Yes. Even without evidence of secondaries a primary has been removed by mastectomy and local radiotherapy, new secondaries can crop up in many different sites, even after 30 years, although one would never be sure that the secondaries are not already in the new locations at the time of primary treatment.
That's an interesting question. I'm not sure if there is any basic scientific research done about this as I'm no a lab guy. In clinical setting, we do see a lot of patient who have the primary breast cancer treated years ago, recurs in a distant site and luckily it can be removed surgically, and then it recurs at a new location again some time later. But it's hard to proof whether this "second recurrence" is from the original breast primary or from the first recurrence.
The most frequent sites of metastases are liver, lung and bone however, breast cancer also metastasize in brain.
COX-2 drives metastatic breast cells from brain lesions into the cerebrospinal fluid and systemic circulation.
Cancer Res. 2014 May 1;74(9):2385-90. doi: 10.1158/0008-5472.CAN-13-2660. Epub 2014 Mar 10.
Chandra:
In fact, we have not only robust data from the Netherlands Cancer Institute [Weigelt et al., Nature Rev Cancer Aug 2005], the US NCI, JCCRI in Japan, and numerous other cancer authorities throughout the world (updated in an internal review of my own as of early 2014), but also the aggregated reported experience in registry records of breast cancer organizations (including my own, the No Surrender Breast Cancer Foundation (NSBCF) where I serve as Director of Medical Research) that breast cancer can (and has) significantly metastasize to 18 different organs and viscera, and these are listed below in rough order of overall incidence:
Bone
Lung
Liver
Pleura
Adrenal glands
Stomach/gastrointestinal (including colon, jejunum, and rectum)
Peritoneum-retroperitoneum
CNS (which includes: brain and/or leptomenigeal)
Skin
Pericardium
Ovary
Kidney
Thyroid
Spleen
Pancreas
Heart
Uterus
There are some sporadic reports of metastatic migration to still other sites, but these have not been decisively confirmed and remain speculative pending dispositive confirmation.
Furthermore, it's very important to note however that these are general incidence stats across all breast cancer types indifferently. However, individual subclasses and subtypes have differential preferences. So, for instance bone metastases are highly uncommon in the basal subclass (which largely but not exclusively includes triple negative breast cancer (TNBC)), but significantly more common in endocrine-positive BC, while in contrast CNS mets (either brain or leptomeningeal or both) are vastly more common in both TNBC and HER2-positive disease where the brain serves as metastatic sanctuary, than in endocrine-positive disease. We therefore say that BC metastases are subclass/subtype-preferential.
Constantine,
I have gone through the publications mentioned above. They represent very valuable and elaborate research. But picking up where Chandra left the question thread, I would like to know that does it matter if the secondaries are from the primary tumor or whether it is the secondaries seeding in a widespread fashion? Would they not stillbe considered as mets, so long as it is established that the HP and other surface markers are the same? Does one need to establish this? Considering for the moment that it is possible to do so, will it change the treatment? What I mean to ask is that does it matter if the metastatic lesion in the brain came from the breast directly or whether it spread from the breast to the bone first and then from there to the brain?
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