Prognosis for Metastatic Breast Cancer — Metastatic is the spreading of cancer cells from the primary tumor to vital organs or distant places on the patient’s body. The process is the result of a series of changes to genetic, epigenetic events and reactions the body against tumor. Metastasis is the central feature on the malignant tumor or that we know with cancer. Metastatic cancer requires an activation of effector genes or gene inaktivation metastasis-suppressor gene metastatic Cascade line is different and more complex than a cascade of tumorigenesis. This concept fits with discovery Kang et al. stating that for certain organ to a metastasis of cancer require specific gene expression of laden who is attached to the primary tumor bad profile. The spread of cells depends on the quantity of the component molecules like adhesion receptors, extracellular, Ligand affinity metrics between membrane receptors and chemoatractan, the enzymes protease, a protein-specific proteins that are bound to a particular cell and molecular skeleton.
Of the various organs, brain metastasis is the worst in its clinical manifestation and prognosis. The incidence of brain metastases for various tumors is 6% to 24% in adults while the kids are at 6% to 10% most often from solid tumors.
treatment for metastatic breast cancer to brain
Lassman and De Angelis did a review on the research and reporting the results of varying numbers of brain metastasis occurrence based on the type of the primary tumor. Found 18% to 64% (lung cancer), 2% to 21% (breast cancer), 2% to 12% (colorectal), 4% to 16% (melanoma), 1% to 8% (kidney), 1% to 10% (thyroid), and 1% to 18% (primary unknown).
Breast cancer (KPD) clinically brain metastases are found to 16% of the population of the KPD with metastasis. The amount will be doubled if the autopsy done on sufferers who died of metastatic KPD. The autopsy results of abnormalities that are found in the form of leptomeningeal lesions.
Prognosis for Metastatic Breast Cancer to Bone
KPD metastatic brain had a poor prognosis with a median survival figures 3 to 6 months, another source States can last up to 3 years. Patients will ultimately fall on the clinical conditions of the form of the neurological abnormalities are progressive. Usually associated with an aggressive tumor behavior, at a young age (pre-menopausal) and often accompanied by lung or liver metastases have on. From some research not found connection with the magnitude of the primary tumor and the number of positive lymph glands.
Estimated in the future will be found an increased incidence of brain metastases, figures as a result of handling systems improvement factor of cancer so extension of survival, the discovery program screening for patients suspected of and increased the ability of the imaging tool in detecting metastatic brain.
For the success of a Cancer Metastatic colonies in the brain makes necessary a variety of loaded so that the cells can pass through the blood-brain barrier (dense connective tissue between the endothelial cells and the brain, the basal membrane thickness and astrocytes that regulate the flow of nutrients, ions and cells into the brain). The process requires the work of various enzymes and degradation of the performance of a variety of receptors that are not found on the outside of brain metastases. The theory of metastasis by Paget is still widely accepted in addition to the multi-step theory propounded by Hellman et al. Metastatic brain blood flow, mainly through the expansion of direct venous Plexus, via spreading or through the nerve fibers and the flow of lymph perineural.
Implantation can place in the leptomeninges, meninges and in parenkin in the brain. Most of its spread through the bloodstream. The lesions found 80% in the cerebrum, the cerebellum, at 15% and 5% in the brainstem. These describe the distribution of blood flow in the brain. Metastatic brain tends to be unbounded firmly without any infiltration into the surroundings, often found the presence of edema around the lesion (perifocal) and rare bleeding.
A known risk factor in the incidence of brain metastases KPD include estrogen and progesterone receptor negative and over-expression of HER2.┬á The latest research with mikroarai DNA revealed a connection between the basallike subtype KPD be intrinsic (ER-PR-, HER2-,) which is found in 10%-15% of the population of the KPD, luminal A (ER +, PR +), as a prognostic factor of brain metastasis of events. Basallike luminal A and has a shorter durability compared to other types of sub. The intrinsic type sub is associated with patient survival KPD. Tumors with histological grading, and a large primary tumor as well as the existence of extra cranial metastasis is also found as a prognostic factor of ugly.
Prognosis for Metastatic Breast Cancer to Spine
From some research obtained the degree of expression of CD44 (a transmembrane glycoprotein that was codified by the 11th chromosome and function in cell adhesion process at hialuronan) on the surface of tumor cells also play a role in the incidence of metastasis.
The presence of a high expression of CD44 is a bad prognostic for the incidence of brain metastases. Mechanism of action in the form of decreased function of adhesion or bonding of the cells to hialuronan with the increase the take up and degradation of hialuronan.
The discovery of clinical patients with brain metastases in the form of a headache (25%-50%), which is a focal weakness (16%-40%), changes in mental condition (24%-31%), seizures (15%-16%), and ataxia (9%-20%). In case of bleeding will develop acute neurological symptoms and signs. Based on data collected since 1973 only 10% in patients of brain metastases were detected by CT or MRI revealing symptoms. Papil edema can be found in 15% of patients.
Although tracking brain metastasis is not a routine procedure in case management, need to be wary of new LIBATION on patients with neurological complaints lasting days or weeks. Radiological examination in the form of a CT scan or MRI to be done. Recommended for metastatic brain imaging with MRI using gadolinium contrast reinforced so it could meningeal metastases have detected. Examination of CT scan done when MRI is not available.
The research of Rosenthal, et al 1998 to seek factors associated with the incidence of brain metastases in the KPD gaining 3 laboratoris parameter in the form of increased serum LDH above 250 U/dl, numbers of platelets more than 350 000/dl and numbers of lymphocytes and 10% or less will be found in patients with brain metastases prior neurological manifestations are found.
Brain metastasis KPD handlers include surgery, radiotherapy or surgery of stereotactic with gamma-knife. As medikomentosa insial therapy in patients with clinical manifestation is suspected by administering dexamethasone 4 mg every 6 hours will improve clinical though the duration of short works. Administering anticonvulsants is recommended even though there has been no clinical manifestations of considering the 20%-30% of patients suffered seizures.
Whole brain radiation therapy is palliative initials for all brain metastasis KPD is no exception when it found multiple lesions. 30 Gy dose (grays) in 10 fractions. Radiotherapy will improve neurological symptoms that arise. Side effects of radiotherapy for patients who survived more than 1 year in the form of the dimentia accompanied by ataxia. To reduce the side effects of stereotactic radiosurgery technique developed. Tumors with a diameter of 3 cm or less were given a dose of 15-20 Gy single faction, while tumors over 3 cm in diameter with a dose of 36 Gy in 6 fractions, 5 times per week.
Surgery on patients that deserve clinical as well as endurance will improve his life. Patients who are selected to undergo resection of metastasectomi is in the form of a single lesion, the location of the tumor can be on-acces, with tumors that used a bulky and not a full response against radiotherapy. Another preoccupation is the lack of a metastasis elsewhere or if there has been a complete responded against systemic therapy.
Patients who underwent carcinomatotic risk of leptomeningeal spread of the tumor has occurred throughout the brain so that needs to be done the therapy instilation chemotherapy into the LCS through port Ommaya reservoir punction lumbar. Methotrexate regimen is 12 mg (10-15 mg) 2-3 times per week to not find cancer cells in the LCS. Reported to be 60%-80% of patients experience clinical improvement. Side effects and complications that occur in the form of symptoms and signs of meningitis (aceptic) as well as the symptoms of brain damage and a layer of screening because of chemotherapy. To minimize the adverse effect needs to be given additional acid folinat per oral or intra venous.
Systemic therapy with the use of medications or chemotherapy with tamoksifen’ve never examined whether having a beneficial effect in dealing with brain metastases, but there is no harm if a try. Techniques to bring a systemic medication can penetrate the blood-brain barrier by means of osmotic blood-brain barrier wrecking. The agent used is mannitol and bradykinin.
Granting of trastuzumab prior to radiotherapy to brain has also been done and give you an advantage in tumour HER2 (2 +). Test the pharmacokinetics give conclusion awarding of trastuzumab 8 mg/kg as a loading dose and continued with a dose of 6 mg every 3 weeks.