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Breast Cancer Metastasized To Bone

Recurrence Of Metastatic Breast Cancer

Quick Guide on Symptoms of Bone Metastases for Metastatic Breast Cancer Survivors

Metastatic breast cancer is considered a chronic disease, so it doesnt go away and recur.

But in recent years, people under age 50 have seen a particularly strong decline in death rates due to breast cancer, according to the Centers for Disease Control and Prevention .

These declines are due in part to improved screening and treatment for the disease.

There are a few general facts that are helpful to know about breast cancer outlook:

  • Breast cancer is the most common cancer diagnosis in the United States, according to the

When Cancer Goes Beyond Your Breast

If your doctor told you that your breast cancer has spread to other parts of your body, it’s at a more advanced stage than if it’s only in your breasts. How far it has spread is one of the things your doctor will consider when they tell you the “stage” of your cancer. It’s considered “metastatic” if it has spread far from your breasts. Every case is different. For some women, it becomes something they live with for a long time. For others, focusing on pain management and quality of life is the main goal.

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Bone Metastases And Bone Problems

People with bone metastases are at risk of serious bone complications such as bone fractures , spinal cord compression and bone pain.

Bone complications are a concern for people with bone metastases as they can cause pain and may lead to loss of mobility, impacting quality of life. Bone complications can also decrease survival . With the use of bone-strengthening drugs, bone complications are not common .

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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.

Is Stage 4 Breast Cancer Curable

BREAST CANCER RIB METASTASIS

Theres currently no cure for stage 4 breast cancer, but with treatments it can be kept under control, often for years at a time.

People with metastatic breast cancer need to receive treatments for the rest of their lives. If a certain treatment stops being effective, another treatment regimen may be tried.

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The Role Of The Microenvironment In Bone Metastasis

The striking contrast between the abundance of circulating tumor cells and the relative rarity of metastatic events strongly suggests that the metastatic process is very inefficient and takes much more than simply the presence of cancer cells in the circulation . Once a cell has overcome the intrinsic barriers to carcinogenesis, it will need to overcome additional environmental barriers that have been evolutionarily perfected to protect multicellular organisms and maintain their homeostasis . Typical environmental barriers include physical , chemical , hypoxia, and low PH), and biological peptides) components .

Once distant from the primary tumor site and resident in the bone narrow, breast cancer cells establish a tight interaction with the marrow microenvironment . Resident metastatic breast cancer cells secrete a plethora of osteolytic factors , capable of both receptor activator of NF-κB ligand -dependent and -independent activation of osteoclast formation and bone resorption . Tumor activation of bone resorption occurs via direct activation of osteoclasts, and their precursors derived from the monocyte/macrophage lineage cells resident in the bone marrow, and are independent of RANKL . Monocytes are also activated to form osteoclasts via indirect effects on osteoblasts, leading to osteoclastogenesis mediated by RANKL. In the presence of colony-stimulating factor 1 , RANK-L promotes the entire process of osteoclastogenesis and the activation of bone resorption .

How To Diagnose Bone Metastasis

Early detection of bone metastasis helps in cancer staging and better the treatment outcome.

The radiographic analysis is the best choice for diagnosing bone metastasis. Instead of a single method, a combined imaging modality of the following technique will give an accurate diagnosis.

1) Plain X-Rays: The initial assessment of one pain in a cancer patient would be a plain X-ray. Pathological fractures or any osteolytic lesions of size more than two centimeters are well apparent in the plain radiograph.

  • Osteolytic bone metastasis will appear with poorly defined bone margins in the X-ray images.

  • While the mixed types of bone metastasis will show well-established modular features. The progress of the disease and their response to treatment can be monitored and maintained with plain X-rays.

2) Computed Tomography :Computed tomography is an advanced radiographic technique that is more sensitive than plain radiographs. Also, CT can assess the density of the affected bone. The CT images are helpful in treatment planning and pre-surgical assessments.

3) Magnetic Resonance Imaging : Magnetic resonance imaging is highly sensitive and specific in diagnosing bone metastasis. Bone marrow involvement and spinal cord compression can also be detected earlier in MRI slices.

5) Single-Photon Emission Computerized Tomography : A SPECT scan is also a type of nuclear imaging test that uses 99mTc-MDP radioisotopes to detect bone lesions. This process is more sensitive than bone scans.

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Bone Mets From Breast Cancer

When breast cancer has spread to the bone or other organs, it is called Stage IV disease. Even though tumors are growing elsewhere, they are still breast cancer cells that are forming the tumors. Therefore, systemic treatments such as chemotherapy or immunotherapy are used in an effort to eradicate the breast cancer wherever it exists in the body.

At the same time, if the metastatic tumor location presents a problem, the patients medical team will also prioritize addressing it for two main reasons:

  • Treating or destroying the local tumor lessens the cancers burden on the body, potentially helping systemic therapies do their job, and
  • Improving quality of life for the patient by controlling pain and other symptoms.
  • The first symptom of bone mets is often bone pain. Other symptoms include bone fractures, and elevated blood levels of calcium as the cancerous tumors in the bone break the bone down which releases calcium into the bloodstream. While pain medication may relieve pain, it does not halt the local tumor activity in the bone. Currently, there are three types of local treatment for bone mets: surgery, radiation, and ablation . The ideal approach would be one that stops the tumor activity and at the same time provide effective pain control.

    Advances In Treatment Of Metastatic Breast Cancer With Bone Metastasis

    New bone-in technique tests therapies for breast cancer metastasis

    Ziping Wu, Jinsong Lu

    Department of Breast Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University , China

    Contributions: Conception and design: All authors Administrative support: None Provision of study materials or patients: All authors Collection and assembly of data: All authors Data analysis and interpretation: All authors Manuscript writing: All authors Final approval of manuscript: All authors.

    Correspondence to:

    Abstract: Bone is the most commonly seen metastatic site in all the metastatic breast cancer . Treatment includes systemic treatment according to different molecular subtypes and specified treatment of the bone. Bisphosphonate and denosumab are the only two drugs approved to use in bone metastatic site. The optimal dosing schedule and duration of the drugs are still under research. New drugs and therapies including curcuminoids, sunitinib and nano particles are potentially available in the near future.

    Keywords: Metastatic breast cancer bone metastasis bisphosphonate denosumab

    Submitted Jun 01, 2018. Accepted for publication Jun 07, 2018.

    doi: 10.21037/cco.2018.06.05

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    Getting Emotional Support After A Metastatic Breast Cancer Diagnosis

    Most people find it helpful to talk openly about any fears, worries, or frustrations they may have while living with breast cancer. While some people choose to confide in friends and family members, others may prefer to talk in a cancer support group setting either in person or online. In either setting, you can talk with other women facing similar challenges and get firsthand advice about managing side effects, fear, and stress.

    If support groups dont appeal to you, you may want to talk to an expert in cancer care such as an oncology social worker, a psychiatrist, a psychologist, or a counselor. Your medical team can probably recommend someone or help point you in the right direction.

    Many people get emotional support and strength from their faith. You may find comfort in praying and talking to members or leaders of your spiritual community. If you need help finding faith-based support, many hospitals have a chaplain who helps guide people of all faiths to nearby organizations.

    You also might need some support at home and at work. Some treatments can make you feel tired and unable to do some of your usual activities. Let people who care about you help out with daily chores or tasks:

    Read more about getting emotional support after a metastatic breast cancer diagnosis:

    Pathogenesis Of Breast Cancer Bone Metastases

    Once metastatic breast cancer cells are in the bone marrow, they do not, on their own, destroy bone. Instead, they alter the functions of bone-resorbing and bone-forming cells and hijack signals coming from the bone matrix, thereby disrupting physiological bone remodeling . Indeed, there is a ‘vicious cycle’ whereby metastatic cells residing in the bone marrow secrete factors that stimulate osteoclast- mediated bone resorption and growth factors released from resorbed bone stimulate tumor growth . Breast cancer cells may also interact stimulation of osteoclast differentiation and maturation . Furthermore, breast cancer cells secrete factors that inhibit osteoblast differentiation and activity . Their interaction with osteoblasts also induces the release of cytokines that promote tumor growth . Taken together, this leads to an imbalance between bone resorption and bone formation, resulting in enhanced skeletal destruction and, as a consequence of osteolysis, occurrence of pathological fractures .

    Figure 1

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    Can Stage 4 Breast Cancer Go Into Remission

    Stage 4 breast cancer can go into remission, meaning that it isnt detected in imaging or other tests. Pathological complete remission indicates a lack of cancer cells in tissues removed after surgery or biopsy.

    But its rare to take tissue samples while treating stage 4 breast cancer. This could mean that although treatment has been effective, it hasnt completely destroyed the cancer.

    Advances in stage 4 breast cancer treatments are helping to increase the length of remission.

    How Effective Are Treatments For Metastatic Breast Cancer In Bones

    Metastatic breast cancer, CT scan

    Treatment for bone metastasis can effectively manage metastatic breast cancer for some time. Many people with bone metastasis continue to have a good quality of life and live for many years. That said, treatment for metastatic cancer doesnt usually eliminate all cancer cells, and eventually, these cells become resistant to therapy.

    According to the American Cancer Society , the 5-year survival rate for metastatic breast cancer is 28 percent for women and 22 percent for men. Its important to note that cancer survival statistics are based on people who were diagnosed and treated at least 5 years ago. That means they dont reflect the effectiveness of the newest treatments and treatments are improving every year.

    Its also worth noting that survival rates for metastatic cancer are very diverse and dependent on the individual and the type of cancer they have. For example, people with hormone-receptor positive cancers and HER2-positive breast cancers may do well for a long time, compared to those with triple-negative breast cancers. So, lumping all forms of metastatic cancer into one statistic can be misleading.

    Regardless of the type of breast cancer you have, early diagnosis and treatment are crucial, as survival rates are higher in the early stages of breast cancer. And remember, the right treatment for stage 4 breast cancer can improve quality of life and longevity.

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    What Are The Signs And Symptoms Of Bone Metastasis

    Patients with bone metastasis often present with a number of signs and symptoms, like,

    • Pain and Tenderness: The pain is typically a dull type with gradual onset in the site of affected bones.

    • Nerve and Blood Vessel Compression:The pain related to nerve injury travels along the path of the affected nerves. Blood vessel compression may affect the associated structures with oxygen deprivation.

    • Elevated Calcium Level in the Blood:In the osteolytic type of bone metastasis, the tumor cells tend to stimulate the osteoclasts, which in turn causes excessive bone resorption and increased level of calcium in the blood . The patients will experience nausea, vomiting, constipation, and mental changes. This condition will confer a very poor prognosis of the existing health.

    • Fracture of the Weakened Bones:As there is excess bone loss, the bone architecture becomes so weak with an increased risk of fracture.

    • Bone Marrow Failure:Anemia and pancytopenia will occur when bone marrow is involved.

    • Spinal Cord Compression: When vertebral bones are affected by metastasis, the spinal cord may get compressed, which is one of the most significant complications that have to be addressed in an emergency. The symptoms included leg weakness, paraesthesia, and other neurological dysfunctions.

    Breast Cancer Metastasis To Bone Life Expectancy

    Metastatic breast cancer in the bones prognosis typically isn’t as favorable as early-stage breast cancers. The five-year relative survival rate for people with metastatic breast cancer is about 29%.

    That means people with metastatic breast cancer are about 29% as likely to be alive five years after diagnosis as people who don’t have that cancer.

    However, some evidence shows that metastatic breast cancer in the bones seems to have one of the best survival rates compared to other types of metastatic breast cancer.

    A 2019 study published in the journal BMC Cancer looked at five years of data to track the survival rates of stage four breast cancer patients and calculated specific rates based on the site of metastasis.

    The researchers found that patients with bone metastasis had the best overall survival rate, with 50.5% surviving for over three years.

    For comparison, people with brain metastases had a three-year OS rate of 19.9%. People with liver and lung metastasis had a three-year OS rate of 38.2% and 37.5%, respectively.

    Other research published in BMJ Open estimated that the one-year survival rate of metastatic breast cancer in the bones is 51%. And the five-year survival rate is 13%. But those numbers are estimates, not foregone conclusions.

    A lot of factors can impact a person’s prognosis, said Dr. Lin, including:

    • The type of cancer they have
    • Where cancerous cells spread
    • Any other pre-existing conditions or health problems

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    Survival Rates Of Bone Metastases

    Survival rates for people with bone metastases vary greatly by cancer type and stage. Your general health condition and the type of treatment you received for the primary cancer are additional factors.

    Discuss your particular situation with your doctor. Remember that survival rates are averages gathered from large numbers of people. Also, survival data may reflect statistics from a period before the most recent treatment advances.

    A large-scale 2017 study of the 10 most common cancers with bone metastasis found:

    • Lung cancer had the lowest 1-year survival rate after bone metastasis .
    • Breast cancer had the highest 1-year survival rate after bone metastasis .
    • Having metastases in bone and also in other sites was found to decrease the survival rate.

    Here are some typical figures from a 2018 study of common cancers and bone metastasis:

    Type of cancer

    Youre likely to have a combination of therapies that may include:

    • radiation to slow metastasis growth and reduce pain
    • chemotherapy to kill cancer cells and reduce tumor size
    • hormone therapy to reduce the hormones known to be involved with breast and prostate cancer
    • painkillers and steroids for pain relief
    • drugs that specifically target bones
    • surgery if necessary to stabilize your bone, fix a break, and help with pain
    • physical therapy to strengthen your muscles and help you with mobility
    • extreme heat or cold that targets cancer cells and may relieve pain

    Soil And Seed Hypothesis

    Dr. David Schuster on Detecting Bone Metastases in Breast Cancer

    Langenbeck once said that Every cancer cell must be viewed as a living organism capable of development. When plants seed, the seeds are carried in all directions, but they only can survive and grow if they land in the right soil. In 1882, Fuchs argued that certain organs might be susceptible to secondary cancer. In 1889, Stephen Paget proposed the seed and soil hypothesis, which held that tumor cells could only grow in fertile soil . He argued that in BC, bones suffer in a way that no embolic theory alone could explain . Therefore, bone tissue must have a specific microenvironment that supports BC cell growth and development. BC bone metastasis is a complex process involving many kinds of cells and cell growth factors . However, it is unclear which cells and cytokines are involved. Therefore, the first thing we need to do is to understand the soil and the seed.

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