Breast Cancer Metastasis

Definition

If the primary and adjunctive therapies are not totally effective in eradicating all disease, breast cancer can return and spread to other parts of the body. The unpredicted growth may occur within the first few years of the original breast cancer diagnosis or years later.

Different cancers seem to have an affinity for different parts of the body, and breast cancer cells, although they can go anywhere, seem especially drawn to the liver, lungs, and bones. Staging tests are done on these three areas and the lymph nodes are examined to decide if there is microscopic spread.

Surgery can only take care of the large cancer in the breast itself - if only one cell has left the breast and is sitting, alone, somewhere else in the body, untouched by the immune system, the most extensive mastectomy will not keep the cancer from returning. That cell will multiply and the cancer will grow.

Radiation also is a local treatment and will clean up cells around the area that has been operated on but does not get any cells that have left that area. A systemic treatment is therefore needed and the choice is either chemotherapy or hormone therapy.

Treatment

The goal of treatment is to control the cancer so that the patient is able to live comfortably. Although a cure is not usually possible, once a recurrence is found, treatment can permit a good quality of life for many years. Breast cancer, unlike many other forms of metastatic cancer, can be well controlled for long periods of time with the use of medications or surgical techniques.

Chemotherapy and/or hormonal therapy are the principal treatments. Tumor shrinkage is common in about 60 percent of patients, although only in 10 to 20 percent does the tumor completely disappear for a long time.

If the metastatic disease is not immediately life threatening or does not involve such critical internal organs as the liver, hormonal management is usually tried before starting chemotherapy. This may involve tamoxifen or removal of the ovaries for premenopausal patients, and progestins, androgens, Cytadren, estrogens or tamoxifen for postmenopausal patients. Hormonal manipulation may be especially useful for those with predominantly bone metastases.

If metastases involve vital organs or are life threatening, chemotherapy combinations similar to those used in earlier stages are given. The five-year survival rate for Stage IV breast cancer is 10 percent.

Questions to Ask Your Doctor

Is there evidence of metastasis?

Which organ is involved?

Is systemic treatment indicated?

Would hormonal therapy be beneficial?

Do you recommend use of tamoxifen?

Will chemotherapy be necessary?