Dormancy In Metastatic Melanoma
The time period between removal of the primary tumor and subsequent recurrence of disease is referred to as metastatic dormancy. In melanomas, a period of dormancy may end with the emergence of recurrent disease at a metastatic site and only rarely at the site of the primary tumor. Melanomas, as well as some other cancers, such as prostate and some types of breast cancer, often have very protracted courses in which metastatic disease does not manifest until years or even decades after removal of the primary tumor. Clinically localized melanoma can recur after disease-free intervals of 10 years or more . In fact, a subset of melanomas will have ultra-long dormancy with recurrence greater than 20 years later . Other tumor types, such as lung and pancreatic adenocarcinomas tend to follow a much swifter clinical course in which discovery of the primary tumor and subsequent metastasis is often a temporally contiguous event . While these differences in metastasis patterns may in part reflect differences in detection amongst different cancer types, it has also been proposed that such observations suggest that certain tumor types might gain full metastatic competency earlier in tumor progression .
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Cancer In Nearby Lymph Nodes
Sometimes cancer is found in lymph nodes that are near to where the cancer started. For example, breast cancer cells may travel to lymph nodes in the armpit or above the collar bone .
If a surgeon removes a primary cancer, they often remove some of the nearby lymph nodes. The lymph nodes are examined to see if there are any cancer cells in them.
The risk of the cancer coming back may be higher if the nearby lymph nodes contain cancer cells. Your doctors may suggest you have more;treatment;after surgery to reduce the risk.
Cancer in lymph nodes that are further away is called;secondary cancer. Cancer found in nearby lymph nodes is usually treated differently to cancer in lymph nodes that are further away from the primary cancer.
Living With Stage : The Breast Cancer No One Understands
Editor’s note: We’re bringing back this piece from October 2014 for Metastatic Breast Cancer Awareness Day and to honor Jody Schoger, featured in the story. Schoger died of metastatic breast cancer in May. Want to learn more about MBC? Look for our tweets at the Northwest Metastatic Breast Cancer Conference this Saturday at Fred Hutch.
A no-nonsense Texan of 60 years, Jody Schoger* has a very no-nonsense way of educating people about her metastatic breast cancer.
âSomeone will say, âWhen are you done with treatment?â and Iâll tell them, âWhen Iâm dead,ââ said Schoger, a writer and cancer advocate who lives near Houston. âSo many people interpret survivorship as going across the board. That everybody survives cancer now. But everybody does not survive cancer.â
An estimated 155,000-plus women in the U.S. currently live with âmets,â or metastatic breast cancer. This type of cancer, also called stage 4 breast cancer, means the cancer has metastasized, or traveled, through the bloodstream to create tumors in the liver, lungs, brain, bones and/or other parts of the body. Between 20 and 30 percent of women with early stage breast cancer go on to develop metastatic disease. While treatable, metastatic breast cancer cannot be cured. The five-year survival rate for stage 4 breast cancer is 22 percent; median survival is three years. Annually, the disease takes 40,000 lives.
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If All The Cancer Was Removed With Surgery Why Do I Need Any Additional Treatment
It has long been recognized that breast cancer is not always cured by locoregional treatment alone.
The goal of treating early breast cancer is to remove the cancer and keep it from coming back . Most people diagnosed with breast cancer will never have a breast cancer recurrence. However, everyone who has had breast cancer is at potential risk of recurrence, and that is why in most cases, there is a recommendation for treatment in addition to surgery, which is known as adjuvant therapy.; The risk of recurrence can never be entirely eliminated, but the aim of adjuvant therapy is to reduce recurrence risk to the absolute minimum.
How Fast Breast Cancer Grows
People may wonder about growth or doubling time when considering how long to wait to begin treatment. This growth is also very important to understand if you have a lump and have been advised to simply observe it over time.
Unless your healthcare provider is extremely confident that a lump is benign, it should be evaluated right away rather than waiting.
In general, the growth of breast cancer can be quite variable, but several studies provide at least an estimate of what may be happening.
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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.
What Is The Lymph System
The lymph system is a part of your bodys immune system. It includes a network of lymph vessels and lymph nodes.;Lymph vessels are a lot like the veins that collect and carry blood through the body. But instead of carrying blood, these vessels carry the clear watery fluid called lymph.;Lymph fluid also contains white blood cells, which help fight infections.
Lymph fluid would build up and cause swelling if it were not drained in some way. Lymph vessels draw up the lymph fluid from around the cells to send it towards the chest. There, lymph fluid collects into a large vessel that drains into a blood vessel near the heart.
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Metastasis To Other Sites
Hepatic metastases are detected clinically in 1020% of cutaneous melanoma patients with metastatic disease . Sub-clinical metastases to the liver are much more common, as they are found in 5477% of melanoma patients at the time of autopsy . Liver metastases occur relatively late in disease progression, with an average lifespan of only 24 months in patients with clinically evident liver metastases . Liver metastases are rarely the first site of disease spread in cutaneous melanoma . Work by Song and colleagues has implicated laminin-1 as a mediator of B16 melanoma cells metastasizing specifically to the liver . In these experiments, cells selected for the ability to adhere to laminin-1 were more efficient in forming liver metastases in mice . Vidal-Vanaclocha and colleagues have implicated interleukins, IL-1 and IL-18 in hepatic metastasis . Mice deficient for IL-1 show an 84-95% reduction in experimental liver metastases. IL-18 is thought to increase expression of VCAM-1 in the hepatic sinusoidal epithelium. Blocking IL-18 with a soluble factor can decrease the adhesion of melanoma cells by inhibiting this mechanism . Laminin-1/VCAM-1 can interact with integrins suggesting again that not only adhesive specificity, but also downstream survival signals are important in determining organ specificity of metastasis.
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Breast Cancer With Possible Spread To Lymph Nodes In Neck
Hi, I have been really worried. Last year I was diagnosed with BC Her2+ and I had chemo Fec-T and radiotherapy. I started zolendronic acid on Friday and I am still on Herceptin. Yesterday I went for an ultrasound to my neck. The radiologist spoke of finding 3 enlarged lymph nodes I think at the base of my neck. I am so worried it has come back and that prognosis will be poor. Has anyone had anything similar? IN other ways I am feeling well. Thank you. Xx
Hi Sunny-day
I’m sorry to hear that the radiologist found some enlarge lymph nodes on your recent ultrasound. It’s understandable that you’re cconcerned about what these may be and what they may mean given that you’ve had breast cancer.;
I would say that we seem to have;a lot;of posts here on the forum at the moment from people who have swollen lymph nodes so try to stay positive and remember that there could be a number of reasons other than cancer for this problem.;
Have you spoken to your GP or Consultant about these findings? It’s certainly worth giving them a call to talk things through and see if they feel further investigation is needed.;
Keep in touch and let us know how you get on.;
Best wishes,;
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Swollen Lymph Nodes: What Do They Mean
Swollen lymph nodes, or swollen glands, are a symptom of many illnessesfrom the common cold to some forms of cancerand a sign that something is wrong in the body. The swelling or enlargement, called lymphadenopathy, occurs in the lymph nodes when theyre filtering cells affected by a condition, such as an infection, injury or cancer. The most common reason lymph nodes swell;is because of an infection, particularly viral infections such as a cold. Its much rarer for swollen lymph nodes to be a symptom of a more serious condition such as cancer.
The lymph nodes are likely to swell in one specific region depending on the illness. This will usually occur in the neck, armpits or groin. Less common is when lymph nodes swell in several regions at the same time. That condition may be brought on by infections such as strep throat or mononucleosis, a reaction to certain medicines, an immune system disorder such as rheumatoid arthritis, and forms of cancer;such;as lymphoma;and leukemia.
When lymph node swelling persists and is accompanied by other symptoms, such as fever or night sweats, or when theres no obvious infection, it may be time to seek medical advice or evaluation from a doctor.
You Must Know How Breast Cancer Spread Faster
In the United States, Breast cancer is the most common cancer diagnosis among women these days.
It is complicated to estimate how a persons breast cancer will change over a year. Several types of breast cancer grow at different rates, and many parts affect its growth and spreading chances.
Here we discuss how breast cancer can spread faster, the common ways it can progress, and the long-term risk for the disease.
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What Is Breast Cancer
Breast cancer is cancer that starts in the breast tissues. Breast cancer is one of the most common cancers that affect women and is the second leading cause of cancer deaths in women. Men can also develop breast cancer, however, less than 1% of breast cancers are diagnosed in men.
Cancers are a unique group of diseases caused by genetic mutations, which make certain types of cells turn abnormal and grow out of control. Most types of cancers grow into masses of tissue known as tumors. Cancer spreads when tumor cells break off from the primary tumor, migrate to other parts of the body and start growing.
How Does Distant Recurrence Occur
Many patients find it hard to understand how they can be apparently cancer free one day and be diagnosed with recurrent cancer the next. If surgery got all of the cancer out and chemotherapy and radiation were supposed to have mopped up the rest, how can recurrence even happen?
In most cases, even the smallest breast cancer detected has been growing for some time before it was caught. During this period of growth, the cancer cells multiplied and divided over and over again, and some cancer cells may splinter off from the main tumour and escaped into the surrounding blood and lymphatic vessels. Cells that spread to lymph nodes can certainly be trapped in those lymph nodes and removed at the time of surgery, but cells can also go into the circulatory system. Even early-stage cancers that originally had no lymph node involvement can recur and develop metastatic disease.
While its less common, cancer cells can bypass lymphatics and lymph nodes and travel via surrounding blood vessels. Cancer cells can continue to circulate and go anywhere the blood vessels will take them, or they can home in on other organs in the body, where they take up residence and continue to grow and divide in that one particular spot.
If and when cancer comes back, the cancer cells that escaped the breast are to blame. Obviously if your recurrence is ten years after your diagnosis, we assume that the cells have been dormant all that time and missed the treatments aimed at dividing cells.
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Axillary Lymph Node Dissection
In this procedure, anywhere from about 10 to 40 lymph nodes are removed from the area under the arm and checked for cancer spread. ALND is usually done at the same time as a mastectomy or breast-conserving surgery , but it can be done in a second operation. ALND may be needed:
- If a previous SLNB has shown 3 or more of the underarm lymph nodes have cancer cells
- If swollen underarm or collarbone lymph nodes can be felt before surgery or seen on imaging tests and a FNA or core needle biopsy shows cancer
- If the cancer has grown large enough to extend outside the lymph node
- If the SLNB is positive for cancer cells after chemotherapy was given to shrink the tumor before surgery
What Does Lentigo Maligna Look Like
Lentigo maligna presents as a slowly growing or changing patch of discoloured skin. At first, it often resembles common freckles or brown marks . It becomes more distinctive and atypical in time, often growing to several centimetres over several years or even decades. Like other flat forms of melanoma, it can be recognised by the ABCDE rule: Asymmetry, Border irregularity, Colour variation, large Diameter and Evolving.
The characteristics of lentigo maligna include:
- Large size: >6 mm and often several centimetres in diameter at diagnosis
- Irregular shape
- Variable pigmentation colours may include light brown or tan, dark brown, pink, red or white
- Smooth surface.
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How Is A Local Recurrence After Lumpectomy Diagnosed
After a diagnosis of early stage breast cancer, any remaining breast tissue should be evaluated annually with scans .
Most local recurrences within the breast after lumpectomy are detected on routine annual breast imaging, which usually takes the form of mammography and ultrasound, and on occasions MRI.
If you have a local recurrence or new primary breast cancer, you may find symptoms similar to an initial breast cancer. This includes:
- A new lump in the breast, armpit area or around the collarbone
- A change in breast size or shape
- Changes to the nipple, such as sores or crusting, an ulcer or inverted nipple
- Clear or bloody nipple discharge
- Changes to the skin including redness, puckering or dimpling
- Breast tenderness or pain
Once a local recurrence has been diagnosed, we do tests to see whether there are signs of cancer elsewhere in the body. These may include a chest X-ray, CT scan, bone scan or PET scan, and blood tests , then we have to figure out how best to treat the tumour in the breast. Usually in these cases we do a mastectomy, as the prior less drastic surgery and radiation didnt take care of it.
Breast Cancer Staging And Lymph Nodes
After an initial cancer diagnosis, youll need to know if it has spread beyond the primary tumor. If you have enlarged lymph nodes, your doctor may be able to perform a needle biopsy. Otherwise, the lymph nodes can be checked when you have breast surgery.
Your doctor will assign a clinical stage based on:
- a physical exam
- imaging tests
- a biopsy of the tumor
After surgery, youll have more detailed information from the breast tissue and lymph nodes. This information helps provide the pathological stage.
Lymph node involvement is a key factor in staging breast cancer. In the TNM staging system:
- T is for tumor size
- N represents lymph node involvement
- M is for metastasis
Heres a closer look at what to know about cancer cells and lymph node involvement.
Other things that can influence breast cancer staging include:
- Tumor grade. This has to do with how abnormal the cancer cells appear under a microscope. The higher the grade, the more aggressive the cancer.
- Biomarker tests. The cancer cells will be checked for certain receptors, such as estrogen, progesterone, and HER2 . All of these can help fuel the growth of cancer cells in the breast.
All these factors are combined to determine the stage.
Breast cancer staging
Breast cancer has four stages. When lymph nodes are involved, its at least stage 2. Metastatic breast cancer is stage 4.
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Diagnosing Symptoms Related To Lymph Nodes
When touching an affected area, swollen lymph nodes may feel soft and round, like lumps the size of a pea, peanut or grape. If theyre painful when touched, that may be a sign of inflammation. Since lymph nodes appear in parallelas, for instance, on both sides of the neckyou can feel lymph glands on both sides to see whether they are a normal size on one side and enlarged on the other, which may be a sign of infection.
In determining a diagnosis, its important for doctors to look at other symptoms or factors. Swollen lymph nodes near the ear may indicate an ear infection, for instance. Swollen glands in the neck area near the collarbone, combined with a sore throat and cough, may be a sign of an upper respiratory infection. When multiple regions of lymph nodes are swollen, it may indicate a body-wide disease that needs immediate attention.
Besides reviewing your medical history, doctors may use some of the following methods to diagnose the cause of swollen lymph nodes:
- Physical examination, feeling with fingers the nodes in the affected area to check their size and whether they feel hard, tender or warm
- Lab tests, including blood tests to check for suspected underlying conditions