What is breast cancer metastasis?

Breast cancer is a cancerous tumor that develops in the breast. This is the most common type of cancer in American women. About one in every eight women develops breast cancer. As tumors grow, they can shed cancerous cells that spread (or metastasize) to other parts of the body through the bloodstream and the lymph system.

When the cancer spreads, it can form new tumors in other parts of the body. These new tumors are called metastases. They are most often found in the lymph nodes (glands) near the breast. If the cancer spreads through the blood, it most commonly travels to the bones of the pelvis, spine, legs, ribs, and skull. Metastases may also be found in the liver, lungs, and brain.

How does the spread occur?

Cancers are uncontrolled growths of abnormal cells. It is not known why they occur. However, some women are more likely to get cancer than others. You are at a greater risk of having breast cancer if:

• you have a close relative, such as a mother, sister, maternal aunt, or maternal grandmother who has or had breast cancer.

• you have never breast-fed a baby or you had your first child after age 30.

• you started your menstrual periods very early or you went through menopause very late.

• you have had a previous breast cancer (in the same or other breast).

Using birth control pills and oral estrogen does not seem to increase the risk of breast cancer.

What are the symptoms?

The first symptom for approximately 80% of the women with breast cancer is a painless lump in the breast. The lump is often difficult to feel. Between 80% and 90% of women find the lump themselves during a breast self-examination. Sometimes the skin over the lump may be dimpled or wrinkled. There may be a discharge from the nipple or the nipple may be pulled inward.

The symptoms of metastases depend on the area of the body in which they are found. Bone metastases are usually accompanied by pain in that area of the body. An enlarged liver found during a physical exam may indicate liver metastases. Lung metastases are usually found on a chest x- ray.

Pain, tenderness, and soreness of the breast without a lump are usually not symptoms of cancer and occur commonly in many women. But all breast symptoms of more than a few days duration need to be evaluated promptly by a physician.

How is it diagnosed?

Your doctor will diagnose metastatic breast cancer by using a number of diagnostic tests in combination with your medical history and a physical exam. These tests may include blood tests to check your liver, a chest x-ray for your lungs, and a total body bone scan to look for signs of cancer spreading to the bones.

Metastases, if they are going to occur, do so most often within the first 3 years after initial treatment for breast cancer. Sometimes they are found at the same time as the primary breast lump.

How is it treated?

The treatment for breast cancer depends on the size of the tumor and how much it has spread. In most cases surgery is done to remove the tumor, all or part of the breast, and the surrounding lymph nodes.

The treatments for metastatic breast cancer include radiation, chemotherapy, and hormone therapies. You may have just one type of treatment or a combination of treatments. These treatments are not expected to cure metastatic cancer, but they do help to slow down growth of the tumor and decrease its size so that the symptoms decrease.

During radiation therapy high doses of radiation are given to a specific part of the body to kill the cells and shrink the tumors. This will decrease the pain. In cases where a tumor is in the bone, radiation therapy will decrease the risk of bone fracture.

During chemotherapy a combination of anticancer drugs are given through your veins to kill the cancer cells.

For hormone therapy, you are given hormones in addition to or instead of other therapy. This treatment is often used for women who are older or who have additional medical problems. Tamoxifen may be used alone or in some cases in combination with chemotherapy. Ongoing studies will show how many years it is beneficial to continue tamoxifen therapy.

Bone marrow or stem cell transplants are usually used only after intensive high-dose chemotherapy. This treatment often has a toxic effect on the bone marrow, namely destroying the bone marrow's ability to make healthy blood cells. When this occurs, a bone marrow or stem cell transplant is necessary for survival.

You will probably take medication to relieve your pain. Even severe pain can be controlled by a combination of medicines that usually includes narcotics. People who are placed on narcotics to control pain do not become drug addicts. As radiation or chemotherapy treatment relieves the pain, the need for pain medication will gradually disappear.

How long will the effects last?

How long you will live after the discovery of metastatic breast cancer varies depending on how widespread the cancer is. Early detection and prompt treatment of spread can sometimes give years of further control of the cancer.

How can I take care of myself?

Rest frequently and follow the treatment plan that your doctor gives you.

Make sure to do breast or chest self-exam and report anything abnormal you find. You should do a breast exam once a month. The best time to do a breast or chest exam is at the end of your period or the first day of the month if you don't have periods.

Ask your doctor for an exercise prescription to follow when you've finished your treatments.

Consult with a dietitian to improve your diet to heal tissue after treatment and to fight further cancer.

Join a breast cancer support group if you haven't already.

Be candid with your family and your doctors about quality of life issues that are important to you. Begin to discuss how you would like to be cared for if you are temporarily or permanently disabled.

Identify those people and activities you most enjoy and enjoy them.