Metastases in breast cancer - symptoms and prognosis. Metastases in breast cancer: types, definition and treatment

Breast cancer comes out on top among cancer diseases among women. 95% of breast cancer is adenocarcinoma, and about 5% is adenosarcoma.
The social significance of breast cancer is so great that oncologists around the world are struggling with this problem first of all. 25% of all cancers in women are breast cancer.
Many years of experience in treating breast cancer have proven that the best results are when treatment is combined. Combination treatment refers to a combination of surgical, radiation and chemotherapy treatment. Despite combination treatment the disease tends to recur. Cancer recurrence is metastasis.
Metastasis is the secondary focus of the tumor.
Metastasis is the process of formation of metastases from the primary tumor. As a result of metastasis, a secondary tumor appears.
The main criterion for malignancy is the ability of a tumor to metastasize. Since breast cancer is a highly differentiated tumor, the degree of its metastasis is high (if the tumor is poorly differentiated, then the probability of metastasis is low).
The American College of Oncologic Surgeons has adopted a standard that minimum size The tumor size is 10 millimeters, but even in patients with this size, the tumor in 30% gives metastases to the lymph nodes, and 10% of these patients die from secondary tumors. Based on these sad facts The only and most important thing to advise patients after treatment for breast cancer is regular diagnosis for the presence of distant metastases.
Computed tomogram of a 56-year-old patient. It is known that 6 years ago she was treated for breast cancer. On the left is a CT scan without contrast enhancement, and on the right is a CT scan with contrast enhancement. Conclusion: single lesion right lobe brain with perifocal edema and displacement of the brain to the left side.

Histological diagnosis: Metastatic carcinoma (secondary tumor).

Metastases after breast cancer.

Breast cancer first spreads to the lymph nodes, but, as American scientists have proven, it spreads equally quickly, both in blood vessels, as well as lymphatic. The most frequent localization lesions of the lymphatic system are axillary, retrosternal, cervical, subclavian. These lymph nodes are examined even before surgical treatment breast cancer. The oncologist determines the stage of the cancer based on how many lymph nodes are affected (N). Also, the stage and prognosis depend on the size of the tumor (T), the degree of malignancy (G) and the number of distant metastases (M).
If there is at least one distant metastasis, the oncologist automatically puts the last fourth stage of breast cancer.
Most often affected by metastases the following bodies: bones, brain, lungs, liver. The most common metastasis is to the bones - 70% of cases, and to the brain - 10% of cases. To the liver and lungs less often.
In case of bone metastases, the patient consults a traumatologist or orthopedist with complaints of bone pain. When describing pain, the patient will claim that the pain is terrible and endless. There may also be swelling of the bone at the site of pain. With metastases to the brain, the patient usually complains to a neurologist about headaches and blurred vision. When the tumor increases in size and moves towards the brain, seizures, vomiting, and nausea occur.

With metastatic liver damage, jaundice is possible, itchy skin, abdominal pain, nausea, vomiting. Abdominal pain is caused by the tumor stretching the organ capsule. The same causes jaundice, which compresses gallbladder, and bile accumulates in it and does not exit into the duct. The liver has eight independent segments and two lobes (each lobe has four segments). Better forecast, when a segment is affected than a lobe. Surgery consists of removing a lobe (50% of the organ) or segment (12.5%) of the organ. Scientists agreed that it is no longer possible to call breast cancer or stomach cancer. Now the term cancer has been introduced since metastasis is a matter of time. If your primary location was the mammary gland, then the diagnosis is cancer with a primary localization of the mammary gland. After this diagnosis, the location of the secondary tumor is listed - it can be the liver or bones.
Most radiologists can confuse metastatic liver damage with benign formations:
1) liver hamartoma - benign education.
2) liver hemangioma - a benign formation of blood vessels.
3) liver adenoma - a benign formation of glandular cells.
4) nodular hyperplasia of the liver.

Metastasis to the liver. The patient had breast cancer in 2006.

A CT scan was performed to reveal an extensive mass in the right lobe of the liver.

Giant cell hemangioma. Hemangioma is a benign formation. The diagnosis confused the radiologists as there was breast cancer in the past and the formation was mistaken for metastasis.

Hepatic adenoma. The mass was also mistaken for metastasis. Benign education.

Breast cancer with bone metastases.

Metastasis to bone in breast cancer in 70% of cases. Scintigraphy is performed to detect metastases at a very early stage.
Scintigraphy is usually prescribed before surgical, radiation and chemotherapy treatment. After treatment, the risks are calculated for patients and, based on this, a research method and frequency of execution are prescribed (once a year or every six months).
The most common site of breast cancer metastasis is bones. The most common sites of cancellous bone metastasis are the following: vertebrae, pelvis, skull bones, brachial bone, femur and large joints, but there is still a chance of damage to any bone.

X-ray chest. Metastatic lesion of the clavicle. The patient has a history of breast cancer.
Indicated by an arrow.

MRI. The same patient. The diagnosis is confirmed. Hypointense formation in the clavicle. Indicated by an arrow.

Breast cancer metastases to the spine. The spine metastasizes in 10% of cases primary cancer, and for breast cancer in 70%.
The bones that most often metastasize are the vertebrae. Clinically, patients complain of pain in the spine, dysfunction pelvic organs(urination, defecation, erectile function), swelling in the area of the damaged vertebra. When a vertebra is destroyed (destructed) by metastasis, it may fracture. Changes in the spine can be detected with standard radiography of the spine. With computed tomography and magnetic resonance imaging, it is possible to describe the pathology in detail and make a diagnosis.
A radiograph of the spine (far left) in a frontal projection and MRI images in a frontal projection ( medium shot) and sagittal image (far right image).

Breast cancer metastases to the brain.

Metastasis to the brain in breast cancer is 10%. Breast cancer ranks third in terms of metastasis among primary tumors.
The manifestations of brain damage are as follows:
1) Seizures.
2) Headache.
3) Nausea, vomiting.
4) Changes in consciousness and behavior.
5) Visual impairment.
The most sensitive methods for diagnosing brain metastases are MRI and CT.

CT scan brain. The patient was treated for breast cancer for 4 years. A CT scan was prescribed by a neurologist because the patient complained of dizziness, vomiting, and severe headaches. A CT scan revealed ring syndrome (indicated by an arrow). This syndrome characteristic of metastases and tumors.

Magnetic resonance imaging plays a role in diagnosing brain metastasis key moment when establishing the stage, malignancy, and choosing treatment tactics.

MRI of the brain. Axial slice. In a patient two years after breast cancer, MRI revealed two formations in the left hemisphere: in the frontal lobe and occipital lobe. Diagnosis of hemorrhagic metastasis (metastasis with hemorrhage).

Breast cancer metastases to the lungs.
In terms of metastasis to the lungs, breast cancer ranks first. Clinically, metastases to the lungs are manifested by coughing with blood, shortness of breath, pneumothorax, and increased respiratory rate.
The best way to visualize the lungs is computed tomography. Using it, it is possible to evaluate the roots of the lungs, lung fields, blood vessels, and the lymphatic system. When lung metastasis occurs, the pathology, its size and location are simply described.
X-ray (upper left corner) and CT scan (upper right and lower left corner). The patient underwent preventive radiography for distant metastases after breast cancer.
The radiograph revealed shading, which is typical for many diseases. A CT scan was ordered. Diagnosis of metastasis in the lung.

Oncology is one of the most dangerous enemies of all modern humanity. Every year, about 8 million people die from cancer around the world. According to some reports, this number is growing endlessly and could double by 2030.

Sad statistics

Breast cancer is one of the most common diseases among the female population. According to statistics, approximately every tenth person faces such a diagnosis.

Men are also at risk of developing this pathology, because their mammary gland is similar in structure to that of women. But due to hormonal reasons representatives of the stronger sex have much fewer cases of the disease (approximately 1% of all cases of breast cancer). The mortality rate is about 50%.

Most common cause mortality is a person’s late request for medical help, when the process is in progress late stages, in which the tumor very actively metastasizes. Indeed, in most cases, the patient dies not from the tumor itself, but from its metastases, which it spreads to almost all organs and systems. Therefore, it is very important to promptly diagnose the tumor and its metastases in breast cancer. This can literally save lives.

When does a tumor begin to metastasize?

As a rule, the movement of malignant cells begins at the 3rd or 4th stage, but in practice there are cases when the tumor metastasized at stages 1-2.

It happens that a woman was diagnosed with cancer on early stages, the main tumor was removed and the full recovery. However, when sharp decline immunity or severe stress the body malfunctioned, as a result of which the malignant process began again and spread with renewed vigor.

In breast cancer, malignant cells spread throughout the body at the very beginning of the disease. However, as long as the immune system is strong, it is able to prevent the spread of the malignant process. However, any cancer patient protective forces gradually decrease, and eventually the body can no longer resist. After this, metastases begin to spread with lightning speed through lymph and blood throughout all organs.

Therefore, we can say that, to some extent, the rate of formation and spread tumor cells depends on strength immune system body.

Where do metastases go?

With breast cancer, metastases can spread very quickly. Even a single cancer cell, entering healthy organ, can cause the development of malignant tumors.

The nearest lymph nodes (cervical, scapular and others) are affected first. Then the cancer can spread to the second breast, and also reach the groin lymph nodes.

With blood, metastases spread far beyond the mammary glands and affect the lungs, brain, liver, kidneys and bones. Metastases from breast cancer most often occur in the lungs.

Of course, this process leads to the appearance of a number of symptoms in the patient:

Pain sensations of varying intensity in the area of the affected organ.
When malignant foci appear in the lungs, the patient experiences persistent cough, shortness of breath, unpleasant oppressive feeling in the chest area.
In breast cancer, metastases can affect the brain, causing dizziness, headaches, fainting and sudden changes in behavior.

Appearance of secondary lesions

What metastases look like directly depends on the organ in which they arose. For example, the lungs are characterized by multiple formations of smooth round shape. In the photo they look like white spots.

In the liver they can be heterogeneous in structure, with irregular shape and a seal in the middle. You can see what metastases in the liver look like in the photo below.

Metastases in the bones of breast cancer appear as asymmetrical spots with uneven borders, reddish in color, more soft structure than bone tissue. Dimensions can reach 5 centimeters in diameter. The formation usually protrudes above the bone by 1-2 mm.

In the lymph nodes, they are nodules of various sizes, are perfectly felt upon palpation and are mobile. Can reach large sizes. For example, in cervical lymph nodes There are such huge formations that they even protrude above the skin and are visible to the naked eye.

Metastases in the brain can be multiple or single. The diameter can be about 8 cm. The surface is uneven and lumpy. Inside, the formation is darker and denser.

Metastases in the intestine are characterized by rapid growth, large size and rich, dark color. These formations of soft consistency can put pressure on neighboring organs and also interfere with work digestive system.

Diagnosis of the presence of metastases

Even if the tumor has already metastasized to distant organs, the patient may not feel it immediately. It often happens that symptoms appear in the last stages, when the process of metastasis in breast cancer has already gone very far. Therefore, it is especially important to carry out timely diagnosis tumor and its secondary foci. For this there is whole line examinations:

Treatment of metastases

Methods of healing from metastases are conventionally divided into two groups:

Systemic therapy. This includes chemotherapy with one, two or more drugs that have anticancer activity, stopping the growth and spread of metastases. If cancer cells are sensitive to hormones, therapy can be carried out with their help, which increases the chances of recovery.
Local therapy. This includes treatment with gamma rays, which can destroy metastatic cells, as well as surgery to destroy metastases.

Pain relief for oncology

Almost every cancer patient suffers from pain to one degree or another. Therefore, pain relief in oncology is an issue that requires special attention. The drug regimen depends on the severity pain and is prescribed by the oncologist individually for each patient. For mild or moderate pain, non-steroidal anti-inflammatory drugs are prescribed. At severe pain The patient is prescribed opioid analgesics, which are narcotics in nature.

Patient's life prognosis

Undoubtedly, dangerous diagnosis is the presence of cancer with metastases in a person. It is difficult to say how long people live with this pathology, since it is impossible to give an exact amount of time. The fact is that many people have a huge influence various factors:

If tumor cells have hormone-sensitive receptors, the prognosis is more favorable. Since in this case it is possible to carry out hormone therapy, destroying malignant cells.
The number of metastases and the range of their distribution have a leading influence on the prognosis. The fewer organs affected, the better the prognosis.

On average, patients with metastases live from several months to ten years. Therefore, we can conclude that everything is strictly individual for each patient.

Nursing

Due to high prevalence oncological diseases V Lately appeared a large number of hospices for cancer patients. Similar establishments already exist in almost all major cities(for example, there are hospices for cancer patients in St. Petersburg, Moscow, Kazan, Yekaterinburg).

These are specialized medical institutions, in which proper care is provided and any necessary help patients on

There are times when a person needs constant assistance in the form of pain relief and round-the-clock care. It can be difficult for family and friends to take on all the care themselves. This is especially difficult psychologically. Therefore, most often such patients are placed in a hospice.

Mostly health care here is to carry out palliative treatment - removal painful symptoms and pain relief for oncology. It improves quality last days patients' lives.

Nutrition for cancer patients who are unable to self-administration food, is carried out through a special probe. Patients who feed themselves should follow a dairy-plant diet. The diet includes at least 500 g of vegetables and fruits per day, dairy products. You should limit red meat, fatty, fried, smoked foods, and salt.

In addition, in hospices for cancer patients in St. Petersburg and other cities, patients receive moral support. Relatives of the patient can also turn to a psychologist for help if it is difficult for them to see how the disease takes away someone close to them, and they cannot come to terms with the upcoming loss.

The main goal of hospices is to improve the patient’s quality of life and alleviate suffering. In addition to nutrition, cancer patients receive complete and high-quality care around the clock.

Conclusion

Thus, we can conclude that the appearance of metastases in breast cancer is a negative sign, indicating that the process is far from at the first stage. In addition, when secondary lesions appear, the patient’s life prognosis significantly worsens. Metastases can have very different locations and appearance. They can also begin to disturb the patient immediately after their appearance, or they can spread and grow in his body, for a long time remaining unnoticed. Therefore, it is so important to monitor your health and undergo regular preventive medical examinations.

Metastatic breast cancer (also known as secondary, advanced, stage IV) - cancer that has spread beyond the breast and axillary area, has spread to other organs and tissues.

The main symptom of this form of cancer is distant metastases breast cancer. But it should not be confused with regional metastases - damage by cancer cells to the lymph nodes located in the axillary region. Damage by metastases to distant organs (lungs, bones, liver, brain) can be detected both when a diagnosis of cancer is made () and during relapse of the disease, a situation where previously treated breast cancer has returned with signs of involvement of the above organs.

This article contains information about the symptoms, diagnosis, and treatment of metastatic breast cancer.

Read in this article

What is meant by “metastatic” breast cancer?

A breast cancer tumor is made up of millions of cells. They are believed to have arisen as a result of “key” mutations that occurred in a normal breast cell. These cancer cells are very similar to their “mother” cell. Therefore, such a tumor is called primary breast cancer, hinting at its origin.

Some cells from the primary breast cancer may break off and travel to other organs, forming new tumors there. In such a situation, they speak of the appearance of metastases or secondary cancer, while the malignant cells of these new (secondary) tumors do not lose their similarity to the cells of the primary cancer.

The location of formation of secondary tumors (in which organs metastases appeared) determines the symptoms: the symptoms of breast cancer with metastases to the lungs differ from the symptoms of metastasis of this cancer to the bones.

How do metastases occur?

Cancer cells from the primary breast cancer tumor are spread throughout the body through the blood or lymph. Entering through the bloodstream or lymphatic vessels to other organs, the bulk of them die there. But some of them can survive and remain inactive in the “trap organ” for many years. By for unknown reasons these cells, after a certain period of time, which can be calculated in years, begin to actively divide, leading to the formation of metastasis. Recently, there has been an active search for the reasons leading to the emergence of cancer cells from the dormant state, which may help to find effective treatment metastatic cancer.

Where does breast cancer most often metastasize?

Breast cancer cells, circulating throughout the body, tend to linger in certain organs and tissues. Traveling around lymphatic system, they can “find refuge” in any lymph node. Most often, these cells affect the lymph nodes located near the chest, in the neck and mediastinum.

Cancer cells that spread through the bloodstream most often settle in the following organs:

bones,
liver,
lungs.

Cancer cells also attack the brain, but this is rare.

There is a relationship between the characteristics of the primary tumor and the frequency of metastases affecting a particular organ, that is, where breast cancer metastasizes largely depends on its characteristics. For example, hormone-positive tumors (contain receptors for estrogen and progesterone) most often metastasize to the bones and lungs, HER2-positive cancers - to the liver and brain.

Metastasis can be diagnosed as a single formation, in this situation it is called “solitary”. But more often, multiple metastases of breast cancer occur, several organs are affected, or several clusters of cancer cells form in one organ.

Symptoms of the disease

Symptoms depend on the location of the metastases where the breast cancer has spread. But metastatic cancer can also be accompanied general symptoms, such as:

feeling constant fatigue;
severe weakness;
loss of appetite.

These symptoms can also occur with other illnesses, such as a cold or flu. Therefore, if they appear, a woman should not immediately worry. See an oncologist or doctor general practice It is worth contacting when the duration of these symptoms exceeds two weeks.

Depending on the damage to a particular organ, the following symptoms may occur:

When lymph nodes are affected you can feel dense and painless lumps under the skin. If the cancer has spread to the groin or axillary lymph nodes- swelling of the limb on the affected side is possible.
Bone metastases may lead to pain. Later, if the cancer is not treated, the bone may lose its strength and break. There are cases when, when the bone is damaged by metastases of breast cancer, it begins to rapidly lose calcium, which enters the blood, which causes fatigue, nausea, irritability, confusion, constipation and thirst.
If breast cancer has spread to the liver, this is accompanied by deterioration general well-being, the appearance of constant fatigue. There may also be discomfort V right half abdomen, its enlargement, nausea and loss of appetite.
Cancer in the lungs. Women whose lungs are affected usually complain of a dry cough or difficulty breathing.
If formed brain metastases, the woman may experience headaches, general weakness, memory problems, behavioral disturbances.

Diagnostics

In the arsenal of doctors there is sufficient quantity diagnostic procedures to find out how far breast cancer has spread. The use of a particular diagnostic test largely depends on the symptoms that a woman has, which helps the doctor suspect the location of metastases and prescribe necessary research. A full body CT scan is often performed to ensure that asymptomatic lesions are not missed. Since metastases from breast cancer most often affect the bones, lungs, and liver, the following diagnostic tests are used:

Bone scan.
Blood tests to check how your liver is functioning. Based on the results of these tests, it is possible to prescribe an ultrasound or CT scan of the liver in the future.
A chest x-ray can help determine if there is damage to the lungs.
CT or MRI of the brain.
PET-CT is a hybrid medical imaging method that combines positron emission tomography and computed tomography. This is a test that helps identify small metastases.
Biopsy of lung and liver cancer lesions.

Cancer treatment

Not long ago, a diagnosis of metastatic breast cancer meant it was time to get my affairs in order. In the 1970s, only 10% of women survived the five-year Rubicon after diagnosis. Today, at least 40% of women with metastatic cancer live more than 5 years. Many doctors view pathology as a chronic disease.

It is completely impossible to rid a patient of metastatic breast cancer, but to control its manifestation for many years modern oncology Maybe. Pathology on this moment viewed as chronic condition, consisting of periods of exacerbation and remission.

Effective treatment of exacerbations and long-term remissions allow long-term control of the growth of metastases and the appearance of new ones. But the problem is that the duration of each subsequent remission is reduced, and with each exacerbation the sensitivity of the tumor to the oncological drug decreases.

Treatment for metastatic and early stage breast cancer differs significantly. At early stages doctors often recommend a very aggressive course of treatment, which is strictly followed despite the severity of side effects. Its main goal is to completely get rid of cancer. This treatment lasts from 6 to 9 months. Treatment philosophy for metastases - get maximum control over the tumor with minimal toxicity, which is achieved by using the following methods:

Radiation therapy is effectively used for metastases formed in the bones and brain.
Surgery can be used in special cases. For example, when it is possible to remove a metastatic lesion without compromising the patient’s quality of life, which will lead to an improvement in symptoms, or in a situation where only one metastasis is detected.
. Tamoxifen or Arimidex usually have fewer side effects than chemotherapy. They are able to control metastatic cancer as well, and sometimes better, than the most effective cytostatic, but provided that the hormonal prescription status of the tumor is positive.
Herceptin. A monoclonal antibody, Herceptin targets cells that express the HER2 protein, which occurs in approximately one in four cases of breast cancer. It has been shown that Herceptin can increase survival in women with these tumors by an average of 13 months.
Chemotherapy. When treating metastatic cancer, doctors typically use one chemotherapy drug, as opposed to early cancers, when their combination is used simultaneously. This allows you to keep the tumor under control for a long time and minimize adverse influence treatment on a woman’s quality of life. At the moment, there are several effective cytostatics that are used for metastatic breast cancer. This makes it easy to change them if one of them “stops working.” One of the best and currently available oncology drugs for the treatment of metastatic breast cancer is Xeloda. It has been used for this pathology for quite a long time, has shown its effectiveness and can be used at home in the form of tablets.

New approaches to supportive therapy (also called accompanying or palliative) have made it possible to reduce the frequency of painful symptoms that occur in women with this pathology. Recently, drugs have appeared that can effectively combat side effects chemotherapy treatment and symptoms that are associated with the progression of the disease, making it more manageable.

For example, a group of drugs known as bisphosphonates (Alendronate, Risedronate (tablet forms) and the stronger injectable Aredia and Zometa) have changed the course of the disease in women with bone metastases.

These medications are extremely effective because they slow down bone destruction, one of the most serious problems in patients with breast cancer metastasis to the bones.

It is important that the woman discusses treatment options in detail with her oncologist. I found out why he recommends this particular option and not another. Made sure she understood all the risks and benefits of this treatment.

Women with this pathology need additional psychological, emotional, and financial support. If we believe that we live in a civilized society, then our duty is to help the sick with metastatic cancer mammary gland. They are fighting for their lives and deserve our attention.

Single tumor cells spread in several ways - hematogenously (through the bloodstream) and lymphogenous (through the lymphatic tract). They are detected already in the early stages of the tumor process, however, the capabilities of the body’s immune system make it possible to prevent the proliferation of tumor cells outside the mammary gland and the formation of metastatic foci. Depletion of the immune system when cancer develops or when the immune system is suppressed by aggressive types of tumor cells. Rapid growth metastases and an increase in their number are observed in aggressive forms of breast cancer.

The ability of breast cancer to metastasize is determined by the expression of ErbB-2 proteins by tumor cells. By performing immunohistochemical analysis from a breast biopsy, it is possible to determine the expression of this protein and confirm the aggressiveness of the disease at an early stage, even before metastases are detected.

Metastasis detected by scintigraphy or PET-CT indicates that the neoplasm cells have spread through the bloodstream to other organs and tissues (liver, brain, bones and lungs). Breast cancer metastases can be detected both at the very beginning of tumor development and after its relapse. A feature of breast tumors is the ability of metastases to persist for a long time in a dormant (latent) state, which can “sleep” for 7-10 years after radical removal of the primary tumor, and then come to light under the influence of various provoking factors.

Main pathways of breast cancer metastasis

Lymphogenic metastases in breast cancer are detected in regional (closest) lymph nodes - anterior thoracic, axillary, sub- and supraclavicular, peri-sternal. Hematogenous metastases are found more often in spongy bones, lungs, spinal cord, kidneys, and liver. - spongy bones, head or spinal cord, as well as the liver. The entry of tumor cells into each of these organs and the enlargement of the tumor island to the size of a metastasis is accompanied by the following clinical manifestations.

Spongy bones of the skeleton: usually observed: pain in the back (vertebrae), pelvic bones or large joints(knee, hip), which steadily increases over 2 - 3 weeks. In case of damage to the vertebrae (usually lumbar), so-called radicular symptoms occur, caused by compression of the spinal nerves - numbness or weakness appears in the limbs, the physiological activity of the intestines is disrupted and Bladder with the development of urinary and fecal incontinence, etc.

Brain: the most common symptom is headache, also very often develops general and muscle weakness in the legs or arms, visual disturbances such as loss of visual fields or double vision may occur. Common with brain damage psychological disorders, decreased level of consciousness, convulsions.

Lungs: most patients have a persistent cough, both productive (with sputum) and without it. As the disease progresses and the effectively functioning lung tissue shortness of breath develops with slight exertion, increasing to shortness of breath at rest.

Liver: the presence of metastases is accompanied by long-term pain in the abdomen, bloating and a feeling of heaviness; As the lesion progresses and the volume of functioning liver tissue decreases, jaundice develops, and a persistent decrease in body weight is observed.

Breast cancer metastases: basic diagnostic methods.

If a secondary outbreak has developed in one place, then it is likely that it will arise somewhere else. In this case, the tumor can be so small that the patient does not even feel it.

The search for metastases is carried out when a recurrence of breast cancer is suspected after a previous study, or in the process of the final diagnosis of breast cancer after its initial detection. One of the primary diagnostic methods when searching for metastasis is to determine the level of tumor markers specific for breast cancer - CEA, CA15-3, CA 27-29.

Given the large area of the body examined, scintigraphy is performed when searching for sites in the bone. skeletal system, which, for single suspicious nodes, can be supplemented by targeted X-ray examination of suspicious areas.

Also used classical methods diagnostics, including ultrasound of organs abdominal cavity, MRI of the spinal cord and brain, CT scan of the chest, abdomen, pelvis or brain, and PET-CT.

Breast cancer metastases. What treatment methods are used?

Treatment of metastases is conventionally divided into 3 types:

local (local) therapy, the purpose of which is to destroy metastases;
systemic therapy aimed at neutralizing malignant cells outside of secondary foci;
painkillers.

Systemic includes hormonal and chemotherapy, and other new methods (including additional ones). The result of its use does not appear immediately, and metastases require rapid action to prevent them Negative influence on the spinal cord, brain, bone tissue. Therefore, it is important to combine the above methods with radiation therapy.

For local use the following methods: radiation therapy, steroid drugs, surgery(to restore bone integrity and eliminate tissue compression).

Waiting for action from application systemic therapy painkillers are prescribed. Secondary lesions negatively affect certain organs, used for relief local treatment. In case of defeat bone tissue are appointed medicines to restore it.

Treatment of metastatic liver cancer is one of the most beneficial branches of oncology. Even among the medical community, a prejudice has taken root that the presence of single metastases in the liver means complete futility of treatment and immediate death. Modern methods minimally invasive treatment allows you to completely remove metastases and preserve normal function liver for several years. For this purpose, techniques such as economical liver resection during open surgery, as well as RFA - percutaneous transhepatic radiofrequency ablation of the liver, as well as using the method of plasma surgery using the PlasmaJet device.

Surgical treatment is replaced by systemic chemotherapy for multiple nodes or metastases of large size and complex shape, affecting several segments of the liver.

When can I expect the best results from treatment?

It is possible to maximize life and its quality (alleviating the manifestations of secondary foci of the disease and increasing the period of remission with minimal side effects):

when the tumor does not spread to such important organs like the lungs, brain and liver;
when secondary lesions affect no more than 3 organs or areas of the body;
if the cells of the metastatic neoplasm have hormonal receptors;
if there is a tumor reaction to hormone and chemotherapy;
if not all treatment methods have been used yet.

If metastases from breast cancer are treated, how long can you live?

Properly selected therapy can extend the life of women with metastatic uhelb cancer by 3-5 years, providing 85-90% five-year survival rate and a very high quality of life. In most countries Western Europe this indicator is about 7-12 years.

No one can say for sure how long the patient will live with this or that metastasis, which is associated with individual characteristics organism, the stage of the disease and its spread. Some manage to extend their lives by a decade (or even more), while others manage to extend their lives by only a few years.

In breast cancer, metastasis occurs along the mammary ducts of the gland; along lymphatic slits, capillaries and vessels; through blood vessels. Depending on the route, metastasis occurs in different tissues and organs.

Metastasis in breast cancer (Sh. X. Gantsev, 2006):

1. Regional (lymphogenous to the lymph nodes):

1.1. Axillary.

1.2. Subscapular.

1.3. Subclavian.

1.4. Supraclavicular.

1.5. Parasternal.

2. Remote (lymphohematogenous):

2.1. Contralateral axillary lymph nodes.

2.2. Contralateral supraclavicular lymph nodes.

2.3. Soft fabrics, skin.

2.4. Liver.

2.5. Lungs.

2.6. Bones: vertebral bodies, pelvic, femoral, etc.

2.7. Pleura.

2.8. Ovaries.

2.9. Brain and other organs.

Lymphogenic metastasis of cancer can occur in various directions:

1) pectoral path (60–70%) - to paramammary lymph nodes and further to the armpits;

2) subclavian path (20–30%) - to the subclavian lymph nodes;

3) parasternal path (10%) - to the parasternal nodes;

4) cross path (5%) - to the axillary lymph nodes of the opposite side and to the other mammary gland;

5) retrosternal path (2%) - to the mediastinal lymph nodes, bypassing the parasternal ones;

6) transpectoral route (rarely) - to the central (upper) axillary lymph nodes;

7) lymphatic drainage through the lymphatic tract of Gerota (rare) - to the epigastric lymph nodes and nodes of the abdominal cavity;

8) intradermal route (rarely) - along the abdominal wall to the inguinal lymph nodes.

Most often, in breast cancer, distant metastases by hematogenous route affect the bones, lungs, liver, and skin. Cancer metastases to the lungs occur in the form of single or multiple nodes. According to V.P. Demidov (2000), metastatic bone lesions in breast cancer are detected during primary treatment of patients in 1.3–6% of cases, and are detected at autopsy in 44–70% of cases; the frequency of cancer metastases to the liver detected by scanning before radical treatment is about 1.5%, and at autopsy - from 35 to 67%

Breast Cancer Clinic

The clinical picture of breast cancer is varied and depends on various factors: the type of tumor growth, its location in the mammary gland, the stage of the disease, the presence of regional and distant metastases. Breast cancer is usually not painful. A woman complains of the presence of a tumor-like formation or lump in the mammary gland, which she often identifies on her own. The tumor gradually increases in size, but sometimes its size does not change for several months. The lump does not increase before menstruation, unlike some forms of mastopathy. Clinically, nodular and diffuse forms breast cancer.

Nodal form

It occurs most often (up to 75%) and is localized in the upper-outer quadrant of the mammary gland (up to 50%) or in the central zone, less often in its other parts. It is characterized by a dense nodular formation in the mammary gland with a nervous surface, unclear contours, cartilaginous density in the absence of pain. Only in some histological variants can the consistency of the tumor be softer, even tightly elastic. Positive Koenig's sign: the node does not disappear when it is pressed in a supine position against the chest wall.

Wrinkling of the skin over the tumor, resulting from shortening of Cooper's ligaments, can appear already in the early stages of cancer. This symptom indicates that the tumor grows most rapidly towards the skin. This symptom also allows you to distinguish cancer from mastopathy. With the central localization of the tumor node, under the same circumstances, a narrowing of the areola, retraction of the nipple, and its deviation towards the node appear. As the size of the tumor increases, skin retraction occurs - a symptom of “umbilification”. Deformation of the nipple (Pribram's symptom), its retraction is detected when the tumor spreads through the milk ducts. The symptom of “lemon” (“orange”) peel is a sign of the spread of the tumor process in the deep skin lymphatic crevices, and swelling of the skin of the mammary gland appears. Immobility of the mammary gland in relation to the pectoralis major muscle (Payre's symptom) indicates the growth of a tumor into it.

Diffuse forms of breast cancer

These include edematous-infiltrative, mastitis-like, erysipelas-like, and armored forms of breast cancer. Diffuse forms of breast cancer are rare - 2–4%. These forms are characterized by rapid development of the process, extensive lymphogenous and hematogenous metastasis.

Edema-infiltrative form occurs most often in young women, often during pregnancy and lactation. The mammary gland is enlarged, its skin is pasty and swollen, hyperemia and the lemon peel symptom are pronounced. The course is acute. There is often no pain. It is difficult to identify a tumor node in gland tissue. An infiltrate without clear contours is palpated, occupying most of the gland. The swelling is caused by blockade of the lymphatic pathways by metastatic emboli or compression by the tumor infiltrate. Metastases appear early in regional lymph nodes.

Armored cancer characterized by tumor infiltration of both the gland tissue itself and the skin covering it. Sometimes the process goes beyond the gland and spreads to the chest wall, to the opposite mammary gland. The skin becomes dense, pigmented, does not move easily, and resembles a shell. Many tumor nodes appear inside the skin. The mammary gland shrinks, pulls upward, and wrinkles. Tumor infiltration compresses the chest wall in the form of a shell. Of all the diffuse forms of breast cancer, the armored form is the most torpid.

Inflammatory forms of breast cancer have an acute course, are extremely malignant, quickly recur and rapidly metastasize.

At erysipelas (erysipeloid) form tumor process accompanied by severe hyperemia of the skin with uneven, tongue-shaped edges, externally resembling erysipelas; it may spread to the skin of the chest wall. The skin of the gland is covered pink spots, which is caused by the spread of tumor cells through the capillaries to the lymphatic vessels (carcinomatous lymphangitis). Most often, the disease is acute, with high body temperature (39–40 °C).

At mastitis-like cancer, the mammary gland is significantly enlarged, tense, compacted, and has limited mobility. Hyperemia and hyperthermia of the skin are pronounced. Diffuse compactions are palpated deep in the glandular tissue. The process spreads quickly, accompanied by a feverish rise in body temperature. Occurs in young women - pregnant and lactating.

There are other variants of breast cancer that do not fit into the typical clinical picture.

Non-palpable The type of breast cancer is determined using mammography. Usually this is a small tumor located in the deep parts of the glandular tissue.

Hidden (occult ) breast cancer first clinically manifests itself as metastases in the axillary lymph nodes. In this case, the primary tumor is not determined.

Paget's disease observed in 1–4% of patients with breast cancer. Clinically, patients have a long history of the disease with the development of eczema-like changes in the nipple, with sensations of itching, burning and weeping. Changes in the nipple are associated with underlying cancer in the breast, which is palpable in 2/3 of cases.