What is Advanced Breast Cancer?
Advanced breast cancer is a term used to refer to stage IV breast cancer. This means that the cancer cells that first attacked the breast have now spread or metastasized to other parts of the body. Some of the common areas of the body that are affected by metastases include bones, liver, brain, or the lymph nodes. Advanced breast cancer is also known as metastatic breast cancer.
Complications of Advanced Breast Cancer
Advanced breast cancer is known to have many complications merely due to the fact that it has moved beyond the site of the original cancer. Further complications can also occur from either the cancer itself or even from the treatment methods being used. These complications vary from person to person and depend on many factors. These include:
- The type of cancer you have
- The extent to which your cancer has spread
- The severity of your symptoms
- What treatment methods are being used
There is also a type of advanced breast cancer known as locally advanced cancer, which means that cancer has spread into the tissues surrounding the breast and not spread to any of the organs yet.
Many of the potential complications that arise from advanced breast cancer are treatable, and these treatments are most effective when they are begun sooner than later. In many cases, recognizing a complication ahead of time can also prevent any serious problems in the future, including paralysis and even death.(1)
Let us take a look at some of the possible complications of advanced breast cancer.
Pain From The Cancer
It surprises many people to know that cancer can cause pain all on its own. This happens because as the tumors grow, they take over the formerly healthy areas of the body. The cancer starts putting pressure on you nerves, bones, and organs, which causes pain or a sharp, stabbing pain. There are also certain types of cancer that secrete chemicals that causes painful sensations.
Pain that stems from metastatic cancer is known to be variable and depends a lot on the location of metastases. Pain can start to disrupt your day to day life, interfering with the quality of your life. You will find that maintaining a high quality of life is going to be one of the primary goals of your doctors while treating advanced breast cancer. While pain is not a common symptom of early breast cancer, as the cancer advances, the tumor can cause pain since it starts pushing into nearby healthy tissue. Women who have inflammatory breast cancer, tenderness or pain in the breast is usually one of the first symptoms. This type of cancer is quite rare and tends to grow and spread quickly.(2)
Your doctor and medical team will help you determine the best treatment plan for managing cancer-related pain. This might include some over-the-counter pain relievers, prescription pain relievers, or even a complementary therapy.
Complications With Your Bones
Breast cancer commonly spreads to the bones, which is known to cause several complications. Most of these complications are caused due to bone resorption. Bone resorption is a natural process that breaks down the bone. In healthy young people, the bone gets rebuilt at the same rate at which it gets broken down, but in older adults who have metastasis to their bones, the bone resorption process tends to occur more quickly.(3)
There are many treatments that are now looking at not only treating the bone metastases but also focusses on finding ways to prevent them from occurring in the first place.
In people who have advanced breast cancer with bone metastases, there are many new bone-modifying drugs available on the market, such as denosumab and bisphosphonates, which help lower the risk of complications such as fractures. Multiple complications might also result from bone metastases.(4)
Here are some of the bone-related complications you may experience from advanced breast cancer.
- Bone Pain: One of the first sign that your breast cancer has spread to the bones is a painful and aching feeling in your bones. As the condition progresses, bone resorption occurs, causing a weakening and thinning of the bones. Once the bones become too weak, the risk of fractures goes up, sometimes even without any major injury. Radiation therapy is known to be highly effective at reducing pain from these metastases. Bone modifying drugs are not very efficient at reducing the pain to the same degree as radiation therapy, but they still can prove to be helpful if taken in combination with some other treatments.
- Pathological Fractures: This is also another common complication of advanced breast cancer that has reached the bones. A pathological fracture happens when a bone breaks at a weak spot. Depending on the location of the fracture, it can reduce your mobility to a great extent.
- Hypercalcemia: Hypercalcemia is a condition marked by elevated levels of calcium in the bloodstream. This can happen when the rate of bone resorption increases, and the calcium from the bones gets into the bloodstream. Hypercalcemia can cause serious problems such as:
Early on into the condition, some of the symptoms it may cause includes:
As the condition progresses, it can lead to more severe symptoms, including:
- Abnormal heartbeats
- Kidney damage
- Kidney failure
- Neurological issues such as dementia
Spinal Compression: Spinal compression is another bone complication that happens from advanced breast cancer. When the cancer cells start to grow in or near the spinal cord, they start putting a lot of pressure on the spinal cord as well as the nerves surrounding the spine. This pressure leads to pain in the neck or the back, difficulty walking, and can also cause tingling and numbness. Sometimes, spinal compression can also lead to difficulty in controlling the bowels and the bladder. Spinal compression is not as common as the other bone complications, but it is a severe complication, and you need to consult your doctor at the earliest if you feel the symptoms. Spinal cord compression should be treated as a medical emergency because it can cause problems in walking, urinating, and even bowel movements. There is also another very serious type of microfracture of the spine that can cause the vertebrae in your back to collapse down on itself. This is known as a compression fracture. Without receiving immediate medical attention to stabilize the spinal cord, a person may end up becoming paralyzed in their lower extremities as well as lose control over their bowels or bladder.
Treatment of Bone Complications: There is a class of drugs that work towards slowing down the rate of bone resorption. Known as bisphosphonates, these drugs function by destroying osteoclasts that are the cells responsible for bone resorption. This helps in lowering the levels of calcium in the bloodstream, slowing down the weakening of bone structure and also reducing bone pain.
Complications With The Lungs
The lungs are known to be the second most common site at which advanced breast cancer spreads to. Lung metastases can occur in nearly a third of all patients with stage IV breast cancer.
The symptoms of lung complications will vary from person to person, with many women not experiencing any symptoms at all, to some experiencing significant shortness of breath. Apart from the regular treatments that are there for metastatic lung cancer, there are now some local treatments that are also being used in people who only have a couple of lung metastases. This has shown to improve life expectancy to some level.
If you experience symptoms such as wheezing, shortness of breath, chest pain, a persistent cough that refuses to go away even after you have taken medication, or any type of discomfort in the chest, then this might be an indication that your cancer has spread to the lungs.(5)
If your doctor finds breast cancer cells in a lung tumor, then the best way for treating this is by continuing systemic medications such as targeted therapy or chemotherapy.
Breast cancer cells are known to sometimes lead to a complication known as pleural effusion. This is a condition when cancer cells spread to the fluid that surrounds the lungs. The treatment for this involves a procedure that removes the excess fluid.
Lung metastases can also go on to cause several other complications, including:
Pneumonia: The presence of tumors in the lungs, particularly near the airways, can lead to the buildup of fluid and bacteria that penetrate deep into the lungs. With the narrowing of the airways due to the tumors, many people develop recurrent pneumonia. This can prove to be much more severe if your white blood cell count gets reduced due to cancer treatments such as chemotherapy. This usually requires hospitalization along with the administration of intravenous antibiotics.
Shortness of breath: Shortness of breath is generally controlled with drugs such as morphine. If an obstruction causes shortness of breath, then your doctor might place a stent. It has been noticed that surprisingly, oxygen is not very helpful in decreasing the feeling of being short of breath.
Coughing up Blood: You may cough up blood, especially when the tumors occur near the large airways. Even a small amount of blood that you cough up should be taken as a medical emergency. Coughing up around one-third of a cup of blood has a mortality rate of nearly 30%. This is why you should never ignore if you start to cough up blood, even if it is only a small amount. If you are diagnosed early on, then a procedure can succeed in stopping the bleeding, regardless of whether it is mild or severe.
Malignant Pleural Effusion: This is a condition in which cancer cells and fluid accumulates between the membranes that line the lungs. The membrane is known as the pleura. The severity of this condition depends on the amount of fluid that has accumulated and also on how quickly it builds up.(6) A small pleural effusion usually does not require any treatment, but a large pleural effusion can cause compression of the lungs, leading to shortness of breath and severe pain. Thoracentesis is generally the first step in treating a malignant pleural effusion. This procedure involves having a needle inserted through the chest wall into the pleural space for draining out the fluid. However, the fluid can recur, requiring further and repetitive treatments.(7)
Pulmonary Hemorrhage: Another serious complication of advanced breast cancer reaching the lungs is pulmonary hemorrhage, or bleeding into the lungs. This is not a commonly occurring complication, but it is known to occur in some people. Pulmonary hemorrhage must be treated as a medical emergency, and you need to seek immediate medical assistance because the condition can prove to be fatal if you do not receive prompt treatment. You need to get immediate medical attention for any of these symptoms that are related to pulmonary hemorrhage:
- Labored breathing or difficulty in breathing
- Acute respiratory failure
- Treatment for pulmonary hemorrhage depends on whether the bleeding is only coming from one place (localized) or bleeding from numerous places (diffuse).
Obstruction of the Airways: When the cancerous tumors start growing near or into your airways, they are likely to cause an obstruction. This can lead to infections such as pneumonia, or shortness of breath. If you have severe obstruction of the airways, your doctor is likely to place a stent in the airway to keep it open.(8)
Complications with the Liver
Approximately half of the people who have been handed over an advanced breast cancer diagnosis will have cancer cells traveling to their liver.(9) Tumors that form on the liver can then affect the functioning of your liver.
It is not necessary for you to experience any symptoms, but there will be some early signs that may include fullness or pain in your stomach as well as shoulder and abdominal pain. You might even experience regular hiccups. Some of the more severe symptoms will consist of:
- Nausea and/or vomiting
- Sudden weight loss
- Jaundice is a condition that causes yellowing of the whites of your eyes or the skin.
Many times, advanced breast cancer that spreads to the liver can also lead to a blockage in the bile ducts. The bile ducts are responsible for removing waste from the body, and if an obstruction occurs in these ducts, you will have to undergo a surgical procedure for unblocking the bile ducts.
The tumor needs to replace quite a large part of your liver in order to cause some major symptoms. When this happens, you will experience several complications. These may include:
- State of confusion and lethargy: When there is an aggressive and extensive metastases in the liver, then lethargy and uncertainty are likely to result as toxins build up in your body. If you feel excessively fatigued even after getting a good night’s rest, you should consider seeing your doctor.
- Ascites: When the liver stops functioning properly, fluid can start to build up in the peritoneal cavity, which leads to ascites.(10) If your stomach becomes severely bloated, it can cause shortness of breath, and it can also be a very painful condition. Shortness of breath can be especially pronounced if you are also having lung metastases. If ascites is diagnosed, then you will have to undergo a procedure known as paracentesis. In this procedure, a needle is inserted through the skin directly into the abdominal cavity in order to drain out the excess fluid that has built up.(11)
- Internal Bleeding: This can be quite a serious complication if it is not treated. Your liver is responsible for manufacturing the clotting factors for the blood. If the liver stops functioning properly, then this can result in the production of an insufficient amount of clotting factors, leading to bleeding and anemia. In some cases, an injury might not stop bleeding because of a lack of clotting factors in the blood. If this happens, then you need to seek medical assistance right away as this can prove to be fatal.(12)
- Itching: Now, itching is usually not considered to be a severe complication. However, the fact is that itching that accompanies liver metastases can actually be severe. Itching occurs due to the accumulation of bile acids in the bloodstream and also on the skin. You should ask your doctor about what medications can be taken to reduce the itching.
Complications with the Brain
The brain is another area in the body to which breast cancer cells can spread to rapidly. While this sounds to be an alarming condition, there are several treatments that are there for removing or shrinking the tumors that spread to the brain.
Brain metastases can affect many vital functions in the body, including your vision, your behavior, and your memory. Symptoms that indicate that the breast cancer cells have spread to the brain may include:
Some of the complications of brain metastases may include:
Seizures: You are likely familiar with the generalized tonic-clonic grand mal seizures in which a person shakes violently and becomes unconscious. These types of seizures are more likely to occur with brain metastases. Seizures can also cause different kinds of symptoms based on the type of seizure you experience. These can range from usual muscle stiffness to appearing dazed and confused, not being aware of your immediate surroundings. If you experience a seizure or develop a swelling in the brain, your doctor will prescribe an anti-seizure medication or a corticosteroid.
Falls: Brain metastases can cause weakness, numbness, and loss of balance, which are all symptoms that increase the risk of falls. Falls can result in serious disability and injury. If you have developed brain metastases, then it is essential to be extra careful about your movements and take preventive measures to ensure that you do not fall.
Some of the other complications that may result from brain metastases include:
- Loss of consciousness
- Sudden changes in your mental status or personality
- Vision problems including loss of vision or double vision
Your doctor will go ahead and determine if the cancer has spread to your brain with the help of imaging tests such as MRIs (magnetic resonance imaging) and CT (computed tomography) scans. If these imaging tests are unable to confirm the diagnosis, then you might need to undergo a biopsy under the guidance of a trained surgeon.
Treatments for brain metastases can include a craniotomy.(13) A craniotomy is a surgical procedure that removes a part of the bone from your skull to expose the brain. The bone is again replaced after the tumors have been removed and surgery completed. Radiation therapy can also help deal with brain metastases. Sometimes, tumors can form around your spinal cord and your brain. In this case, you will need to undergo a particular type of chemotherapy known as intrathecal chemotherapy.(14)
If your doctor decides to treat brain metastases through radiation, then if only a few metastases are present, they will use a particular type of radiation therapy known as stereotactic body radiotherapy (SBRT).(15) SBRT gives radiotherapy to the tumors from many different angles around the body, meaning that the tumor receives a high dose of radiation, but the healthy tissues around it receive a lower dose. This helps in reducing the side effects caused by radiation therapy.
Complications Arising From Cancer Treatment
While there are complications from advanced breast cancer itself (as discussed above), the actual treatment for cancer can also give rise to several complications.
Cancer treatments focus on getting rid of the abnormal cells from the body, which is why you might experience some unpleasant side effects. In some cases, patients start to feel like the treatment is actually even worse than the cancer itself. However, it is essential to realize at this stage that the discomfort and pain stemming from the treatment will eventually go away, and your healthy cells will start to recover.
Cancer treatments are known to make you sick and cause pain. For example, chemotherapy treatments usually result in nausea, nerve damage, mouth sores, and diarrhea. Radiation therapy, on the other hand, is known to cause scarring and burning pain. Any surgical intervention will also be painful and is going to require significant time for recovery.
Even when doctors remove your lymph nodes to look for any cancer cells, this causes a disruption to the flow of lymph fluid in the body. If there are not enough lymph nodes left in the body to properly drain fluid from any particular area, you will notice that a painful swelling will occur, known as lymphedema.
It is best if lymphedema is caught early so that it can be treated with massage, physical therapy, or a compression sleeve. Pain from a lymphedema can be treated with over-the-counter pain relievers or by taking stronger prescribed pain killers. Side effects of chemotherapy can also be treated with other medications.
Advanced breast cancer does not have any cure, but is manageable through treatments. The actual cancer, as well as the treatments used, are known to give rise to certain complications. Pain and other unpleasant complications from stage IV breast cancer can make it challenging to manage your symptoms. You need to keep your doctor updated about any type of complication you experience as it is necessary to determine whether the symptoms indicate a more severe problem or if the present treatment can be allowed to continue. Your doctor will work together with you to help manage the symptoms and complications and to help you feel better.
- Cancerresearchuk.org. (2019). What is advanced breast cancer? | Cancer Research UK. [online] Available at: https://www.cancerresearchuk.org/about-cancer/breast-cancer/advanced/about [Accessed 18 Aug. 2019].
- Breastcancer.org. (2019). Breast Cancer Pain | Breastcancer.org. [online] Available at: https://www.breastcancer.org/treatment/pain/causes/cancer [Accessed 18 Aug. 2019].
- Macedo, F., Ladeira, K., Pinho, F., Saraiva, N., Bonito, N., Pinto, L. and Gonçalves, F., 2017. Bone metastases: an overview. Oncology reviews, 11(1).
- Suva, L.J., Griffin, R.J. and Makhoul, I., 2009. Mechanisms of bone metastases of breast cancer. Endocrine-related cancer, 16(3), pp.703-713.
- Breastcancer.org. (2019). Breast Cancer Metastasis to Lung: Symptoms and Diagnosis. [online] Available at: https://www.breastcancer.org/symptoms/types/recur_metast/metastic/lung [Accessed 18 Aug. 2019].
- Cancer.Net. (2019). Fluid Around the Lungs or Malignant Pleural Effusion. [online] Available at: https://www.cancer.net/coping-with-cancer/physical-emotional-and-social-effects-cancer/managing-physical-side-effects/fluid-around-lungs-or-malignant-pleural-effusion [Accessed 18 Aug. 2019].
- Aydin, Y., Turkyilmaz, A., Intepe, Y.S. and Eroglu, A., 2009. Malignant pleural effusions: appropriate treatment approaches. The Eurasian journal of medicine, 41(3), p.186. Verma, A., Goh, S.K., Tai, D.Y., Kor, A.C., Soo, C.I., Seow, D.G., Sein, Z.N.N., Samol, J., Chopra, A. and Abisheganaden, J., 2018. Outcome of advanced lung cancer with central airway obstruction versus without central airway obstruction. ERJ open research, 4(2), pp.00173-2017.
- Living Beyond Breast Cancer. (2019). Liver Metastases. [online] Available at: https://www.lbbc.org/learn/types-breast-cancer/metastatic/liver-metastases [Accessed 18 Aug. 2019].
- Niedziałek, J., Kiciński, P., Przybylska-Kuć, S., Prystupa, A., Krzyżanowski, K., Dzida, G., Mosiewicz, J. and Jaroszyński, A. (2019). Ascites as the first sign of breast cancer – case report. [online] Jpccr.eu. Available at: http://www.jpccr.eu/Ascites-as-the-first-sign-of-breast-cancer-case-report,71407,0,2.html [Accessed 18 Aug. 2019].
- Cleveland Clinic. (2019). Ascites Management and Treatment | Cleveland Clinic. [online] Available at: https://my.clevelandclinic.org/health/diseases/14792-ascites/management-and-treatment [Accessed 18 Aug. 2019].
- Pereira, J. and Phan, T., 2004. Management of bleeding in patients with advanced cancer. The oncologist, 9(5), pp.561-570.
- Anon, (2019). Craniotomy. [online] Available at: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/craniotomy [Accessed 18 Aug. 2019].
- Oncolink.org. (2019). Intrathecal Chemotherapy (IT Chemo) | OncoLink. [online] Available at: https://www.oncolink.org/cancer-treatment/cancer-medications/overview/intrathecal-chemotherapy-it-chemo [Accessed 18 Aug. 2019].
- Cancerresearchuk.org. (2019). Stereotactic radiotherapy | Cancer treatment | Cancer Research UK. [online] Available at: https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/radiotherapy/external/types/stereotactic-body-radiotherapy-sbrt [Accessed 18 Aug. 2019].
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