Breast metastasis refers to the spread of breast cancer cells to other parts of the body through the blood or lymphatic system.
Pathway
of
metastasis
-Lymphatic metastasis: The breast is rich in lymphatic drainage, and cancer cells are prone to metastasize to axillary lymph nodes through lymphatic vessels, which is the most common site of lymphatic metastasis. When axillary lymph nodes are involved, they may further metastasize to subclavian and supraclavicular lymph nodes.
-Hematogenous metastasis: After cancer cells enter the blood circulation, they can metastasize to distant organs with the blood flow. The more common metastatic sites are lung, bone, liver and brain. Cough, hemoptysis and other symptoms may occur if the disease is transferred to the lung; bone pain and pathological fracture may occur if the disease is transferred to the bone.
Influencing factors
-Tumor characteristics, such as tumor size, grade, type, etc., can affect metastasis. Generally speaking, the larger the tumor, the higher the grade and the higher the malignancy of breast cancer, the more likely it is to metastasize.
-Treatment: If breast cancer is not treated promptly and effectively in the early stage, the risk of metastasis of cancer cells will also increase.
Diagnostic method
Imaging examination: For example, CT can detect metastasis of internal organs of the body; bone scan can detect bone metastasis; breast molybdenum target is mainly used to check the breast itself, but it also has a certain suggestive effect on metastasis.
-Pathological examination: The tissue at the suspected metastatic site is obtained by puncture or surgery for pathological examination, which is the “gold standard” for the diagnosis of metastasis.
Treatment strategy
-Local treatment: For isolated metastases, such as single brain or bone metastases, surgical resection or radiotherapy may be considered to control the local tumor.
-Systemic treatment: including chemotherapy, endocrine therapy, targeted therapy, etc. For example, endocrine therapy is an important treatment for patients with hormone receptor-positive breast cancer metastases, and targeted therapy combined with chemotherapy can improve the efficacy for HER-2 positive patients.
Breast cancer metastasis to the lungs is mainly treated by the following methods:
Systemic treatment
Chemotherapy: Chemical drugs are used to kill cancer cells. Through intravenous injection or oral medication, the drug will reach the metastatic focus of the lung along with the blood circulation and inhibit the growth and spread of cancer cells. For example, the use of paclitaxel, docetaxel and other drugs.
-Endocrine therapy: for patients with hormone receptor positive breast cancer. It inhibits the growth of cancer cells by regulating hormone levels in the body. Drugs such as tamoxifen and letrozole can control the development of lung metastases to some extent.
-Targeted therapy: For patients with lung metastases from HER-2 positive breast cancer, targeted drugs can precisely act on specific targets of cancer cells. For example, trastuzumab can effectively inhibit the proliferation of cancer cells.
Local treatment
-Radiation therapy: high-energy rays are used to irradiate lung metastases, destroying the DNA of cancer cells and depriving them of the ability to regenerate. Radiotherapy can effectively relieve symptoms and control the growth of local tumors for oligometastatic (fewer metastases) or symptomatic metastases, such as those causing hemoptysis and chest pain.
-Surgical treatment: In some cases, if the lung metastasis is isolated and can be completely removed, and the patient’s body can tolerate the operation, surgical removal of the lung metastasis may also be considered. However, such cases are relatively rare and require a comprehensive assessment of the patient’s overall condition and metastasis.
The course of chemotherapy for lung metastasis of
adenocarcinoma is affected by many factors.
Chemotherapy regimen
Different chemotherapeutic drug combinations have different courses of treatment. For example, the commonly used AC-T regimen, A is Adriamycin, C is Cyclophosphamide, and T is Docetaxel. The AC program is generally a course of treatment every 3 weeks, a total of 4 courses; after the T program is also a course of treatment every 3 weeks, a total of 4 courses. The CMF regimen (cyclophosphamide, methotrexate, fluorouracil) is usually 21-28 days as a cycle, usually 6 cycles.
Patient status
-Physical tolerance: If the patient has good physical tolerance and can withstand the side effects of chemotherapy drugs, it may follow the standard course of treatment. However, if the patient has serious adverse reactions, such as bone marrow suppression (low white blood cells, platelets, etc.), severe nausea and vomiting, liver and kidney function damage, the doctor may appropriately extend the interval of the course of treatment, or adjust the dosage of drugs, change drugs to ensure the safety of patients, so that the course of treatment will be extended.
-Disease progression: If the lung metastases are found to be well controlled and significantly reduced through imaging examinations (such as chest CT) during chemotherapy, the course of treatment may be completed as planned. However, if the disease progresses, new metastases appear or the original lesions increase, doctors may consider changing the chemotherapy regimen, and the course of treatment will change accordingly.
The course of
chemotherapy requires the doctor to make a comprehensive judgment according to the chemotherapy plan, the patient’s physical condition and the progress of the disease, and generally adjust constantly in the course of treatment in order to achieve the best therapeutic effect.
There are many side effects after chemotherapy for lung metastasis of
breast cancer.
Digestive tract side effects
-Nausea and vomiting: This is relatively common and is caused by the stimulation of the gastrointestinal tract by chemotherapy drugs. The degree may vary, with some patients experiencing only mild nausea and others experiencing frequent and severe vomiting.
-Canker sores: Chemotherapy drugs can affect the normal cell turnover of the oral mucosa, making the oral mucosa fragile and prone to ulcers, leading to pain in eating.
-Diarrhea or constipation: Some chemotherapy drugs can affect intestinal function, accelerate intestinal peristalsis and cause diarrhea, or slow down intestinal peristalsis and cause constipation.
Myelosuppression
-Chemotherapy drugs can inhibit bone marrow hematopoiesis. The most common is leukopenia, which can reduce the immunity of patients, easily infected, fever, cough and other symptoms.
-Thrombocytopenia is also common, which may cause patients to be prone to ecchymosis, nosebleeds, gingival bleeding, and visceral bleeding in severe cases.
Hair loss
Chemotherapy drugs may affect hair follicle cells and cause hair to fall out. However, hair loss is usually temporary, and hair usually grows back after chemotherapy.
Nervous system side effects
-Some chemotherapy drugs can cause numbness and tingling in the hands and feet, which feels like “ants crawling”, because the drugs damage the peripheral nerves.
-Headache, dizziness and other symptoms may also occur, affecting the daily life of patients.
Other side effects
-There will be fatigue and fatigue, and the patient will feel weak and have no strength.
-Some chemotherapy drugs may affect heart function, such as palpitation, palpitation and other symptoms.
-It may also lead to liver and kidney function damage, and abnormal liver function indicators (such as glutamic-pyruvic transaminase) or kidney function indicators (such as creatinine) can be found through blood tests.
