has spread to between one and three nearby lymph nodes.
• A tumor in the breast is larger than 50 millimeters, but cancer has not spread to any lymph nodes.

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