When breast cancer spreads to the lymph nodes, tests are done to check for metastasis (when the cancer spreads to other organs, such as the bones, lungs or liver). Although the cancer starts in the breast, it can be carried to other parts of the body through the lymph fluid and/or the blood. Once breast cancer spreads, prognosis is poorer.
About five percent of U.S. women have metastatic breast cancer when they are first diagnosed . Most people with metastases have been treated for breast cancer in the past and that cancer has returned (recurred) and spread. Learn more about breast cancer recurrence.
Shortness of breath, chronic cough, weight loss and bone pain can be symptoms of metastases. Tests must be done to confirm or rule out metastases. The three main tests are:
Positron emission tomography (PET) and other tests for metastases may be done, depending on a person's symptoms and the findings from the three main tests.
The letter “M’ in the TNM breast cancer staging system shows the presence or absence of metastases. Cancer has either spread beyond the breast and nearby lymph nodes to other areas of the body (M1) or it has not (MO).
Tests for metastases include:
Metastases cannot be assessed
Learn about treatment for metastatic breast cancer.
Oncotype Dx is a test that helps predict the chance of metastasis (when cancer spreads to other organs) for some breast cancers. It tests a sample of the tumor (removed during a biopsy or surgery) for a group of 21 genes. Along with other prognostic and diagnostic factors, the results of the Oncotype Dx test can be used to tailor treatment plans.
If the test shows a person has a fairly high risk of metastasis (the Oncotype DX score is high), a more aggressive treatment plan that includes both hormone therapy and chemotherapy may be advised [33-36]. If the test shows a low risk of metastasis (the Oncotype DX score is low), the use of hormone therapy alone may be considered. In this way, Oncotype Dx may help some people avoid chemotherapy and its side effects.
Oncotype Dx helps predict the chance of metastasis for breast cancers that are all of the following [31-33]:
Oncotype DX may also be used in select postmenopausal women with invasive breast cancers that are all of the following [33-36]:
Although Oncotype Dx can provide some prognostic information in select premenopausal women with lymph node-positive breast cancers, it is not used to guide treatment for these women. Researchers have not yet studied whether it can help predict chemotherapy benefit for lymph node-positive premenopausal breast cancers.
Researchers are studying whether Oncotype DX can predict how well breast cancers will respond to different chemotherapy drugs.
The Oncotype DX test for invasive breast cancer has been modified to help predict the chance that ductal carcinoma in situ (DCIS) will return as DCIS or invasive breast cancer . This could help identify which cases of DCIS would benefit most from radiation therapy after lumpectomy (and which women might be treated with lumpectomy alone) . This test needs further study and is not yet part of standard practice.
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