Almost every other woman out there who has undergone strenuous treatment for breast cancer would have a fear of the cancer recurring and spreading to other parts of her body. And rightly so! Nearly 10% of all breast cancer cases fall into a category called ‘metastatic’ which indicates the rapid movement of the cancer cells from the point of origin (the breast) to different areas of the body (mostly the vital organs).
A metastatic breast cancer is used to describe a form of breast cancer that has already spread from the breast to distant organs within the body at the time of diagnosis. The condition is said to be the most advanced stage of breast cancer (Stage IV) in women and accounts for more than 90% of deaths caused by the disease.
Characteristics of Metastatic Breast Cancer
Metastatic breast cancer would usually affect a woman a few years after she has been diagnosed with primary breast cancer. It is also possible for the condition to manifest after successful initial treatment for primary breast cancer.
Metastatic breast cancer cells are usually more resistive to traditional treatments and medications that are used to treat primary breast cancer. Metastatic cancer cells are less receptive to treatments and possess specific properties that help them spread to distant organs (and other parts of the body) rapidly.
Different Types of Metastatic Breast Cancer
Metastatic Breast Cancer that usually occurs as a recurrence of primary breast cancer can be divided into three types based on the extent of infection. These include local, regional and distant recurrences.
Local and regional metastatic breast cancers refer to primary breast cancer recurrences that occur close to the original site of the tumor. They can be detected easily via mammograms, ultrasounds or T scans, and are not considered to be serious.
Distant metastatic breast cancer however refers to primary breast cancer recurrences that occur far away from the original site of the Distant metastatic breast cancer, however, refers to primary breast cancer recurrences that occur far away from the original site of the tumor. In this case, it would be hard to detect the exact position of the tumors within the body. A distant recurrence would be considered more serious to handle and treat, with the fatality rate being high for this type of recurrence.
A metastatic breast cancer can also be classified based on the area of its occurrence outside the original site. Accordingly, lung metastases occur if the cancer cells have spread to the lungs. Liver metastases occur if the cancer cells spread to the stomach and abdominal regions. Neurological metastases occur if the cells spread to the brain. And bone metastases occur if the cancer cells spread to the bone marrow.
Symptoms of Metastatic Breast Cancer
The symptoms of metastatic breast cancer start showing up only when the disease has reached its final stage. Certain symptoms that occur beforehand are usually ignored or mistaken for other conditions.
The following symptoms may not necessarily indicate the recurrence of a primary breast cancer, but can potentially indicate that all is not well. These include respiratory issues (lung metastases), loss of appetite (liver metastases), sudden weight loss (liver metastases), gastrointestinal disorders, fever, bone marrow pain (bone marrow metastases) and headaches, disorientation and other kinds of neurological problems (neurological metastases).
Complications Caused by Metastatic Breast Cancer
Distant metastases are usually very serious conditions and can occur in any area of the body including the bones, lungs, liver, brain, spinal cord, ovaries and eyes etc. The highest frequency of occurrences is noted in the bones, lungs and liver though.
In this case, the cancer cells spread to the bone marrow and quickly affect areas like the spine, skull, pelvis, ribs, arms and legs. Bone metastases are classified into two categories; osteoblastic metastases and osteolytic metastases.
While osteoblastic metastases cause bone fractures (surprisingly, they increase the mineral density of the bones), oesteolytic metastases would form holes in the bones (usually in the legs, pelvis or hips) and reduce bone density.
In addition to causing immense discomfort and pain, both types of bone metastases cause other complications like hypercalcemia, surgical issues (for fractures) and spinal cord compression etc.
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Lung metastases account for more than 70% of deaths related to metastatic breast cancer. The condition is characterized by the metastasization of the cancer cells throughout the lungs. Lung metastases usually cause severe respiratory issues in individuals.
If the cancer is detected in only a small portion of the lung, it is treated by surgically removing the affected area while leaving the rest of the lungs untouched. Cases where the cancer spreads throughout the lungs need to be treated more extensively with anti cancer drugs and chemotherapy though.
A primary breast cancer recurrence can metastasize to the liver, causing liver metastases. In most cases, liver metastases would be diagnosed via liver blood tests and a liver biopsy. Common complications of liver metastases include weight loss, fever, gastrointestinal disorders and loss of appetite etc.
Diagnosis of Metastatic Breast Cancer
If a routine mammogram or ultrasound reveals a suspicious looking lump at the site of the original tumor or nearby, the doctor would recommend a list of tests to be taken to check if the cancer has spread to distant organs, including blood tests, bone marrow scans, MRI scans, CAT scans and chest X-rays.
Treatment of Metastatic Breast Cancer
Treatment of metastatic breast cancer would depend mainly on the extent of metastasization. Local and regional metastases can be treated using traditional methods of breast cancer treatment, including either a lumpectomy or a mastectomy (the latter is more preferable).
Distant metastases, however, need to be treated extensively. Complete recovery would be considered impossible owing to the fact that the cancer would have already spread to the vital organs within the body at the time of diagnosis. Therefore, the focus would be primarily on easing the symptoms of the condition and trying to extend the patient’s lifetime by a few years.
Standard Treatments for Distant Metastases
The specific therapy used for the treatment would depend on the patient’s health condition and response to different treatments.
Radiation therapy is usually used to treat distant metastases that are small in number (maybe one or two tumors within an organ). The treatment aims at reducing the size of the cancerous cells and provides relief from the pain caused by the condition.
Chemotherapies are usually opted for advanced stages of distant metastases. Usually administered via anti cancer drugs, these sessions are given daily, weekly or even monthly for a period of 6-8 months. The sessions would have frequent rest cycles in between to help the body regenerate healthy cells (chemotherapy would destroy healthy cells in addition to the cancerous ones).
A person with distant metastases can also be treated with drug therapies that include drugs like Aromasin, Tamoxifen, Herceptin, Taxol and biphosphonates. For instance Biphosphonates are a class of drugs that are used to treat bone metastases. Some of the drugs in this category include Fosamax, Skelid, Zometa, Didronel and cloronate etc.
Aredia is another commonly prescribed drug to treat Stage IV metastatic breast cancer in women. The drug is usually used in conjunction with chemotherapy and is administered intravenously during treatment.