Medications For More Severe Bone Pain
Tramadol or opioids, such as morphine or oxycodone, can be added if the ibuprofen, naproxen or acetaminophen alone dont relieve the pain.
All of these drugs can cause constipation, so you may need to change your diet or take medications to promote regular bowel movements. For example, your health care provider may recommend eating high-fiber foods, such as fruits and vegetables, and drinking plenty of liquids to manage constipation.
Other side effects of these drugs include sleepiness and nausea. These usually go away after about a week. If they dont, tell your health care provider. These side effects can be treated.
If youre prescribed opioid medications, your health care provider will carefully monitor the amount prescribed so you dont take too much. People may worry about taking opioid medications, fearing side effects or addiction. However, when used as prescribed, these drugs can offer a great deal of pain relief.
How Breast Cancer Spreads
Breast cancer can spread to other regions of the body in a few primary ways:
When breast cancer spreads to another organ it is still breast cancer. For example, if breast cancer were to spread to the lungs it would not be called lung cancer. Instead, we’d refer to it as breast cancer spread to the lungs or breast cancer with lung metastases. If you were to look at the cancer cells in the lungs under the microscope they would be cancerous breast cells, not cancerous lung cells.
Cancers that have spread to other tissues may be different than the original tumor, and this is another area of confusion. Cancers aren’t just a clone of abnormal cells that propagate mindlessly. Rather, they are continually changing and developing new mutations. For this reason, a tumor that was estrogen receptor positive when found in the breast may now be estrogen receptor negative. HER2 status may change as well. This also explains why metastatic tumors are sometimes more aggressive than the original tumor.
Why It Spreads And Recurs
You may be wondering why breast cancer cells travel at all. Or, why normal cells don’t spread around our bodies. Cancer cells differ from normal cells in many ways. One of these is that normal cells have what is known as “adhesion molecules.” These adhesion molecules act like glue and keep cells where they belong in a particular part of the body.
Normal cells also have “boundaries” or ways in which cells communicate with each other. This is like one country saying to another “you don’t belong here.” Cancer cells, in contrast, don’t respect these cellular communications, essentially ignoring the “fences” between different tissues.
Yet another confusing topic when talking about breast cancer spread is why it can happen years or even decades later. We know that, especially with estrogen receptor-positive breast cancers, cancer can seemingly disappear only to recur many years after the original tumor. Nobody is certain exactly how this happens, but there are theories about recurrence that suggest that some breast cancer cells are hardier than others and that these cancer “stem cells” are able to lie dormant even through treatment.
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Should I Have Regular Routine Scans Or Blood Tests To Check For Distant Breast Cancer Recurrence
No. Routine scans to check for the presence of distant disease recurrence are not recommended in the absence of symptoms
Given the ominous nature of stage 4 disease, the obvious question is, why dont we scan for spread regularly after a first diagnosis, so that we can detect it early if it does return? The reason we dont scan or test for metastasis is that there really is no early stage 4 disease, and thus no real opportunity to intervene earlier and increase the chance of cure. Its also important to know that with recurrence, one does not progress from one stage to the next: a woman who was originally diagnosed with stage 1 breast cancer does not recur as stage 2, because once cells have taken up residence elsewhere, she is immediately considered to have stage 4 disease. And with stage 4 disease, either you respond well to treatment and the disease regresses, or you dont and it doesnt. Studies have shown that getting frequent scans after a first cancer diagnosis does not lead to improved survival, which is why we dont scan for stage 4even if we wish we could.
Current guidelines and evidence therefore recommend against routine CT or bone scans, or blood tests, to look for recurrence of cancer in patients who do not have any symptoms or other concerns that need to be followed up on.
If you do have concerning symptoms , then you should bring them to the attention of your healthcare team to be checked out.
What Are The Symptoms Of Breast Cancer Recurrence
You may experience different signs of breast cancer recurrence depending on where the cancer forms.
Local breast cancer recurrence may cause:
- Breast lump or bumps on or under the chest.
- Nipple changes, such as flattening or nipple discharge.
- Swollen skin or skin that pulls near the lumpectomy site.
- Thickening on or near the surgical scar.
- Unusually firm breast tissue.
- Biopsy of the site of suspected recurrence.
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How Do Breast Cancer Cells Spread
So what is the mechanism being examined here? Previous work has demonstrated one mechanism by which breast cancer cells can gain access to blood vessels and spread . In this mechanism, breast cancer tumor cell spread occurs at microscopic structures dubbed tumor microenvironment of metastasis . Each TMEM is composed of three cell types, all in direct physical contact with each other: a tumor cell making a protein that regulates a structural protein known as Mammalian-enabled , a perivascular macrophage , and an endothelial cell . Vascular permeability due to TMEM has been shown to be localized and mediated by vascular endothelial growth factorA release from the TMEM-bound macrophages, which express the angiopoietin receptor TIE2. Now, I used to do a lot of work with VEGF-A back in the 1990s, when I studied tumor angiogenesis, the process by which tumors interact with their environment to stimulate the ingrowth of new blood vessels. Basically, the macrophages associated with TMEM secrete this factor, which increases vascular permeability, making holes through which tumor cells can gain entry to the blood vessel and spread via blood. However, only tumor cells expressing high levels of MENA can take advantage of this. Tumors with a high TMEM score in animal models have a higher likelihood of metastasis compared to tumors with low TMEM scores.
The Paradox Of Chemotherapy
Although tumors can be reduced to undetectable level by modern chemotherapy, in many cases they recur at the original or distant sites. Traditionally, this was thought to be a manifestation of survival of the fittest: The chemotherapeutic drugs exert selection pressure that allowed resistant cancer cells to survive, grow, and eventually thrive. However, emerging pictures from cancer research in the last decade showed that, paradoxically, chemotherapy can actively induce changes that favor cancer progression. These pro-cancer changes can be either inside or outside the cancer cells. For intrinsic changes, chemotherapeutic drugs have been shown to up-regulate the expression of anti-apoptotic genes , and to increase the ability of cancer cells to migrate/invade . For extrinsic changes, chemotherapeutic drugs have been shown to change the non-cancer cells within the hostthe organism that carries the cancer cells . Note that the issue at hand here is the pro-cancer effect of chemotherapy, rather than the well-recognized side effect of chemotherapy, such as nausea and hair loss.
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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 youÃ¢re feeling. They will ask you about any symptoms youÃ¢re 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 thatÃ¢s 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:
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.
Palliative And Supportive Care
Palliative and supportive care focuses on symptom control and support. Its an extremely important part of the care and treatment for many people with secondary breast cancer and can significantly improve quality of life for them and their families.
People often associate palliative care with end-of-life treatment. However, many people value having it at any stage of their illness, alongside their medical treatment, to help prevent and relieve symptoms such as pain or fatigue. It can also help with the emotional, social and spiritual effects of secondary breast cancer.
The palliative and supportive care teams are based in hospitals, hospices and the community. You can be referred by your treatment team, GP or breast care nurse depending on your situation.
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Breast Cancers Long Tail
For this research, Ghajar and his team focused on the most common type of breast cancer, estrogen-receptor positive , which comes back as metastatic disease five or more years after treatment in up to 17 percent of early-stage patients. In comparison, the metastatic recurrence rate for all breast cancer patients is thought to be between 20 and 30 percent.
âThereâs this long tail in ER+ breast cancer where patients will go for years and years without any kind of problem and then five, seven, 10, 15, 20 years later, they have a recurrence,â Ghajar said.
Unlike some early-stage cancers, metastatic disease is incurable. Patients with stage 4 disease are in treatment for the rest of their lives. And while some patients live with their cancer for years â or even decades â when their treatment stops working or they run out of options, they die.
Ghajarâs finding, if it holds true, could reduce the number of early stagers who go on to become metastatic, effectively snipping off breast cancerâs long tail.
âWeâre not trying to treat a primary tumor or trying to treat mets,â he said. âWeâre trying to treat DTCs, for which there are no current therapies.â
Teri Pollastro, 58, another research advocate who worked with Ghajar, went from DCIS, or stage 0, to stage 4 years after her initial treatment. She believes her advanced cancer was a direct result of awakened DTCs.
How Can I Prevent Breast Cancer Recurrence
Healthcare providers dont know why some people experience breast cancer recurrence. A recurrence isnt your fault. You didnt do anything wrong to cause it or fail to do something more to prevent it.
Certain medications may reduce the risk of breast cancer recurrence in people who have early stage breast cancer. For estrogen-receptive breast cancer, hormonal therapies including tamoxifen or aromatase inhibitors block either the activity of estrogen or the bodys production of estrogen. Chemotherapy may also be recommended to reduce risk of breast cancer recurrence.
Early diagnosis may make it easier to treat a recurrence. Follow your healthcare providers recommendations for mammograms and other screenings. You should also perform regular breast self-exams. Get familiar with how your breasts look and feel so you can see your provider quickly if you notice changes. And remember that most breast changes occur for reasons other than cancer.
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Chemotherapy Regimens For Early
At some point, your medical oncologist will recommend a chemotherapy plan for you. Also called a chemotherapy regimen, the plan will have important details about your treatment, including:
- which drugs youre receiving
- the order in which you receive them
- the amount of each drug
- how often and how long you will need chemotherapy
Most women with early-stage breast cancer receive chemotherapy for approximately three to six months. Theres time in between treatments to allow your body to recover. If you are receiving targeted therapy for early HER2-positive breast cancer, treatment could last up to a year.
For some people, doctors may recommend a dose-dense chemotherapy regimen. Dose-dense chemotherapy means there is less time between treatments. You will not need to have a larger dose of chemotherapy.
Research has shown that dose-dense chemotherapy can improve survival and lower the risk of the breast cancer coming back compared to a traditional chemotherapy schedule. Dose-dense chemotherapy does not result in more side effects.
The Types Of Radiotherapy
The type of radiotherapy you have will depend on the type of breast cancer and the type of surgery you have. Some women may not need to have radiotherapy at all.
Types of radiotherapy include:
- breast radiotherapy after breast-conserving surgery, radiation is applied to the whole of the remaining breast tissue
- chest-wall radiotherapy after a mastectomy, radiotherapy is applied to the chest wall
- breast boost some women may be offered a boost of high-dose radiotherapy in the area where the cancer was removed however, this may affect the appearance of your breast, particularly if you have large breasts, and can sometimes have other side effects, including hardening of breast tissue
- radiotherapy to the lymph nodes where radiotherapy is aimed at the armpit and the surrounding area to kill any cancer that may be in the lymph nodes
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If All The Cancer Was Removed With Surgery Why Do I Need Any Additional Treatment
It has long been recognized that breast cancer is not always cured by locoregional treatment alone.
The goal of treating early breast cancer is to remove the cancer and keep it from coming back . Most people diagnosed with breast cancer will never have a breast cancer recurrence. However, everyone who has had breast cancer is at potential risk of recurrence, and that is why in most cases, there is a recommendation for treatment in addition to surgery, which is known as adjuvant therapy. The risk of recurrence can never be entirely eliminated, but the aim of adjuvant therapy is to reduce recurrence risk to the absolute minimum.
No Need To Fear: Breast Needle Biopsy Wont Cause Cancer To Spread
Despite some patients concerns, there is no evidence that a breast needle biopsy can cause cancer to spread. It is extremely unlikely that cancer cells will spread during standard procedures for biopsy. The United States sees more than one million women undergo biopsies every year, which are estimated to diagnose around 20 percent of breast cancer cases.
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Depending on characteristics such as how many tumor cells, blood vessel cells, and immune cells are touching each other, the tumor microenvironment can nearly triple the chance that a common type of breast cancer that has reached the lymph nodes will also metastasize, Condeelis and colleagues showed in a 2014 study of 3,760 patients. The discovery of how the tumor microenvironment can fuel metastasis by whisking cancer cells into blood vessels so impressed Dr. Francis Collins, director of the National Institutes of Health, that he featured it in his blog.
The new study took the next logical step: Can the tumor microenvironment be altered so that it promotes or thwarts metastasis?
To find out, Einsteins George Karagiannis spent nearly three years experimenting with lab mice whose genetic mutations make them spontaneously develop breast cancer, as well as mice given human breast tumors. In both cases, paclitaxel changed the tumor microenvironments in three ways, all more conducive to metastasis: The microenvironment had more of the immune cells that carry cancer cells into blood vessels, it developed blood vessels that were more permeable to cancer cells, and the tumor cells became more mobile, practically bounding into those molecular Lyfts.
Pre-op chemo may have unwanted long-term consequences in some breast cancer patients, the Einstein researchers wrote.
The Pros And Cons Of Chemotherapy And Radiation Therapy
Your doctor will take your tumor size and location into account when determining whether or not to administer chemotherapy to you. Chemotherapy may be the best option for you if your cancer has spread or is a particularly aggressive type. Chemotherapy treatments typically last four weeks, with each treatment lasting a break. The cycle begins all over again. Radiation therapy is used to treat a wide range of cancers. The cancer cells are destroyed as a result of its action. Cancer is usually prevented from growing or spreading by this treatment. In general, radiation therapy takes about a week, but it can take longer depending on the type of radiation therapy used, the size of the tumor, and its location.
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Can Receiving Less Chemotherapy Result Ultimately In Better Outcomes
Chemotherapy can shrink cancer and slow its growth, which is why it has been used to treat breast cancer in conjunction with surgery for so many years. But the side effects can be difficult.
In the short term, these side effects can include such problems as nausea, fatigue, and hair loss, which can sometimes last far beyond treatment. We know that, after a course of chemotherapy, a number of women, up to several years out, don’t regain their full vitality, Dr. Winer says.
But even more concerning are the long-term effects, which can include rare, but difficult, complications such as heart problems, neuropathy, and leukemia, which can ultimatelyand indirectlyaffect outcomes.
These potentially debilitating side effects are why personalizing chemotherapy treatment has become so important. If a patient can do just as well with fewer medical treatments, it’s almost always a better thing, says Dr. Winer. Less chemotherapy can mean fewer side effects, less anxiety, improved quality of life, and possibly even a longer life, he adds.
Also, when side effects are truly debilitating, treatment delivery may be impaired, Dr. Lustberg says. If we can enhance how patients are feeling during treatment, they may actually tolerate treatment better, stay on it longer, not need dose reductions or modifications, and have better disease outcomes. It’s all interrelated.