Breast Cancer Metastasis in Women

What is breast cancer metastasis?

When cells in the body grow out of control, it is called cancer. A growth of cancer cells is called a tumor. Breast cancer is metastatic when the cancer spreads beyond the tumor in the breast and the lymph nodes in the nearby armpit. This happens when cells shed by the tumor spread (or metastasize) to other parts of the body through the bloodstream or lymph system.

After the cancer spreads, it can form new tumors in other parts of the body. These tumors are called metastases. As the cancer spreads through the blood, it most commonly travels to the bones of the pelvis, spine, upper arms and legs, ribs, and skull. Metastases are also commonly found in the liver, lungs, and brain.

Metastases happen most often within 3 years after initial treatment for breast cancer, but they can occur many years, even decades, later.

How does breast cancer occur?

Cancers are uncontrolled growths of abnormal cells. It is not known why they occur. Any woman can get breast cancer, but some women are more likely to develop it than others. You have a greater risk of breast cancer if:

• You have a mother, sister, or daughter who has had breast cancer.
• You or a parent, sister, brother, son, or daughter has changes in the genes called BRCA1 and BRCA2. Blood tests usually show these gene abnormalities in families with many women who have had breast or ovarian cancer.
• You have had breast cancer before.
• You had your first menstrual period before age 13.
• Your menopause (when you stopped having periods) was after the age of 55.
• You are over age 50. (Four out of five breast cancers occur in women over age 50.)
• You never gave birth to a child or you had your first child after age 30.
• You did not breast-feed.
• You had radiation therapy to the chest (including your breasts) before age 30.
• You have taken hormone therapy with estrogen or progesterone after menopause.
• You are overweight after going through menopause.
• You are physically inactive.

What are the symptoms?

The most common symptom of breast cancer is a painless lump in the breast. The symptoms of metastases depend on where the cancer has spread. Bone metastases usually cause bone pain. An enlarged liver found during a physical exam often indicates spread to the liver. Tumors in the lungs may cause a cough or shortness of breath. Tumors in the brain may cause headache, blurred vision, poor balance, or weakness on one side of the body.

How is it diagnosed?

A physical exam and tests may show tumors growing in other parts of your body. Tests usually include:

• blood tests to check your liver
• a chest X-ray
• a bone scan to look for signs of cancer spreading to the bones
• a CT scan (computed tomography) of your liver or chest
• a CT or MRI (magnetic resonance imaging) of your brain.

How is it treated?

The treatment for breast cancer depends on the size of the tumor and how much it has spread. Almost always surgery is done to remove the tumor or all or part of the breast. Some lymph nodes in the armpit area will also be removed.

For breast cancer that has spread, treatment may include radiation, chemotherapy, or hormone therapy. You may have just one type of treatment or a combination of treatments. These treatments are not expected to cure the metastatic cancer, but they do help to slow down growth of tumors or decrease their size so that symptoms lessen or go away.

• Radiation is given to a specific part of the body, usually a bone or the brain, to kill the cancer cells and shrink tumors. This will decrease or get rid of the pain or brain symptoms. When a tumor is in the bone, radiation therapy will decrease the risk of bone fracture.
• During chemotherapy anticancer drugs are given, usually through your veins (IV), to kill cancer cells. Sometimes just pills are used, or the treatment may include both pills and IV drugs.
• For hormone therapy, you are given medicine (pills) that stops hormones in your body from helping tumors grow. Tamoxifen and Arimidex are the drugs most often used for this treatment.

Sometimes biological therapy, such as the drugs trastuzumab (Herceptin, given IV) or lapatinib (Tykerb, taken as pills), is used for treatment. Biological therapy can help your immune system fight the cancer.

You will probably take medicine to relieve your pain. Even severe pain can be controlled with a combination of medicines that usually includes narcotics. People taking narcotics to control pain do not become drug addicts. As radiation or chemotherapy treatment relieves the pain, the need for pain medicine will lessen and can even go away.

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 and how sensitive the cancer is to various drugs. Treatment of metastases can sometimes give years of further good control of the cancer.

How can I take care of myself?

• Rest often and follow the treatment plan that your healthcare provider gives you.
• Ask your healthcare provider for an exercise prescription to follow when you have finished your treatments.
• Consult with a dietitian to improve your diet to heal tissue after treatment and to fight the cancer.
• Join a breast cancer support group.
• Ask your healthcare provider any questions you have about the course of the disease, treatments, side effects of the treatments, support groups, and anything else that concerns you.
• Spend time with the people and activities you most enjoy.
• Ask your provider about alternative methods of pain control, such as relaxation techniques, guided imagery, and hypnosis.
• For more information, contact:

  American Cancer Society, Inc.
  Phone: 800-ACS-2345 (800-227-2345)
  Web site: http://www.cancer.org

  National Cancer Institute
  Phone: 1-800-4CANCER, or 1-800-422-6237 (TTY: 1-800-332-8615)
  Web site: http://www.cancer.gov

How can I help prevent the spread of breast cancer?

Because the chance for cure and control depend on finding the cancer early and treating it before it spreads too far, it is important to:

• Do frequent, usually monthly, breast self-exams.
• Tell your healthcare provider about any new sign or symptom you have.
• Some women who take the anti-estrogen pill, tamoxifen, as a precaution for 5 years after their breast cancer is discovered may benefit later from also taking another anti-hormone drug, letrozole (Femara).