Sunday, February 25, 2024

End Stage Breast Cancer Timeline

Disseminated Tumour Cells As Culprits For Metastatic Recurrence

Stages of Cancer: Tumor Staging and Grading TNM System Nursing NCLEX Review

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.

Knowing What To Expect In The Final Days Or Hours Helps Comfort The Family

Most people don’t know the signs that show death is near. Knowing what to expect can help them get ready for the death of their loved one and make this time less stressful and confusing. Healthcare providers can give family members information about the changes they may see in their loved one in the final hours and how they may help their loved one through this.

The Stages Of Breast Cancer

NOTE: Although a lot of this information is still valid, The American Joint Committee on Cancer has recently updated their classifications for staging breast tumors.

We will be updating all our articles on staging in the near future. In the meantime, please click HERE for a brief summary of the major changes in January 2018.

If a breast biopsy confirms that breast cancer is indeed the diagnosis, the staging process begins.

The stages of breast cancer are really the extent of breast cancer. So, in order to choose and begin the best treatment, it is necessary to stage breast cancer. The staging process shows the progression of breast cancer.

Breast cancer progresses in relatively predictable and consistent ways, so it is possible to categorize breast cancer in terms of stages.

There are basically five stages of breast cancer, with some subcategories .

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No Further Escalation Of Care

Patients with advanced cancer are often unprepared for a decline in health status near the end of life and, as a consequence, they are admitted to the hospital for more aggressive treatments. This complicates EOL decision making because the treatments may prolong life, or at least are perceived as accomplishing that goal. At that point, patients or families may express ambivalence or be reluctant to withdraw treatments rather than withhold them.

Conversely, some situations may warrant exploring with the patient and/or family a time-limited trial of intensive medical treatments. The patient or surrogates may choose to withdraw all LST if there is no improvement during the limited trial. From an ethical standpoint, withdrawing treatment is equivalent to withholding such treatment. Both actions are justified for unwarranted or unwanted intensive care.

What Caregivers Can Do

End Stage Breast Cancer Timeline
  • Help the patient turn and change positions every 1 to 2 hours. It’s best to time any position changes to be about 30 minutes after pain medicine is given.
  • Speak in a calm, quiet voice and avoid sudden noises or movements to reduce the chances of startling the patient.
  • If the patient has trouble swallowing pain pills, ask about getting liquid pain medicines or a pain patch.
  • If the patient is having trouble swallowing, do not give them solid foods. Try ice chips or sips of liquid.
  • Do not force fluids. Near the end of life, some dehydration is normal.
  • Apply cool, moist washcloths to head, face, and body for comfort.

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Withdrawal Of Ventilatory Support

Two methods of withdrawal have been described: immediate extubation and terminal weaning.

Immediate extubation. Immediate extubation includes providing parenteral opioids for analgesia and sedating agents such as midazolam, suctioning to remove excess secretions, setting the ventilator to no assist and turning off all alarms, and deflating the cuff and removing the endotracheal tube. Gentle suctioning of the oral cavity may be necessary, but aggressive and deep suctioning should be avoided. In some cases, patients may appear to be in significant distress. Analgesics and sedatives may be provided, even if the patient is comatose. Family members and others who are present should be warned that some movements may occur after extubation, even in patients who have no brain activity. Such movements are probably caused by hypoxia and may include gasping, moving extremities, or sitting up in bed. Immediate extubation is generally chosen when a patient has lost brain function, when a patient is comatose and unlikely to experience any suffering, or when a patient prefers a more rapid procedure.

References
  • Cochrane TI: Unnecessary time pressure in refusal of life-sustaining therapies: fear of missing the opportunity to die. Am J Bioeth 9 : 47-54, 2009.
  • Morgan CK, Varas GM, Pedroza C, et al.: Defining the practice of “no escalation of care” in the ICU. Crit Care Med 42 : 357-61, 2014.
  • Tumour Dormancy And Reawakening

    Tumour dormancy is generally defined as a prolonged state of asymptomatic micrometastatic disease. In cancer of the breast or prostate, cancer cells can remain dormant for years and even decades before recurring as metastatic disease. During this latent period, patients are considered to be disease-free due to the lack of any symptoms of illness and because they have no detectable neoplasms by clinical imaging. Often described as one of the most wicked cancer cell misbehaviours, tumour dormancy shares many features in common with chronic diseases. Yet, its nature appears to be reversible, as myriad mechanisms have been shown to induce a switch to reawaken indolent DTCs . Furthermore, tumour dormancy is not exclusively a phenomenon of end-stage tumorigenesis, as it can apply to the presence of occult neoplasms until clinical diagnosis , and/or to MRD left behind after treatment . Attention, however, must be paid to the molecular underpinnings of these two scenarios as mechanistic differences between primary and metastatic dormancy might exist.

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    Four Stages Of The Disease

    There are 4 breast cancer stages. Stage 1 breast cancer is a single tumor up to 2 cm in size, which has no regional metastases. They are located in lymph nodes, in close proximity to the affected organ in the armpit fossa. Can you die from stage 1 breast cancer? Highly unlikely! For first stage breast cancer, survival rate averages 95% and reaches 100% in some developed European countries. Those numbers also answer the which cancer is the most curable question. The most important thing here is to contact a specialist after noticing the first signs of the disease.

    Stage 2 breast cancer is a small tumor, up to 2 cm or slightly larger, but often with single metastasis in the armpit fossa. The more cancer that is in the body, the more actively its harmful cells travel through the body. If stage one and stage zero are considered to be almost safe and can be easily cured, then from stage two onwards, the treatment will differ in its intensity and the measures used. At this stage, the probability of positive treatment is 60-70%. The main priority is timeliness and the use of progressive treatment methods. In the case of remote metastases being present, the situation and treatment can slightly aggravate the effectiveness of progress.

    What Is Stage Iii Breast Cancer

    How to Treat Stage II (2) Breast Cancer

    In stage III breast cancer, the cancer has spread further into the breast or the tumor is a larger size than earlier stages. It is divided into three subcategories.

    Stage IIIA is based on one of the following:

    • With or without a tumor in the breast, cancer is found in four to nine nearby lymph nodes.
    • A breast tumor is larger than 50 millimeters, and the cancer has spread to between one and three nearby lymph nodes.

    In stage IIIB, a tumor has spread to the chest wall behind the breast. In addition, these factors contribute to assigning this stage:

    • Cancer may also have spread to the skin, causing swelling or inflammation.
    • It may have broken through the skin, causing an ulcerated area or wound.
    • It may have spread to as many as nine underarm lymph nodes or to nodes near the breastbone.

    In stage IIIC, there may be a tumor of any size in the breast, or no tumor present at all. But either way, the cancer has spread to one of the following places:

    • ten or more underarm lymph nodes
    • lymph nodes near the collarbone
    • some underarm lymph nodes and lymph nodes near the breastbone

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    Thermal Ablation Or Cryoablation

    Thermal ablation or cryoablation can be used alone or in combination with surgery. These procedures involve destroying cancer cells by either heating or freezing them. For example, radiofrequency ablation involves inserting a needle into individual tumours in the liver and destroying them with heat. RFA is a specialist treatment and not widely available. Your treatment team can tell you if it may be suitable for you.

    Stages Of Breast Cancer: Stage Iiic

    Stage IIIc breast cancers basically involve tumors of any size with significant metastases to:-

    • the lymph nodes behind the sternum
    • lymph nodes under the arm
    • the lymph nodes above or below the collarbone

    The extent and depth of lymph node involvement make these patients unsuitable candidates for surgical treatment as a primary mode of therapy. Chemotherapy is the treatment of choice for women with stage IIIb and IIIc breast cancers.

    However, up to 70% of patients with stage III breast cancers who have chemotherapy remain alive and disease-free after 7 years.

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    Phase : Downward Phase

    The downward phase of illness was characterised by episodes of illness and crisis of increasing frequency. Acute episodes were often a result of chemotherapy side effects, physical deterioration, uncontrolled symptoms, such as breathlessness and cerebral symptoms. Five of the women attended an accident and emergency department during this phase.

    Crisis events marked the final downward phase for four of the women. All were admitted to hospital via an accident and emergency department two for uncontrolled pain and two for neutropenic sepsis associated with chemotherapy.

    What Can I Expect While Living With Metastatic Breast Cancer

    End Stage Breast Cancer Timeline

    Your care team will monitor you every few months to check if the cancer is responding to treatment, and also to see if you are having any side effects. The process of restaging the cancer includes:

    • History/physical exam.
    • Imaging tests, including CTs and bone scan or PET scan.

    Before your scans or tests, its normal to feel anxiety. It may help to bring a friend or family member to the appointment with you.

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    When Cancer Reaches The End

    Since your diagnosis, youâve been tested and treated to control the cancer in your body. When something worked, you stuck with it. If it stopped working, you and your health care team reviewed the options and perhaps tried a different treatment.

    When you reach the end-of-life stage of cancer, there may be no more methods available to control your cancer — or you are ready to stop all the testing and treatment.

    Your care, however, continues. The focus shifts from trying to stop the cancer to focusing on helping you live as well and as comfortably as possible for the rest of your life.

    Can Earlier Detection Of Recurrence Improve Breast Cancer Outcomes

    The risk of metastatic relapse weighs heavily on the minds of patients, physicians and caregivers for years, sometimes decades, after treatment of the primary tumour is complete. Nearly 17 million cancer survivors are living in the United States, 3.9 million of whom are breast cancer survivors, and repeated monitoring for cancer recurrence in these individuals presents a significant challenge to healthcare delivery systems. For breast cancer patients, current American Society of Clinical Oncology and National Comprehensive Cancer Network guidelines limit follow-up care to mammography, medical history and physical exam, stating that in the absence of clinical signs and symptoms suggestive of recurrent disease, there is no indication for laboratory or imaging studies for metastases screening., Despite these guidelines, however, many patients receive high-cost imaging analysis and tumour marker blood tests during routine follow-up exams, exposing them to radiation and increasing healthcare costs.,,, So, what has led to the current precarious balance between the desire to detect recurrence early and clinical guidelines that limit the use of diagnostic tests?

    Table 1 Exploiting tumour dormancy as a window of therapeutic opportunity to target MRD.

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    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 living 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 support 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.

    Exercise And Secondary Breast Cancer In The Liver

    Metastatic Breast Cancer – living the last weeks in the ‘dying time’

    Some people with secondary breast cancer in the liver have no symptoms while others have a combination of pain, sickness, loss of appetite, hiccups, tiredness and fatigue. While physical activity may help reduce some symptoms its important to listen to your body and not push yourself too hard. Gentle, regular activity, such as walking, is often most effective.

    If youre currently having treatment you may need to exercise at a slightly lower level. Stop straight away if it hurts or feels like youre working too hard.

    When choosing your exercise, try to focus on aerobic activities such as walking, swimming or cycling. Activities such as dancing and gardening can also be beneficial. You could also include some light toning or conditioning exercises such as stretching or low-impact yoga. The most important thing is to choose something you can safely enjoy.

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    What To Do If You Have Breast Cancer

    When you learn about such an unpleasant diagnosis, the first thing to do is to avoid panic in any way. Try to pull yourself together. After that, be sure to look for an experienced doctor who will tell you what to do and how to proceed. Only an experienced doctor will be able to give you the right diagnosis, assess your overall condition, and be able to provide assistance that will lead to a positive result.

    The main thing, in this case, is to see a professional doctor. Unfortunately, many countries have adopted a radical fight against this disease. Therefore, the question, whether it is possible to cure without surgery, the answer is a resounding no. But in the USA, such treatment can be carried out much more gently. Clinics here offer to conduct surgery for breast cancer, but try to keep as much healthy tissue as possible. In addition, after surgery in such centers, you will certainly be offered plastic surgery to restore the breast.

    So, if you or your loved one was diagnosed with breast cancer, even if it is stage 4, do not panic. Find a great oncologist, select the best treatment option, and start it immediately. With this approach, the probability of a positive outcome increases many times. Remember even the worst and most difficult diagnosis can be a thing of the past if you start the right treatment on time and believe in the best outcome.

    Why Prepare These Documents

    There are two very important reasons to prepare these documents. One reason is for yourself so that your wishes are honored. They give you a chance to dictate what will happen if you are unable to speak for yourself.

    Another reason is for your family. Decisions near the end of life are difficult to begin with, but are even more challenging if family members second guess themselves wondering if they are truly abiding by your wishes. This can become even more of an issue if family members disagree, and can lead to hurt feelings and family friction. Taking the time to spell out your wishes may prevent painful disagreements as your family members argue over what they believe you would have wanted.

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    Avoid Family Food Battles

    It can be very upsetting to family if you start eating less. Some of them may think your interest in food represents your interest in life. By refusing food or not eating much, it may seem to your family that youre choosing to shorten your life or that you will starve.

    Its important that you and your loved ones talk about issues around eating. The last stage of your life doesnt have to be filled with arguments about food. Again, loss of appetite and being unable to eat happens to many people with advanced cancer. When you feel like eating less, its not a sign that you want to leave life or your family. Its often a normal part of the processes that can happen in the last stage of life. If youre getting into arguments with your loved ones, try to let them know that you appreciate their concern and understand their attempts are acts of love. You can let them know youre not rejecting their love, but your body is limiting what it needs at this time.

    You can learn more in Eating Problems.

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