Palliative And Supportive Care
Palliative and supportive care focuses on symptom control and support. Its an extremely important part of the care and treatment for many people living with secondary breast cancer and can significantly improve quality of life for them and their families.
People often associate palliative care with end-of-life treatment. However, many people value having it at any stage of their illness, alongside their medical treatment, to help prevent and relieve symptoms such as pain or fatigue. It can also help with the emotional, social and spiritual effects of secondary breast cancer.
The palliative and support care teams are based in hospitals, hospices and the community. You can be referred by your treatment team, GP or breast care nurse depending on your situation.
Can Breast Cancer Spread To The Kidneys
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Most Common Places It Spreads
It’s still breast cancer, even if it’s in another organ. For example, if breast cancer spreads to your lungs, that doesn’t mean you have lung cancer. Although it can spread to any part of your body, there are certain places it’s most likely to go to, including the lymph nodes, bones, liver, lungs, and brain.
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How Will I Know If My Breast Cancer Spreads
Your doctor will use specific kinds of tests to find out if your cancer has gone to other places in your body. First, your doctor will want to know how youâre feeling. They will ask you about any symptoms youâre having and your overall health. They might also look at the size of your tumor and check your lymph nodes.
After that, the doctor may give you:
Blood tests. They look for signs of anything abnormal thatâs happening in your body. For example, results from a liver function test can let your doctor know that breast cancer may have gone to your liver. High levels of some substances in your blood hint that the cancer has spread to your bones.
Imaging scans. These tests make detailed pictures of the inside of your body. They help your doctor pinpoint any cancer spread. These tests include:
- X-ray
Support For Living With Secondary Breast Cancer
Everyones experience of being diagnosed with secondary breast cancer is different, and people cope in their own way.
For many people, uncertainty can be the hardest part of living with secondary breast cancer.
You may find it helpful to talk to someone else whos had a diagnosis of secondary breast cancer.
- Chat to other people living with secondary breast cancer on our online Forum.
- Meet other women with a secondary diagnosis and get information and support at a Living with Secondary Breast Cancer meet-up.
- Live Chat is a weekly private chat room where you can talk about whatever is on your mind.
You can also call Breast Cancer Nows Helpline free on 0808 800 6000.
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Outlook Once Cancer Has Spread To The Bones
The research on cancer metastasis is rapidly growing. As researchers better understand the mechanisms of bone metastasis, new drugs and other treatments are being developed. These target particular processes in cells involved in how the cancer cells invade and grow in bones.
The use of nanoparticles to deliver drugs is very encouraging. These tiny particles are able to deliver drugs to the bone with minimal toxicity to the person with cancer.
Rapidly treating bone metastasis can lead to a
Laparoscopic Nephrectomy And Robotic
These approaches to the operation are done through several small incisions instead of one large one. If a radical nephrectomy is needed, many doctors and patients now prefer to use these approaches when they can.
Laparoscopic nephrectomy: Special long instruments are inserted through the incisions, each of which is about 1/2-inch long, to remove the kidney. One of the instruments, the laparoscope, is a long tube with a small video camera on the end. This lets the surgeon see inside the abdomen. Usually, one of the incisions has to be made longer in order to remove the kidney .
Robotic-assisted laparoscopic nephrectomy: This approach uses a robotic system to do the laparoscopic surgery remotely. The surgeon sits at a panel near the operating table and controls robotic arms to operate. For the surgeon, the robotic system may allow them to move the instruments more easily and with more precision than during standard laparoscopic surgery. But the most important factor in the success of either type of laparoscopic surgery is the surgeons experience and skill. This is a difficult approach to learn. If you are considering this type of operation, be sure to find a surgeon with a lot of experience.
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Intrahepatic Chemotherapy And Chemoembolisation
Intrahepatic chemotherapy and chemoembolisation involve giving chemotherapy directly into the liver. This is done through a thin tube, called a catheter, into the main blood supply to the liver.
Giving chemotherapy directly into the liver means a higher concentration of the drug can be delivered to the area of cancer.
In chemoembolisation, the chemotherapy is delivered along with an oily liquid or foam which blocks the blood supply to the cancer. The cancer is deprived of oxygen and nutrients, and the chemotherapy stays in the area for longer. The liver continues to be supplied with blood in the normal way.
These treatments may not be routinely available on the NHS but may be offered as part of a clinical trial.
When Can Bone Metastases Occur
Bone metastases may be present when metastatic breast cancer is first diagnosed, or the cancer may spread to the bones at a later time.
The bones are the first site of metastases for almost half of women diagnosed with metastatic breast cancer . For many of these women, the bones will be the only site of metastases .
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Stage Iii Breast Cancer Locally Advanced
A stage 3 breast cancer is sometimes referred to as a locally advanced breast cancer.
Stage III breast cancers are actually a heterogeneous group of cancers but account for about 7% of all initial breast cancer diagnosis.
Basically, a stage III breast cancer is one in which there is:-
- a primary tumor of greater than 5cm in diameter with no apparent metastasis
- OR the tumor is between 2cm and 5cm in diameter with evidence of rather significant metastasis.
Another way of looking at it is that stage III breast cancers either have a large but operable breast tumor . Or sometimes Stage III breast cancers present with a medium-size breast tumor which is more difficult to fully treat and cure with surgery alone.
Treatment Options For Metastatic Breast Cancer
Treatment for metastatic breast cancer often is based on systemic therapies, which use drugs rather than surgery or radiation. Metastases treatments are designed to shrink tumors and slow their growth, help ease symptoms and improve quality of life. Treatment may change, such as when one therapy stops working, or the side effects become too uncomfortable. Rather than having only one treatment, most patients undergo several treatments combined to help fight the cancer.
The four broad categories of drug-based treatments are:
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Osteonecrosis Of The Jaw
In rare cases, with either bisphosphonates or denosumab, a disorder called osteonecrosis of the jaw may occur . To reduce the risk of this disorder, have a dental exam and take care of any dental work before starting treatment with bisphosphonates or denosumab .
Talk with your oncologist before getting any dental work while youre on bone-strengthening therapy.
Renal Cell Carcinoma Metastasis To The Breast: A Rare Presentation
Heba O. E. Ali
1Altnagelvin Area Hospital, WHSC Trust, UK
2Faculty of Medicine, Cairo University, Egypt
Abstract
Worldwide breast malignancy is the most common cancer in women however, metastases to the breast from extramammary malignancies are very rare and only a few sporadic cases are reported in the international literature. In this article, the authors report a case of a 73-year-old woman, who underwent nephrectomy for clear cell renal cell carcinoma and 3 years later presented with a breast metastasis from renal cell carcinoma .
1. Introduction
Globally, renal cell carcinoma accounts for 2% of all neoplasms in adults. In 2019, 74,000 new cases of renal carcinoma were diagnosed according to the surveillance, epidemiology, and end results statistics report accounting for 4.2%double universal averageof all cancer diagnoses .
We present a rare case of primary renal carcinoma metastasis to the breast 3 years after nephrectomy. This is the first case to be reported from Northern Ireland.
2. Case Report
| Haemoglobin estimation | |
| Red blood cell count | 3.64 |
| Mean corpusc. Hb. conc. | 313 |
| Red blood cell distribution width | 16.3 |
She had evidence of a small volume of metastatic disease in her preoperative imaging. Follow-up every 3 months was scheduled interval scans in between guided by the clinical examination were done.
3. Discussion
Ethical Approval
This article follows the ethical guidelines in accordance with the Declaration of Helsinki .
Conflicts of Interest
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Receptors For Secondary Breast Cancer
Breast cancer cells may have receptors . Hormones, or a protein called HER2, can attach to the receptors and encourage the cells to grow. A doctor called a pathologist tests cancer cells taken during a biopsy or surgery for these receptors. Your doctor uses the results of these tests to help plan your treatment.
If you have had primary breast cancer before, the receptors may not be the same as when you were first diagnosed. This may mean different treatments are useful. Your doctor may be able to diagnose a secondary cancer from your scan results. But they may still recommend a biopsy to find out more about the cancer cell receptors.Cancer that does not have receptors for either hormones or HER2 is called triple negative breast cancer.
Poor Appetite And Weight Loss
Sometimes people with secondary breast cancer cannot eat as much as usual. This means they may have difficulty maintaining their weight as well as providing the body with energy.
Poor appetite can be due to the effects of the cancer, treatment or anxiety. You might find it easier to eat little and often instead of having set meals. If you still feel youre not eating enough, or are losing weight, talk to your doctor or nurse about dietary supplements or ask to speak to a dietician for specialist advice. In some circumstances you may be prescribed medication to help stimulate your appetite.
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Stages Of Breast Cancer: Stage Iiic
Stage IIIc breast cancers basically involve tumors of any size with significant metastases to:-
- the lymph nodes behind the sternum
- lymph nodes under the arm
- the lymph nodes above or below the collarbone
The extent and depth of lymph node involvement make these patients unsuitable candidates for surgical treatment as a primary mode of therapy. Chemotherapy is the treatment of choice for women with stage IIIb and IIIc breast cancers.
However, up to 70% of patients with stage III breast cancers who have chemotherapy remain alive and disease-free after 7 years.
Risks And Side Effects Of Surgery
The short-term risks of any type of surgery include reactions to anesthesia, too much bleeding , blood clots, and infections. Most people will have at least some pain after the operation, which can usually be helped with pain medicines, if needed.
Other possible risks of surgery include:
- Damage to internal organs and blood vessels during surgery
- Pneumothorax
- Incisional hernia
- Leakage of urine into the abdomen
- Kidney failure
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What Kind Of Treatment Will I Need
There are many ways to treat kidney cancer.
The treatment plan thats best for you will depend on:
- The stage and grade of your cancer
- The chance that a type of treatment will cure the cancer or help in some way
- Your age
- Other health problems you have
- Your feelings about the treatment and the side effects that come with it
Where Can Breast Cancer Go
Breast cancer mostly spreads to the bones, lungs, liver, and brain. When it does, you may start to notice symptoms that affect that area of your body.
Bones: swelling, intense pain, bones that break easily, and pain in your bones, back, neck, or joints
Lungs: long-lasting cough, trouble breathing, chest pain
Liver: Jaundice, or skin with a yellow tint, rashes and itchy skin, not feeling hungry, stomach pain
Brain: headaches that wonât go away, problems with your vision, seizures, vomiting and nausea, memory troubles, feeling dizzy
Other, less common, places where breast cancer spreads include:
- Ovaries
- Adrenal glands
- Pancreas
- Skin
Let your doctor know as soon as you can if you have any of these symptoms. They donât always mean your cancer has moved to another organ, but your doctor might want you to take some tests to make sure.
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Symptoms If Cancer Has Spread To The Lymph Nodes
Lymph nodes are part of a system of tubes and glands in the body that filters body fluids and fights infection.
The most common symptom if cancer has spread to the lymph nodes is that they feel hard or swollen. You might have any of the following symptoms if your cancer has spread to the lymph nodes:
- a lump or swelling under your armpit
- swelling in your arm or hand
- a lump or swelling in your breast bone or collar bone area
One of the first places breast cancer can spread to is the lymph nodes under the arm on the same side as the breast cancer. This is not a secondary cancer.
Thermal Ablation Or Cryoablation
Thermal ablation or cryoablation can be used alone or in combination with surgery. These procedures involve destroying cancer cells by either heating or freezing them. For example, radiofrequency ablation involves inserting a needle into individual tumours in the liver and destroying them with heat. RFA is a specialist treatment and not widely available. Your treatment team can tell you if it may be suitable for you.
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Diagnosis Of Secondary Breast Cancer
You may be diagnosed with secondary breast cancer after having tests to check a new symptom. This could be through your GP or at a breast cancer follow-up clinic. Sometimes there may be no obvious symptoms and the diagnosis is made after routine follow-up tests.
Some women who have just been diagnosed with primary breast cancer have tests that show the cancer has already spread to other parts of the body. Sometimes the secondary breast cancer is diagnosed first and tests show that it first started in the breast.
Your cancer doctor or nurse will ask you about your symptoms and general health. You may need some of the following tests:
Diagnosis Of Breast Cancer
Diagnosis is the process of finding out the cause of a health problem. Diagnosing breast cancer usually begins when you find a lump in your breast or a screening mammography suggests a problem with the breast. Your doctor will ask you about any symptoms you have and do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for breast cancer or other health problems.
The process of diagnosis may seem long and frustrating. Its normal to worry, but try to remember that other health conditions can cause similar symptoms as breast cancer. Its important for the healthcare team to rule out other reasons for a health problem before making a diagnosis of breast cancer.
The following tests are usually used to rule out or diagnose breast cancer. Many of the same tests used to diagnose cancer are used to find out the stage . Your doctor may also order other tests to check your general health and to help plan your treatment.
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What Is Bone Metastasis
The bone is a common site for metastasis. Bone metastasis or bone mets occurs when cancer cells from the primary tumor relocate to the bone. Prostate, breast, and lung cancers are most likely to spread to the bone. However, other cancers are not excluded. Bone metastases do not begin from the bones but move there from the primary tumor site. On the other hand, primary bone cancers are rare cancers where the primary tumor actually starts in the bone. Therefore, bone cancer and bone metastases are not the same.
As an example, consider a patient with prostate cancer. Prostate cancer cells from the primary tumor can break away and get into the bloodstream. Once in the blood, the cancer cell can travel to the bone and form a new tumor. It is important to remember that this secondary tumor is made up of abnormal prostate cancer cells, not abnormal bone cells. The result of this process is referred to as prostate cancer that has metastasized to the bone or metastatic prostate cancer. This is otherwise known as bone metastasis.
When cancer cells metastasize to the bone, they can cause changes to the bone. The process by which portions of the bone are damaged is called osteolysis. Oftentimes, small holes result from osteolysis. These holes in the bone are referred to as osteolytic lesions or lytic lesions. Lytic lesions can weaken the bones and increase the risk of breakage or other problems. It is also common for bone metastasis patients to experience pain with lesions.
Symptoms Of Metastatic Breast Cancer
The symptoms of metastatic breast cancer may be different than those of early-stage breast cancer, but not always. Sometimes, there are no symptoms at all.
You should always speak with your doctor if you experience any new signs or symptoms, but here are some of the most common signs that breast cancer has spread:
- Bone pain or bone fractures due to tumor cells spreading to the bones or spinal cord
- Headaches or dizziness when cancer has spread to the brain
- Shortness of breath or chest pain, caused by lung cancer
- Jaundice or stomach swelling
The symptoms of breast cancer metastasis may also vary depending on where in the body the cancer has spread. For example:
- If the breast or chest wall is affected, symptoms may include pain, nipple discharge, or a lump or thickening in the breast or underarm.
- If the cancer has spread to bones, symptoms may include pain, fractures or decreased alertness due to high calcium levels.
- If the cancer has spread to the lungs, symptoms may include shortness of breath, difficulty breathing, coughing, chest pain or fatigue.
- If the cancer has spread to the liver, symptoms may include nausea, fatigue, swelling of the feet and hands or yellowing skin.
- If cancer has spread to the central nervous system, which includes the brain or spinal cord, symptoms may include pain, memory loss, headache, blurred or double vision, difficulty with and/or movement or seizures.
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