Hormone Therapy For Premenopausal Women
For premenopausal women with metastatic breast cancer, hormone therapy almost always begins with ovarian suppression and either an aromatase inhibitor, tamoxifen or other hormone therapy drug.
Ovarian suppression lowers hormone levels in the body so the tumor cant get the estrogen it needs to grow. This may involve surgery to remove the ovaries or, more often, drugs to stop the ovaries from producing hormones.
Combining ovarian suppression and a hormone therapy drug improves survival over either treatment alone .
If breast cancer progressed during past treatment with a hormone therapy drug, the same hormone therapy drug may not be an option for treatment.
If Breast Cancer Spreads
Cancer cells can spread from the breast to other parts of the body. This spread is called metastasis.
Understanding how a type of cancer usually grows and spreads helps your healthcare team plan your treatment and future care.
If breast cancer spreads, it usually spreads to regional lymph nodes. These are lymph nodes on the same side of the body as the tumour in the following areas:
- ;under the arm
Breast cancer can also spread to:
- muscles on the chest
- the skin on the breast
- American Cancer Society. Breast Cancer. 2015: .
- Foxson SB, Lattimer JG & Felder B. Breast cancer. Yarbro, CH, Wujcki D, & Holmes Gobel B. . Cancer Nursing: Principles and Practice. 7th ed. Sudbury, MA: Jones and Bartlett; 2011: 48: pp. 1091-1145.
- Morrow M, Burstein HJ, and Harris JR. Malignant tumors of the breast. DeVita VT Jr, Lawrence TS, & Rosenberg SA. Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015: 79: 1117-1156.
Where Does Breast Cancer Spread To First
Like all forms of cancer, breast cancer can potentially spread beyond the breast tissue where it initially developed to other areas of the body. In order for breast cancer metastasis to occur, cancerous cells must break away from the original tumor and attach themselves to the outer wall of a lymph vessel or a blood vessel. Then, the cancer must penetrate the vessel wall so that it can flow with the blood or lymphatic fluid to reach a lymph node or organ.
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Looking For More Of An Introduction
If you would like more of an introduction, explore these related items. Please note that these links will take you to other sections on Cancer.Net:
- ASCO AnswersFact Sheet: Read a 1-page fact sheet that offers an introduction to metastatic breast cancer. This free fact sheet is available as a PDF, so it is easy to print.
- ASCO AnswersGuide:Get this free 52-page booklet that helps you better understand breast cancer. The booklet is available as a PDF, so it is easy to print.
- Cancer.Net Patient Education Video: View a short video led by an ASCO expert in metastatic breast cancer that provides basic information and areas of research.
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.
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.
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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Conventional Stages Of Breast Cancer Progression: 0 Through Iv
As mentioned, there are five basic stages of breast cancer with a couple of sub-categories.
This is a bit of an unclear term which specialists use to describe the development of abnormal cells that are not yet invasive breast cancer. Indeed physicians consider Ductal Carcinoma in situ, or DCIS,; stage 0 breast cancer.
Here the malignant cancer cells are present in the lining of the breast d uct but have not yet invaded the surrounding breast tissue or spread beyond the duct. Almost 100% of DCIS is curable, but it obviously, does need treatment.
Early-stage breast cancer; Stage 1
Stage 1 breast cancer is an early stage breast cancer. There is a considerable difference in medical opinion as to what exactly constitutes early stag e breast cancer.; Also, how aggressive the treatment for Stage I breast cancer is another area of debate.
The standard definition of a stage 1 breast tumor is that a certain amount of breast cancer cells invade tissues and structures beyond the duct lining.; ;However, no cancer cells have spread beyond the breast.
Furthermore, the tumor size is less than 2 cm in diameter. If physicians can detect and treat breast cancer before it grows beyond 2cm, the prognosis is very very good.
The average age of diagnosis of a stage 1 breast tumor is about 52 years old. In over 90% of cases, treatment tends to involve breast conservation surgery,; followed by radiation therapy.
Chance of stage 1 cancer recurrence or spreading.
Treatment For Locally Advanced Breast Cancer
Treatment for locally advance breast cancer is likely to include a treatment that affects the whole body .;
This might be chemotherapy, hormone therapy or targeted therapy.
If you have previously had chemotherapy, you may be offered different chemotherapy drugs this time.
If you were already taking hormone therapy when your cancer returned, your doctor may consider switching you to a different drug.
Targeted therapies are a group of drugs that block the growth and spread of cancer.
The most widely used targeted therapies are for HER2 positive breast cancer. However, other targeted therapies are available to treat locally advanced breast cancer that is HER2 negative.;;
Radiotherapy and surgery;
You may be offered radiotherapy if cancer cells are found in the lymph nodes above or below the collarbone, under the breastbone or between the ribs. Its not usually possible to remove the cancer using surgery in this situation.
If the recurrence has affected the muscles on the chest wall, surgery may be offered as well as radiotherapy.
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Effect Of Hormonal Changes On Breasts
As women develop from pre-puberty through puberty, pregnancy and to menopause, the breasts will be affected by a variety of fluctuations in hormones.
During puberty, hormones produced by the ovaries ; cause growth and development of the breast. After puberty, the hormones oestrogen and progesterone will change throughout a womans monthly menstrual cycle. This may cause women to have swollen or tender breasts at different times of the month.
During pregnancy the body will produce additional oestrogen and progesterone, which trigger further growth and development of the breast to prepare mothers for breastfeeding.
Around the time of menopause , the ovaries stop producing female hormones including oestrogen. Without oestrogen, the breast tissue decreases in size. After menopause , monthly menstrual periods stop.
What Is A Breast Made Of
Both men and women have breasts, but women have more breast tissue than men.
The female breast is made of different components, including:
- ;lobules, which produce breast milk
- ducts, which carry milk to the nipple
- fatty tissue and connective tissue, which surround the lobules and ducts.
All breasts contain fatty and fibrous tissue. Lobules can also be referred to as glandular tissue. The male breast has ducts but few or no lobes or lobules.
Breast tissue extends from the collarbone to lower ribs, sternum and armpit.
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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.
Support For Living With Secondary Breast Cancer
Everyones experience of being diagnosed with secondary breast cancer is different, and people cope in their own way.
For many people,;uncertainty;can be the hardest part of living with secondary breast cancer.
You may find it helpful to talk to someone else whos had a diagnosis of secondary breast cancer.
- Chat to other people living with secondary breast cancer on;our;online Forum.
- Meet other women with a secondary diagnosis and get information and support at a;Living with Secondary Breast Cancer;meet-up.
- Live Chat;is a weekly private chat room where you can talk about whatever is on your mind.
You can also call Breast Cancer Nows;Helpline;free on;0808 800 6000.
About Those Lymph Nodes
A surgeon will usually take a lymph node biopsy to determine if the breast cancer has spread to the axillary lymph nodes. This is not always necessary, however. A lymph node biopsy is not usually necessary for DCIS.; However,; for invasive breast cancer, yes, they do need to check the lymph nodes.
Sometimes, doctors will perform a sentinel node biopsy, rather than a full lymph node excisional biopsy if the concerns about cancer spread are minimal. Cancer cells tend to appear first in the sentinel node before spreading to the other nodes, or other areas of the body.
How Does Breast Cancer Spread
First, the cancer cells break away from tissue in the breast. They travel through your blood and lymphatic system, which is a part of your immune system. They usually appear first in the lymph nodes, small glands that filter fluid, under your arm and near your breast. Sometimes, they move to lymph nodes near the collarbone or breastbone. From there, they continue to move to other areas of your body and form tumors there.
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What Is A Primary Tumor
The primary tumor refers to the original breast tumor.;;So, any metastases are either secondary tumors, or simply metastatic breast cancer.
Note, when breast cancer spreads to the bones, it is not bone cancer, it is metastatic breast cancer in the bones.
Metastatic describes a breast cancer that has already spread to distant areas and organs of the body. Metastatic cancer is the most advanced stage of breast cancer.; Furthermore,; the most common sites for breast cancer to metastasize to are the:-
Once breast cancer is at this most advanced metastatic stage, the odds of completely curing the breast cancer are quite low.; .
The treatment of metastatic breast cancer, after a reasonable effort, will often focus on the quality of life and relieving symptoms rather than a cure.
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.
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Ask Your Doctor About Solutions
Patients should not be shy about discussing intimacy issues;with their doctor. He or she may be able to prescribe medications to help. Certain medicationssuch as sildenafil , tadalafil or vardenafil are typically tried first. But these drugs may not help men achieve an erection if the nerves responsible are not healthy. In fact, the medications only work for a small percentage of men in the first few months after surgery, according to a 2017 study published in the International Journal of Sexual Health.
Besides oral medications for erectile dysfunction, there are other options available to men with ED after prostate cancer treatment, says Dr. Shelfo. These include penile injection therapy, which involves injecting a small amount of medication directly into the base of the penis. That has helped many men achieve erections. Another option is an intraurethral suppository of medication, an external vacuum erection device, or surgery may be performed to implant a penile prosthesis.
While regaining erectile function is not possible for all men treated for prostate cancer, it is important to remember that an erection is just one aspect of a satisfying sex life.;Intimacy;is another major component, one that may become more important as sexual relationships become more difficult after cancer treatment.
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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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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.
What Happens When Breast Cancer Spreads To The Liver
When metastases spread to the liver they may cause abdominal pain, a feeling of fullness, weight loss, poor appetite, and jaundice, which is a yellowing of the skin. The symptoms result from the fact that the cancer cells interfere with the normal cells ability to make the liver work properly. The liver does much more than many realize. The liver makes chemicals for many bodily functions, stores nutrients, and detoxifies substances in the body.
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How Quickly Breast Cancer Develops
You may have heard remarks that cancer has been present for five years before it is diagnosed, and this may sometimes be true.
The actual time it takes for breast cancer to grow from a single cancer cell to a cancerous tumor is unknown, as estimates based on doubling time assume that this is constant throughout the duration of tumor growth.
If doubling time were constant, cancer with a doubling time of 200 days would take 20 years to develop into a detectable tumor, and a doubling time of 100 days would take 10 years to be evident on exam.
In contrast, a breast tumor with a doubling time of 20 days would take only 2 years to develop.
Since the majority of studies have found the average doubling time to be between 50 days and 200 days, it’s likely that most breast cancers that are diagnosed began at least 5 years earlier .
Metastatic Breast Cancer Symptoms And Diagnosis
The symptoms of metastatic breast cancer can vary greatly depending on the location of the cancer. This section covers the symptoms of breast cancer that has spread to the bone, lung, brain, and liver, and the tests used to diagnose metastatic breast cancer.
Bone Metastasis: Symptoms and DiagnosisThe most common symptom of breast cancer that has spread to the bone is a sudden, noticeable new pain. Breast cancer can spread to any bone, but most often spreads to the ribs, spine, pelvis, or the long bones in the arms and legs. Learn more.
Lung Metastasis: Symptoms and DiagnosisWhen breast cancer moves into the lung, it often doesnt cause symptoms. If a lung metastasis does cause symptoms, they may include pain or discomfort in the lung, shortness of breath, persistent cough, and others. Learn more.
Brain Metastasis: Symptoms and DiagnosisSymptoms of breast cancer that has spread to the brain can include headache, changes in speech or vision, memory problems, and others. Learn more.
Liver Metastasis: Symptoms and DiagnosisWhen breast cancer spreads to the liver, it often doesnt cause symptoms. If a liver metastasis does cause symptoms, they can include pain or discomfort in the mid-section, fatigue and weakness, weight loss or poor appetite, fever, and others. Learn more.
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