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.
Advanced Or Metastatic Breast Cancer: Stage Iv
Stage IV breast cancers indicate the presence of distant metastasis to other parts of the body, such as the liver or bones.
About 5% of women, in 2017 have a stage IV breast cancer at the time of initial diagnosis.
The long term survival rate for stage IV breast cancer tends to be low, but is improving all the time. In 2012 the National Cancer Institute statistics show the 5-year survival rate for Stage IV breast cancer to be around 22%.
However, a more recent study shows that 37% of women survive for 3 years after a Stage IV breast cancer diagnosis.
Also, it is important to remember that each case is individual and there is no telling exact survival rates for any of the stages of breast cancer.
Are There Treatments For Bone Metastases
Yes. Multiple interventions are available for comfort and improved quality of life. Treatment decisions are dictated by whether the spread is localized or widespread and whether the type of cancer is fueled by hormones such as estrogen. The oncologist also considers prior treatments and how the patient responded to each therapy. And of course the degree of severity of symptoms as well as the patients overall health are important in deciding which treatment option is best.
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Symptoms Of Breast Cancer
Although a lump in the breast is a common symptom of breast cancer, not all breast cancers have obvious symptoms. For example, some lumps may be too small to be felt, but can be detected with a screening mammogram or other tests. There are also some benign conditions that can cause lumps in the breast, such as cysts and fibroadenomas .
Most breast changes are not caused by cancer. However, it is important to see your doctor if you notice any new lumps or other unusual breast changes as soon as possible. Early detection gives the best chance of survival if you are diagnosed with breast cancer.
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.
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Local Or Regional Treatments
The systemic therapies described above are the main treatments for metastatic breast cancer.
However, local and regional treatments, including radiation, surgery, and chemotherapy can also be used to help treat metastatic cancer in a specific part of the body, but theyre unlikely to completely eradicate it.
Usually, these therapies are used to treat symptoms or complications of the cancer.
For example, radiation and surgery may be used in these situations:
- when a breast tumor causes an open wound in the breast
- to treat a small number of metastases in a specific area, such as the brain
- to help prevent bone fractures
- when a tumor is pressing on the spinal cord
- to treat a blood vessel blockage in the liver
- to provide pain relief or to relieve other symptoms
Chemotherapy can also be delivered directly to a certain area , to help relieve symptoms or complications.
Is There A Way To Prevent Cancer From Metastasizing
At this time, there are no reliable methods for preventing cancers spread. The best way to keep cancer from spreading is to remove primary tumors when they are very small, before they have a chance to move to other areas of the body. This is in part why cancer screening is so important. But even when cancer is detected and removed early, tumor cells may already be circulating in the blood and lymph vessels or hiding out in other parts of the body.
Learning more about how tumor cells spread and take root in other parts of the body is an important area of research at many cancer centers, including MSK. Sloan Kettering Institute Director Joan Massagué has been studying the biology behind cancer metastasis for nearly two decades. Read more about Dr. Massagués groundbreaking discoveries.
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Symptoms That May Accompany Any Form Of Metastatic Breast Cancer
Nonspecific symptoms that may accompany any form of metastatic breast cancer include:
- fatigue
- a general feeling of unwellness
- loss of appetite
Some symptoms may not be caused by the cancer itself, but by the treatment that youre undergoing. If youre experiencing any of these symptoms, speak with your doctor. They may be able to recommend a therapy to alleviate some symptoms.
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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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.
Common Sites Of Metastasis
- Brain: 7.3%
- All less common sites: 22.4%
Invasive lobular carcinoma tends to have a significantly different pattern of metastases than ductal breast cancer. In one 2017 study, almost 70% of people with metastases from lobular carcinoma had peritoneal metastases.
For roughly a third of women , cancer spreads to multiple organs at the same time.
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What Does A Mammogram Show
A mammogram is a test used to examine the inside of the breasts, using a low dose X-ray. A trained clinician can interpret the images to identify any abnormal areas, masses or calcium deposits that may or may not indicate breast cancer. Mammograms performed on women who have no signs or symptoms of breast cancer are called screening mammograms. Mammograms that used to evaluate an abnormal breast symptom are called diagnostic mammograms.
What Are The Types Of Breast Cancer
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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How Does Cancer Spread Beyond The Breast
Breast cancer can invade through nearby tissue, or spread through the body via the lymphatic system and blood.
- Tissue: the cancer spreads from the original site and grows into nearby areas .
- Lymphatic system: breast cancer cells break away from the original site and can enter nearby lymph tubes , grow in nearby lymph nodes or travel through lymph vessels to other parts of the body.
- Blood: breast cancer cells break away from the original site and can enter and travel through nearby blood vessels to other parts of the body.
What Are Breast Lobes And Breast Ducts
Each female breast contains 15-20 sections called lobes. Each lobe is made up of many smaller sacs called lobules . It is these lobules that produce milk in breastfeeding women. The lobes and lobules are connected to the nipple by tubes called ducts, which carry milk to the nipple. Milk flows through the nipple to the outside during breastfeeding.
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Symptoms And Diagnosis Of Metastatic Breast Cancer
The most common parts of the body where breast cancer tends to spread are the bones, lungs, brain, and liver. But metastatic breast cancer can affect other parts of the body, as well.
Metastatic breast cancer symptoms can be very different depending on the cancers location, but may include:
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back, bone, or joint pain that does not go away
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difficulty urinating , which can be a sign that the cancer is pinching nerves in your back
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numbness or weakness anywhere in your body
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shortness of breath or difficulty breathing
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abdominal bloating, pain, or tenderness
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constant nausea, vomiting, or weight loss
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jaundice
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vision problems
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biopsy of any suspicious area
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a tap, removal of fluid from the area with symptoms to check for cancer cells a pleural tap removes fluid between the lung and chest wall a spinal tap removes fluid from around the spinal cord and a tap of fluid in the abdomen removes fluid in the abdominal cavity
These tests may also be used if you have no history of breast cancer and your doctor is having trouble determining the cause of your symptoms.
A biopsy may be done to determine these factors that can influence your treatment, which will be listed in your pathology report. Learn more about Understanding Your Pathology Report.
How Will I Know If My Breast Cancer Spreads
Your doctor will use specific kinds of tests to find out if your cancer has gone to other places in your body. First, your doctor will want to know how youâre feeling. They will ask you about any symptoms youâre having and your overall health. They might also look at the size of your tumor and check your lymph nodes.
After that, the doctor may give you:
Blood tests. They look for signs of anything abnormal thatâs happening in your body. For example, results from a liver function test can let your doctor know that breast cancer may have gone to your liver. High levels of some substances in your blood hint that the cancer has spread to your bones.
Imaging scans. These tests make detailed pictures of the inside of your body. They help your doctor pinpoint any cancer spread. These tests include:
- X-ray
- PET scan
- Bone scan
Biopsy. Your doctor removes a small amount of tissue from your body and looks at it under a microscope to see if there are any cancer cells in it.
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What Is Survival Rate
The survival rate is the percentage of people who survive a disease such as cancer for a specified amount of time after diagnosis. But it is presented in many different ways.
Between 2015 and 2019, about 1 in 5,000 women in the U.S. died of breast cancer. Mortality rates for breast cancer have been declining steadily since 1990.
Before 1990, mortality rates for breast cancer in women hovered between 30 to 35 women dying from breast cancer for every 100,000 women in the U.S. population. In 2019 this number dropped below 20 for the first time.
Between 1989 and 2017, breast cancer death dropped by 40%, and 375,900 deaths were avoided during those 28 years.
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. Let’s find out more about it.
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How Fast Does Metastatic Breast Cancer Spread
Like all cells, breast cancer cells grow by cellular division. But because cancer cells are mutated, their growth rate can be difficult to predict.
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.
Generally speaking, the more cells divide, the bigger the tumor grows. The larger the tumor, the greater the odds that it may invade nearby tissues, the lymphatic system, or the circulatory system, and spread to other organs.
Breast cancer grading and staging can provide some clues to how aggressive your cancer is.
Grade 3 breast cancer is likely to spread faster than grade 1 or 2, for example.
that can affect how quickly your breast cancer may spread include:
- the
are the two primary metrics used to assess breast cancer.
Symptoms And Diagnosis Of Bone Metastasis
A sudden, noticeable new pain is the most common symptom of breast cancer that has spread to the bone. The pain may come and go at first but can become constant over time. It can be hard to tell the difference between bone metastasis pain and arthritis pain or exercise strain. If the pain feels just as bad or even worse when you rest or lie down, it can be a sign of a problem. Its a good idea to see your doctor right away if it is bone metastasis, prompt treatment can prevent a fracture down the road.
Complications of bone metastasis are called skeletal-related events and can include the following:
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sudden severe pain and the inability to move, which can be a sign of fracture
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pain in the back or neck, numbness or weakness in an area of the body, or difficulty passing urine or having bowel movements all possible signs of spine compression, which can happen when a fractured vertebra presses on the spinal cord nerves that control various bodily functions
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fatigue, weakness, nausea, loss of appetite, or dehydration, which can indicate very high levels of calcium in the blood due to bone breakdown
To diagnose bone metastasis, your doctor usually orders one or more of the following imaging tests:
Your doctor also may order a blood test to check for high levels of calcium or alkaline phosphatase , another substance that can be elevated because of bone metastasis.
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The Wide Window Of Relapse In Breast Cancer
In contrast with other solid tumours in which metastatic recurrence can occur within a few weeks or a few years following diagnosis, breast cancer is characterised by a wide window of relapse, spanning months to decades after surgery. The basis of this peculiar pattern of recurrence is still elusive, but is likely to be linked to the aforementioned molecular differences underlying each subgroup, with basal-like and HER2-enriched patients experiencing early relapses , as opposed to patients with luminal cancers characterised by a more favourable prognosis.,, Nonetheless, patients with luminal B tumours tend to have shorter survival times than luminal A patients. In addition to the contribution of the molecular subtype of the primary tumour, the risk and timing of recurrence is also influenced by other tumour-related factors that constitute the pillars of the TNM classification system: tumour size and spread , regional lymph node involvement and the presence of distant metastasis . Based on the premise that the chance of survival is intimately linked to the anatomic extent of the disease, the TNM staging system stratifies cancer patients at diagnosis into four stageswith patients with Stage I disease having a much better prognosis as opposed to patients with Stage IV diseasethus representing the gold standard tool for prognostication.
How Does Kidney Cancer Spread
The cancer can breakaway and spread from where it started to another area of the body. The original area where it grows for the first time is called primary site and the original cancer is called primary cancer.
When it has spread, it may cause a new growth of tumor called secondary cancer . The secondary, metastatic cancer has the same type of cancer cells where they come from, the primary cancer.
For instance when kidney cancer spreads to the lung, the cancer cells in the lung are kidney cancer cells it is metastatic kidney cancer or called secondary lung cancer not primary lung cancer. The process of the cancer cells moves from the original /primary site to other parts of the body and create a new abnormal growth is called metastasis.
The metastasis of kidney cancer can occur in several different ways direct invasion, hematogenous spread, and through lymphatic system.
Direct invasion
With this way, the cancer spreads and grows into surrounding tissues or structures. For instance, kidney cancer can easily spread to the adrenal gland a small, essential gland located on top of each kidney.
Hematogenous spread
The cancer cells can break free from the primary tumor and travel through bloodstream to a new location in the body. With this hematogenous metastasis, they can spread far away from where they started.
Lymphatic system spread
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