metastatic breast cancer

Recurrent and Metastatic Breast Cancer

We know you really don't want to be here, reading about breast cancer recurrence or metastasis. If you've had breast cancer, the possibility of recurrence and spread (metastasis) of breast cancer stays with you. You may be here because you fear this possibility. Or you may be here because it's already happened.

Keep in mind that a recurrence of breast cancer or metastatic (advanced) disease is NOT hopeless. Many women continue to live long, productive lives with breast cancer in this stage. It is also likely that your experience with treatment this time will be somewhat different from last time. There are so many options for your care and so many ways to chart your progress as you move through diagnosis, treatment, and beyond.

Because there are so many options, this is a long section. You may want to read just a few pages at a time. You might find it very difficult to concentrate, think straight, and remember what you've read. That's natural when you're anxious, uncertain, overwhelmed. We'll do our best to help you find what you're looking for.

If you're already feeling stuck in the fear and you need to deal with that first, here are a few places to try right away:

· Start with the TALK BACK TO FEAR button, to find some comfort as well as logical answers for your fears.

· Then read about coping with fear of recurrence · Also visit the discussion boards and chat rooms, where other women who've been there are ready to reach out and help you get through the whole experience.

breast cancer bracelet

IBC typically cannot be identified through:

Mammogram – Because IBC usually does not occur in the form of a lump (the cancer is spread throughout breast tissue), it is difficult to detect with a mammogram. The most characteristic mammography findings consist of swelling of the skin.

Ultrasound – This test confirms the swelling (edema) of the skin and can better identify breast nodules (if present). It also is the most appropriate test for the evaluation of lymph nodes.

Magnetic Resonance Imaging (MRI) – This is probably the most sensitive test because it includes a functional description of the abnormal findings. It should be included among the diagnostic tests once the pathological diagnosis is confirmed. It is extremely useful in evaluating the clinical response to chemotherapy.

Core biopsy – Typically, fine-needle aspiration or a core biopsy (removal of tissue with a needle) is performed to obtain a pathological diagnosis of invasive disease, but these diagnostic procedures are not appropriate for IBC because of the peculiar growth pattern in the breast lymphatic system.



What diagnostic tests identify IBC?

Surgical biopsy – Most of the time a skin biopsy or a surgical biopsy is necessary. These procedures are able to collect larger samples that include the skin and underlying tissue with higher chances to identify the cancer cells.

PET Scan – In the near future, this could be one of the most important diagnostic/staging tests for IBC, though it still is under study. We have found that with the PET scan we can see more disease.



We can see lymph nodes far from the breast, which tells us we have a metastatic cancer already at the time of diagnosis. If we limit staging to mammogram, CT (computed tomography – computerized X-rays) and bone scans we may miss different components of this inflammatory spreading, which may have significant consequences in the way we treat the cancer and the way we process patients.



What is the survival rate for IBC?

The five-year median survival rate for inflammatory breast cancer is approximately 40%. The main reasons for such a disappointing outcome are multiple and include: a delay in diagnosis, the lack of expertise in treating IBC because it is so rare and the relative resistance the disease has to standard chemotherapeutic agents.



With regard to the first critical issue, it is important to keep in mind that IBC is a fast-growing cancer (it can spread within weeks), and it is often mistaken for something other than breast cancer, such as a rash or infection.

breast cancer site

Every year at this time, cancer doctors and researchers gather at the annual Breast Cancer Symposium in San Antonio, Texas, to hear the latest news in the field.

This year we heard surprising news from investigators at M.D. Anderson: there was an overall 7 percent relative decline in diagnosed cases of breast cancer between 2002 and 2003. The number of breast cancer cases had increased in the 20 years before 2002.

The steepest decline - 12 percent - occurred in women between ages 50 and 69 diagnosed with estrogen receptor positive (ER-positive) breast cancer. ER-positive breast cancer depends on hormones for tumor growth. One reason for the decline, according to the researchers, may be the 2002 announcement that hormone replacement therapy (HRT) is a major contributor to breast cancer growth. The announcement led thousands of women to stop taking these drugs.

Although the researchers aren't 100 percent sure that stopping HRT is the only reason for the decline, Peter Ravin, Ph.D., the study's senior investigator, says "it makes perfect sense" if you consider that use of HRT may be an important contributing factor to breast cancer development. "Research has shown that ER-positive tumors will stop growing if they are deprived of the hormones, so it is possible that a significant decrease in breast cancer can be seen if so many women stopped using HRT," he says.

We want everyone to help us raise funds for breast cancer research.

There are many ways you can get involved, whether you fundraise for us by organising your own activity or buy merchandise.

Register your interest now to find out about our sponsored walks taking place across the UK this Autumn.

Together we will beat cancer.

ABOUT THE BREAST CANCER SITE

Your click on the "Fund Free Mammograms" button helps fund free mammograms, paid for by site sponsors whose ads appear after you click and provided to women in need through the efforts of the National Breast Cancer Foundation to low-income, inner-city and minority women, whose awareness of breast cancer and opportunity for help is often limited.

EARLY DETECTION: DO YOU KNOW THE FACTS?

This year in America, more than 211,000 women will be diagnosed with breast cancer and 43,300 will die. One woman in eight either has or will develop breast cancer in her lifetime. In addition, 1,600 men will be diagnosed with breast cancer and 400 will die this year. If detected early, the five-year survival rate exceeds 95%. Mammograms are among the best early detection methods, yet 13 million U.S. women 40 years of age or older have never had a mammogram.

sign of breast cancer

Breast cancer is the most common malignancy in women and the second leading cause of cancer death (exceeded by lung cancer in 1985). Breast cancer is three times more common than all gynecologic malignancies put together. The incidence of breast cancer has been increasing steadily from an incidence of 1:20 in 1960 to 1:7 women today.

The American Cancer Society estimates that 211,000 new cases of invasive breast cancer will be diagnosed this year and 43,300 patients will die from the disease. Breast cancer is truly an epidemic among women and we don't know why.

Breast cancer is not exclusively a disease of women. For every 100 women with breast cancer, 1 male will develop the disease. The American Cancer society estimates that 1,600 men will develop the disease this year. The evaluation of men with breast masses is similar to that in women, including mammography.

The incidence of breast cancer is very low in the twenties (age) gradually increases and plateaus at the age of forty-five and increases dramatically after fifty. Fifty percent of breast cancer is diagnosed in women over sixty-five indicating the ongoing necessity of yearly screening throughout a woman's life.

Breast cancer is considered a heterogenous disease, meaning that it is a different disease in different women, a different disease in different age groups and has different cell populations within the tumor itself. Generally, breast cancer is a much more aggressive disease in younger women. Autopsy studies show that 2% of the population has undiagnosed breast cancer at the time of death. Older women typically have much less aggressive disease than younger women.

breast cancer awareness

About National Breast Cancer Awareness Month

National Breast Cancer Awareness Month (NBCAM) is dedicated to increasing awareness of breast cancer issues, especially the importance of early detection. It works through a nationwide education campaign aimed at the general public, state and federal governments, health care professionals, employers, and women of all ages and ethnic groups.

Breast Cancer Care's press pack for Breast Cancer Awareness Month, October 2006, is available to download from the foot of this page.

Evelyn Lauder

In 1993 Evelyn Lauder introduced Breast Cancer Awareness Month across the world. Since then October has been awash with pink ribbons, now a global symbol for breast cancer awareness.

Breast Cancer Care was the first breast cancer charity in the UK to get involved in Breast Cancer Awareness Month and through it has helped bring the subject of breast cancer to the forefront of people's minds and to the top of the health agenda in this country.

Supporting

Breast Cancer Care uses Breast Cancer Awareness Month as an opportunity to make people aware of the ways in which it helps those affected by breast cancer.

The charity also focuses a lot of its key fundraising activities around the month including events, corporate partnerships and the sale of pink-themed merchandise, including the pink ribbon pin badge.

Campaigning

Breast Cancer Awareness Month also provides a platform for Breast Cancer Care to push for better treatment and support for people affected by breast cancer through its high-profile Government-lobbying campaigns such as 80over50 (2003) and Same Difference (2005).

Fundraising

Breast Cancer Awareness Month sees a hive of activity from Breast Cancer Care's corporate supporters with many pink products on sale to raise money for the charity.

Long-standing partners include ASDA, with its highly successful Tickled Pink campaign and Boots which not only raises money but awareness through its Be Up Front campaign.

The charity is also lucky enough to have support from high profile brands including QVC, Dorothy Perkins, Swarovski and Interflora among others.

What are the "stages" of breast cancer

STAGE 0 (carcinoma in situ) is sometimes called noninvasive carcinoma or carcinoma in situ.

Lobular carcinoma in situ (LCIS) refers to abnormal cells in the lining of a lobule. These abnormal cells seldom become invasive cancer. However, their presence is a sign that a woman has an increased risk of developing breast cancer. This risk of cancer is increased for both breasts. Some women with LCIS may take a drug called tamoxifen, which can reduce the risk of developing breast cancer. Others may take part in studies of other promising new preventive treatments. Some women may choose not to have treatment, but to return to the doctor regularly for checkups. And, occasionally, women with LCIS may decide to have surgery to remove both breasts to try to prevent cancer from developing. (In most cases, removal of underarm lymph nodes is not necessary.)

carcinoma in situ (DCIS) refers to abnormal cells in the lining of a duct. DCIS is also called intraductal carcinoma. The abnormal cells have not spread beyond the duct to invade the surrounding breast tissue. However, women with DCIS are at an increased risk of getting invasive breast cancer. Some women with DCIS have breast-sparing surgery followed by radiation therapy. Or they may choose to have a mastectomy, with or without breast reconstruction (plastic surgery) to rebuild the breast. Underarm lymph nodes are not usually removed. Also, women with DCIS may want to talk with their doctor about tamoxifen to reduce the risk of developing invasive breast cancer.

Women who have stage IV breast cancer receive chemotherapy and/or hormonal therapy to destroy cancer cells and control the disease. They may have surgery or radiation therapy to control the cancer in the breast. Radiation may also be useful to control tumors in other parts of the body.

Inflammatory Breast Cancer

1. What is inflammatory breast cancer (IBC)?

Inflammatory breast cancer is a rare but very aggressive type of breast cancer in which the cancer cells block the lymph vessels in the skin of the breast. This type of breast cancer is called “inflammatory” because the breast often looks swollen and red, or “inflamed.” IBC accounts for 1 to 5 percent of all breast cancer cases in the United States. It tends to be diagnosed in younger women compared to non-IBC breast cancer. It occurs more frequently and at a younger age in African Americans than in Whites. Like other types of breast cancer, IBC can occur in men, but usually at an older age than in women. Some studies have shown an association between family history of breast cancer and IBC, but more studies are needed to draw firm conclusions

2.What are the symptoms of IBC?

Symptoms of IBC may include redness, swelling, and warmth in the breast, often without a distinct lump in the breast. The redness and warmth are caused by cancer cells blocking the lymph vessels in the skin. The skin of the breast may also appear pink, reddish purple, or bruised. The skin may also have ridges or appear pitted, like the skin of an orange (called peau d'orange), which is caused by a buildup of fluid and edema (swelling) in the breast. Other symptoms include heaviness, burning, aching, increase in breast size, tenderness, or a nipple that is inverted (facing inward). These symptoms usually develop quickly-over a period of weeks or months. Swollen lymph nodes may also be present under the arm, above the collarbone, or in both places. However, it is important to note that these symptoms may also be signs of other conditions such as infection, injury, or other types of cancer.

2. How is IBC diagnosed?

Diagnosis of IBC is based primarily on the results of a doctor’s clinical examination. Biopsy, mammogram, and breast ultrasound are used to confirm the diagnosis. IBC is classified as either stage IIIB or stage IV breast cancer (2). Stage IIIB breast cancers are locally advanced; stage IV breast cancer is cancer that has spread to other organs. IBC tends to grow rapidly, and the physical appearance of the breast of patients with IBC is different from that of patients with other stage III breast cancers. IBC is an especially aggressive, locally advanced breast cancer.

Cancer staging describes the extent or severity of an individual’s cancer. (More information on staging is available in the National Cancer Institute (NCI) fact sheet Staging: Questions and Answers at on the Internet.) Knowing a cancer’s stage helps the doctor develop a treatment plan and estimate prognosis (the likely outcome or course of the disease; the chance of recovery or recurrence).

Breast Cancer Treatment

With this report, women with breast cancer have access to information on the way breast cancer is treated at the nation’s leading cancer centers. Originally developed for cancer specialists by the National Comprehensive Cancer Network (NCCN), these treatment guidelines have now been translated for the public by the American Cancer Society.

Since 1995, doctors have looked to the NCCN for guidance on the highest quality, most effective advice on treating cancer. For more than 90 years, the public has relied on the American Cancer Society for information about cancer. The Society’s books and brochures provide comprehensive, current, and understandable information to hundreds of thousands of patients, their families and friends. This collaboration between the NCCN and ACS provides an authoritative and understandable source of cancer treatment information for the public. These patient guidelines will help you better understand your cancer treatment and your doctor’s counsel. We urge you to discuss them with your doctor. To make the best possible use of this information, you might begin by asking your doctor the following questions:

How large is my cancer? Do I have more than one tumor in the breast?

What is my cancer’s grade how abnormal the cells appear) and histology (type and arrangement of tumor cells) as seen under a microscope?

Do I have any lymph nodes with cancer (positive lymph nodes, i.e. nodal status)? If yes, how many?

What is the stage of my cancer?

Does my cancer contain hormone receptors? What does this mean for me?

Is my cancer positive for HER-2? What does this mean for me?

Is breast-conserving treatment an option for me?

In addition to surgery, what other treatment do you recommend? Radiation? Chemotherapy? Hormone therapy?

What are the side effects?

Are there any clinical trials that I should consider?

Inside Breast Tissue

The main parts of the female breast are lobules (milk-producing glands), ducts (milk passages that connect the lobules and the nipple), and stroma (fatty tissue and ligaments surrounding the ducts and lobules, blood vessels, and lymphatic vessels). Lymphatic vessels are similar to veins but carry lymph instead of blood. Most breast cancer begins in the ducts (ductal), some in the lobules (lobular), and the rest in other breast tissues.

Lymph is a clear fluid that has tissue waste products and immune system cells. Most lymphatic vessels of the breast lead to underarm (axillary) lymph nodes. Some lead to lymph nodes above the collarbone (called supraclavicular) and others to internal mammary nodes which are next to the breastbone (or sternum). Cancer cells may enter lymph vessels and spread along these vessels to reach lymph nodes. Cancer cells may also enter blood vessels and spread through the bloodstream to other parts of the body.

Lymph nodes are small, bean shaped collections of immune system cells important in fighting infections. When breast cancer cells reach the axillary lymph nodes, they can continue to grow, often causing swelling of the lymph nodes in the armpit or elsewhere.If breast cancer cells have spread to the axillary lymph nodes, it makes it more likely that they have spread to other organs of the body as well.

Breast Cancer Symptom

There is no right way for a person to deal with a diagnosis of cancer. In this section, we simply hope to share options and coping skills with you that have worked for others.

As you go through the process of diagnosis, treatment, and follow-up care, you’ll likely experience side effects from the treatment. It’s different for everyone. Some drugs cause nausea or hair loss. You may feel physical symptoms, such as pain or fatigue. Your feelings and emotional coping skills may be challenged by the trauma of facing a serious, sometimes life threatening illness. If you are a spiritual person, you may find your faith tested.

These many kinds of distress are common among people who are going through what you are going through. Because they are common, your healthcare team can offer you choices for managing them in ways that suit your personality and lifestyle. Ask for advice on ways to cope with side effects.

Other sections of this Guide address the type of help available to you from support groups, complementary therapy, and your spiritual advisors. This section reviews some ways to find relief from some of the physical symptoms you may experience.

Whenever a symptom comes up that concerns you, no matter how insignificant that symptom might seem, talk with your doctor or nurse about it. Don’t wait until the symptom feels almost unbearable. The sooner you let someone know what is bothering you, the sooner you will be offered ideas about ways of managing it.

Many breast cancers are detected by mammography before any symptoms are noticed.

Other signs include breast lumps (although most of these are benign), change in size or shape of the breast, dimpling of breast skin, nipple inversion, change in the nipple, swelling or lump in the armpit and very rarely a blood-stained discharge from the nipple or rash around the nipple.

A recent meta-analysis concluded that breast self examination is not an effective method of reducing breast cancer mortality. The NHS recommends that all women are 'breast aware': know what is normal for them and what signs of disease to look for , and that women aged 50 or over attend for breast screening.

Treatment guidelines have been published to improve and standardise the treatment of breast cancer in the UK. 3-7

Surgery and radiotherapy are used to control local disease, and systemic treatments (chemotherapy and /or hormonal therapy) to combat frank or occult metastatic disease.

Systemic treatments may also be administered up front as a primary treatment to reduce the size of the tumour prior to surgery. Nearly all patients, whatever the stage of their disease, have some form of surgery. Other tests are carried out to assess the extent of the disease.

breast cancer

Definition of breast cancer: Cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.

Breast cancer is cancer arising in breast tissue. Cancer is simply a group of abnormal cells that have abnormal growth patterns.

● Although breast cancer is primarily a disease of women, about 1% of breast cancers occur in men.

Breast cancer is the most common type of cancer in women and is the second leading cause of death by cancer in women, following only lung cancer

● In 2005, the American Cancer Society estimated that 212,930 new cases of breast cancer would be diagnosed in the United States.

● The incidence of breast cancer has been gradually increasing, averaging a 0.5% increase per year from 1987-2001. Death rates, on the other hand, have been gradually declining.

The breasts are made of fat, glands, and connective (fibrous) tissue. The breast has several lobes, which are divided into lobules and end in the milk glands. Tiny ducts run from the many tiny glands, connect together, and end in the nipple.

● These ducts are where 80% of breast cancers occur. This condition is called infiltrating ductal cancer.

● Cancer developing in the lobules is termed infiltrating lobular cancer. About 10-15% of breast cancers are of this type.

● Other types of breast cancer include inflammatory breast cancer and cancer involving the nipple, which is termed Paget's disease.

EARLY DETECTION: DO YOU KNOW THE FACTS?

This year in America, more than 211,000 women will be diagnosed with breast cancer and 43,300 will die. One woman in eight either has or will develop breast cancer in her lifetime. In addition, 1,600 men will be diagnosed with breast cancer and 400 will die this year. If detected early, the five-year survival rate exceeds 95%. Mammograms are among the best early detection methods, yet 13 million U.S. women 40 years of age or older have never had a mammogram.

Kinds of Treatment Of Breast Cancer

Breast cancer is treated in several ways. It depends on the kind of breast cancer and how far it has spread. Treatments include surgery, chemotherapy, hormonal therapy, biologic therapy, and radiation. People with breast cancer often get more than one kind of treatment.

• Surgery. An operation where doctors cut out and remove cancer tissue.


• Chemotherapy. Using special medicines, or drugs to shrink or kill the cancer. The drugs can be pills you take or medicines given through an intravenous (IV) tube, or, sometimes, both.


• Hormonal therapy. Some cancers need certain hormones to grow. Hormonal treatment is used to block cancer cells from getting the hormones they need to grow.


• Biological therapy. This treatment works with your body's immune system to help it fight cancer or to control side effects from other cancer treatments. Side effects are how your body reacts to drugs or other treatments. Biological therapy is different from chemotherapy, which attacks cancer cells directly.


• Radiation. The use of high-energy rays (similar to X-rays) to kill the cancer cells. The rays are aimed at the part of the body where the cancer is located.

It is common for doctors from different specialties to work together in treating breast cancer. Surgeons are doctors that perform operations. Medical oncologists are doctors that treat cancers with medicines. Radiation oncologists are doctors that treat cancers with radiation.

Fast Facts Of Breast Cancer

Not counting some kinds of skin cancer, breast cancer in the United States is

• The most common cancer in women, no matter your race or ethnicity.


• The most common cause of death from cancer among Hispanic women.


• The second most common cause of death from cancer among white, black, Asian/Pacific Islander, and American Indian/Alaska Native women. ¹

In 2003 (the most recent year numbers are available):

• 181,646 women and 1,826 men developed breast cancer.


• 41,619 women and 379 men died from breast cancer. sup>1

Can Men Get Breast Cancer?

Men can also get breast cancer. In men, breast cancer can happen at any age, but is most common in men who are between 60 and 70 years old. Male breast cancer is not very common. For every 100 cases of breast cancer, less than 1 are in men.

Breast Cancer Continuing Medical Education Program

CDC has teamed with Medscape™ from WebMD™ to develop an online continuing medical education (CME) program called Follow Up of Abnormal Clinical and Imaging Findings of the Breast: Five Self-Study Modules for Primary Care Clinicians. The five self-directed, interactive training modules are designed to educate clinicians on providing appropriate and timely care to women with early signs of breast cancer, and to train physicians on the latest evidence, protocols, and guidelines around detecting breast cancer.

These modules were developed by CDC's Division of Cancer Prevention and Control (DCPC), endorsed by the American College of Obstetricians and Gynecologists, and acknowledged by the United States Food and Drug Administration. The modules were edited and certified for CME credit by Medscape.

Breast Anatomy, Physiology, and Pathology,
Health History and Clinical Breast Examination,
Workup of Abnormal Clinical Findings,
Follow up of Abnormal Imaging Findings: Biopsy Methods, and
Risk Management.
The format of the modules is designed to promote self-study and to be updated regularly to reflect new clinical research and advances in technology.

Breast cancer is the most common cancer to occur among women in the United States, and 12.3% of all U.S. women are expected to develop this malignancy in their lifetime.¹ This online CME activity will help health professionals better understand different approaches to early breast cancer detection, as well as provide the opportunity to earn CME credits.