Metastases
In advanced stages of breast cancer disease, tumor metastases can spread to other organs, for example to the bones. Individual breast cancer cells migrate via the blood or lymph stream to other tissues or organs. So far, it has not been useful to search for these individual cells using sophisticated methods, as many of them perish as a result of adjuvant hormone or chemotherapy.
Nevertheless, some of these breast cancer cells may sooner or later grow into metastases, most frequently: these metastases can still be detected decades after an initially successful treatment of breast cancer. Currently, it is not always possible to achieve a permanent cure when metastases occur in breast cancer. The current treatment goal is to control the disease for as long as possible, to relieve symptoms and to maintain the quality of life of the affected persons.
Depending on where metastases have formed, the course of the disease can vary greatly. A number of factors play a role in the treatment, such as biological tumour characteristics, age, hormonal situation, general state of health and the wishes of those affected. First and foremost, drugs are considered in the treatment of metastases, as they act systemically (affecting the whole body).
Hormone and chemotherapies are available, and in the case of bone metastases also bisphosphonates. In some cases, metastases can also be operated or irradiated. .
- In the bones
- Of the lung
- The lymph node above the collarbone
- Of the liver
- The skin or
- In the brain
Bone metastases in breast cancer are most frequently found in the spine, the pelvis or in the long tubular bones, such as the femur. They can be manifested by pain in that area or by sudden fractures without trauma. Bone metastases are either stabilized by surgery or they can also be irradiated.
Irradiation can both restore the stability of the bone substance and relieve pain. Which treatment method is used must always be decided on in each individual case. Metastases in the liver are not untypical for advanced breast cancer and often occur within the first three years after initial findings.
Typical symptoms can be a yellowing of the skin or a palpable enlargement of the liver. As long as they can be localized and have not yet grown around larger vessels, they can be operated and removed. It is important that the metastases are removed in their entirety and that no remains are left.
Metastases in the brain can manifest themselves in the form of paralysis, other failures or changes in nature. This depends very much on how large the metastasis is and where in the brain it is located. If there is only a single metastasis, one would try to remove it with an operation and then irradiate the region.
From two metastases onwards, whole brain radiation is considered. In addition to this specific therapy, systemic treatment with chemo-, immuno- and hormone therapy should also be considered. An infestation of lymph nodes generally means that tumour cells have accumulated in the lymph nodes.
It also means that it is no longer a local tumour growth, but that the tumour has already reached a systemic spread. The tumour cells are transported to the next lymph nodes via the lymph drainage system of the breast. In the case of the breast, these are the lymph nodes of the armpit.
Lymph node involvement also plays an important prognostic role in breast cancer. It depends on whether lymph nodes are affected and how many. Lymph node involvement also has an effect on therapy.
If one suspects that the sentinel lymph nodes are affected before the operation, they must be removed and pathologically examined during the operation. The sentinel lymph nodes are the lymph nodes that are affected first when the tumour spreads. If the sentinel lymph nodes are not affected by tumour cells, the remaining lymph nodes can remain in the body. In case of an infestation, at least 10 lymph nodes are removed from the armpit.
