Sunday, March 3, 2024

Where Does Breast Cancer Spread To First

Symptoms If Cancer Has Spread To The Lymph Nodes

Early Signs of Breast Cancer

Lymph nodes are part of a system of tubes and glands in the body that filters body fluids and fights infection.

The most common symptom if cancer has spread to the lymph nodes is that they feel hard or swollen. You might have any of the following symptoms if your cancer has spread to the lymph nodes:

  • a lump or swelling under your armpit
  • swelling in your arm or hand
  • a lump or swelling in your breast bone or collar bone area

One of the first places breast cancer can spread to is the lymph nodes under the arm on the same side as the breast cancer. This is not a secondary cancer.

What Are Lymph Nodes

Lymph nodes are small, rounded structures of about 1 mm to 25 mm that are found throughout the body.

The lymph nodes form part of the lymphatic system. The lymphatic system is an important part of the immune system that protects the body from disease and infection. It contains a network of thin tubes called lymph vessels that are found throughout the body. These lymph vessels transport a clear fluid called lymph between the lymph nodes. The lymph nodes filter the lymph to trap or remove substances harmful to the body, such as bacteria or cancer cells. This helps to protect the body from disease or infection. The lymph then passes back to the blood.

The closest lymph nodes to the breast are those in the armpit, which are known as axillary nodes. The axillary nodes drain lymph from nearby tissues, including the breast. There are also lymph nodes under the breastbone and in the neck . The number of lymph nodes varies between different people. There are usually about 15-30 lymph nodes in the armpit.

Because the lymph vessels carry lymph away from the breast, in the case of breast cancer, cancer cells can enter the lymph vessels and begin to grow in the lymph nodes. The axillary nodes are often the first place of cancer spread outside the breast. Usually, surgery is used to remove one or more of the axillary nodes to help check for cancer spread. Cancer found in the lymph nodes affects the staging and treatment of breast cancer.

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.

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Am I Still At Risk Of Local Recurrence If I Have Had A Mastectomy

Yes. Local recurrence can also happen after a mastectomy, although the likelihood is usually low.

Some of the signs of local recurrence after mastectomy include

  • A lump or raised bump in or under the skin, especially near the previous mastectomy scar
  • Changes to the skin, including redness or thickening

After reconstruction a local recurrence can appear at the suture line of the flap or in front of the implant. When its in the skin itself, it is red and raised. Reconstruction rarely if ever hides a recurrence. With implants, the recurrences are in front of the implant. With a flap, the recurrences are not in the flap itself but along the edge of the breast skin.

Local recurrence after mastectomy is often described as a chest wall recurrence, which isnt entirely accurate because it implies that the cancer is in the muscle or bone. But usually such a recurrence appears in the skin and fat where the breast was before, and only rarely does it include the muscle.

Ninety percent of local recurrences following mastectomy happen within the first five years after the mastectomy. Approximately 20 to 30 percent of women with local recurrences after mastectomy have already been diagnosed with metastatic disease, and another 20 to 30 percent will develop it within a few months of diagnosis. Therefore, just as with local recurrences after breast conservation, tests should be done to look for distant disease.

Integrative Therapies For Metastatic Breast Cancer

Range of Ductal Carcinoma in situ

You may find it beneficial to add integrative therapies to your treatment plan. There are many evidence-informed integrative modalities to boost the mind and body. Practices like gentle yoga, meditation, massage and music therapy may feel enjoyable and reduce stress and anxiety levels.

To help our patients maintain quality of life after a metastatic breast cancer diagnosis, our team of breast cancer experts may offer supportive care services to help manage side effects of the disease and its treatments. These may include:

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Treatment Of Stage Iii Breast Cancers

Sometimes large breast cancers invade into muscles or attach to major arteries, veins or nerve trunks, which makes them impossible to surgically remove completely.

So, for these patients, the treatment usually starts with radiation or chemo to try to shrink it first, before surgery. But even a large tumor that has not attached itself onto muscle can, sometimes, be completely removed. There is no direct relationship between tumor size and whether or not it may be treated surgically or not.

Obviously, Stage 3 breast cancers that surgeons can completely remove do tend to have a significantly better prognosis than inoperable stage 3 breast cancers. However, some breast tumors, particularly those that are ER-positive, respond very well to chemotherapy. So well, in fact, that they actually downstage.

So, it is difficult to predict the overall prognosis for stage 3 breast cancer, as it will vary from individual to individual. If the response to chemotherapy is favorable, the overall survival rate is around 72%.

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What To Ask A Doctor Before Starting Oral Chemotherapy

Here are some questions you may want to ask a doctor:

  • Whats each drug expected to do?
  • Exactly how should I take this medication?
  • Can the pills be broken or crushed? Do they need to be taken with a meal?
  • Are there any particular foods I should avoid while taking this medication?
  • What should I do if I miss a dose?
  • What happens if I throw up after taking it?
  • How should I handle and store the drug?
  • What side effects can I expect from this drug, and what should I do if I have them? What are the warning signs of serious problems?
  • How often should I check in with your practice? When will I need blood tests or scans?
  • How long will I need to take it?
  • How will we know its working?

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How Long Does It Take For Stage 2 Breast Cancer To Spread

Cancer cells divide and multiply quickly in such a way that as a tumor gets bigger, it divides and grows even faster. The average doubling time for breast cancer tumors is between 50 and 200 days. Breast cancer tumor growth rate is impacted by hormonal factors, such as hormone receptor status and HER2 status.

Feeling Or Being Sick

What is breast cancer staging?

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.

It is important to take anti sickness medicines as prescribed even if you dont feel sick. It is easier to prevent sickness rather than treating it once it has started.

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Can Supplements Prevent Breast Cancer From Coming Back

So far, theres no proof that any vitamin, mineral, or herbal supplement can treat breast cancer or prevent it from coming back.

To date, there are no studies which demonstrate that certain supplements will lower your risk of recurrence, Johnson says. They may help with symptoms, but there isnt enough research to support using them to prevent breast cancer.

But there are other things you can do to lower your risk of breast cancer coming back. Make these lifestyle changes:

  • Eat a healthy diet.

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Treatment Of Noninvasive Cancer

For ductal carcinoma in situ, treatment usually consists of one the following:

  • Removal of the tumor and a large amount of surrounding normal tissue with or without radiation therapy

Some women with ductal carcinoma in situ are also given hormone-blocking drugs as part of their treatment.

For lobular carcinoma in situ, treatment includes the following:

  • Classic lobular carcinoma in situ: Surgical removal to check for cancer and, if no cancer is detected, close observation afterward and sometimes tamoxifen, raloxifene, or an aromatase inhibitor to reduce the risk of developing invasive cancer

  • Pleomorphic lobular carcinoma in situ: Surgery to remove the abnormal area and sometimes tamoxifen or raloxifene to reduce the risk of developing invasive cancer

Women with lobular carcinoma in situ are often given tamoxifen, a hormone-blocking drug, for 5 years. It reduces but does not eliminate the risk of developing invasive cancer. Postmenopausal women may be given raloxifene or sometimes an aromatase inhibitor instead.

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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.

Learn more about opioids and other pain medications, their side effects and fear of addition.

Most Common Places It Spreads

Breast Cancer

It’s still breast cancer, even if it’s in another organ. For example, if breast cancer spreads to your lungs, that doesn’t mean you have lung cancer. Although it can spread to any part of your body, there are certain places it’s most likely to go to, including the lymph nodes, bones, liver, lungs, and brain.

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What Is My Prognosis

This is a very common question that isnt always easy to answer. There are many factors involved in working out prognosis. Remember that a prognosis is just a figure at the point at which you receive it. For most people, the prognosis gets better with time.

Sometimes we use a five-year figure because we know that if cancer comes back, most of the time it comes back within five years. If the cancer has not come back within five years, then the chance of it coming back within ten years is quite low, and if it does not come back within ten years, then you have an almost normal life expectancy.

Its a bit like buying a second hand car. You dont really know how long its going to last, but if it lasts year after year without breaking down, then the car starts to look more and more reliable to make that long trip.

Working out prognosis can be difficult.

Phase Iii Keynote 355 Trial

The much anticipated KEYNOTE-355 trial was presented at the inaugural virtual ASCO annual meeting in June 2020. This trial investigated pembrolizumab/chemo vs chemo in patients with treatment-naïve, metastatic TNBC. Patients were excluded if they had active brain metastases or recurrence of disease < 6 mo prior to primary treatment. PD-L1 was assessed with the IHC 22C3 pharmDx CPS assay in a central laboratory. The primary outcome measure was pre-defined as OS and PFS in the PD-L1 positive population and the ITT population. In this trial, a hierarchial statistical testing method involved statistical testing of OS and PFS in the CPS > 10 group initially, followed by CPS > 1 and then the ITT population. The trial included 566 patients in the chemotherapy/IO arm vs 281 in the chemotherapy arm. In patients with a CPS score of 10 or greater, the median PFS favoured pembrolizumab with a PFS of 9.6 mo vs 5.6 mo . In patients with a CPS score of 1 or greater, the median PFS favoured the pembrolizumab arm with a PFS of 7.6 mo vs 5.6 mo . This was not statistically significant. This was similar to the ITT population where the PFS was 7.5 mo in the pembrolizumab arm and 5.6 mo in the placebo arm . OS data is awaited. This progression free survival improvement led to accelerated FDA approval for pembrolizumab in combination with chemotherapy in the first-line setting in November of 2020.

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Stage Iv Breast Cancers May Be Recurrences Following Initial Treatment

Up to 5% of initial breast cancer diagnoses are of the most advanced or metastatic stage. However, this number has significantly reduced with the implementation of widespread breast cancer screening programs.

Metastatic breast cancer can appear to be a rapid deterioration of a disease that has been present for some time undetected.

But metastatic breast cancer can also be the result of a recurrence of breast cancer after successful initial treatment. Sometimes the terms local and regional recurrence indicate a return of breast cancer to the original tumor site or elsewhere in the breast or contralateral breast.

If the cancer returns in other areas of the body it is a distant metastasis or distant recurrence.

For more detail on Stage IV survival rates, recurrence rates and treatment please see our new post HERE.

The Impact Of Generic Medications On Breast Cancer Prevention

Newly diagnosed with metastatic breast cancer

Nhuan Nguyen, PharmD, MBA, ChEClinical PharmacistUniversity of Georgia College of PharmacyAthens, Georgia

US Pharm. 2016 41 :14-18.

ABSTRACT: Breast cancer is one of the most common cancers in American women. The high cost of brand-name breast cancer medications results in a low rate of chemoprevention of invasive breast cancer. Patient adherence is also affected by misconceptions about the efficacy of generics. Following the approval of less-expensive generic formulations of brand-name breast cancer medications, more women are using generics for prevention. Cost savings from generics have significantly increased adherence rates, and the impact of generic medications on breast cancer survival rates is expected to be significant in the long term. By making recommendations about generic versions of breast cancer medications to high-risk patients, pharmacists can play a significant role in increasing the number of women opting for breast cancer chemoprevention, thereby increasing the survival rate.

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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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Possible Side Effects Of Chemo For Breast Cancer

Chemo drugs can cause side effects, depending on the type and dose of drugs given, and the length of treatment. Some of the most common possible side effects include:

  • Hot flashes and/or vaginal dryness from menopause caused by chemo

Chemo can also affect the blood-forming cells of the bone marrow, which can lead to:

  • Increased chance of infections
  • Easy bruising or bleeding

These side effects usually go away after treatment is finished. There are often ways to lessen these side effects. For example, drugs can be given to help prevent or reduce nausea and vomiting.

Other side effects are also possible. Some of these are more common with certain chemo drugs. Ask your cancer care team about the possible side effects of the specific drugs you are getting.

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The Emerging Concept Of Triple Negative Breast Cancer

Breast cancers are commonly associated with a high incidence and a high mortality rate in the female population worldwide. However, at a microscopic and molecular level, breast cancer is not a homogeneous disease, thus being the focus of numerous ongoing studies. The molecular heterogeneity of the normal breast tissue has been previously documented and has outlined the different molecular profiles of epithelial and non-epithelial cells responsible for the existence of several molecular types of breast carcinomas, already characterized . Starting from the histopathological classification up to the molecular classification, breast cancer has been constantly redefined in order to ensure a better management of the patient. In 2012 Boyle et al. stated that the minimal characterization of breast cancer was a situation that had lasted for a century, until a quiet revolution has taken place so that in modern times breast cancer is characterized by its molecular and clinical heterogeneity .

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