Patients with metastatic breast cancer may have elevated levels of the tumor markers CA 27.29 and 15-3, though higher levels are not necessarily linked with metastatic disease — or even a diagnosis of breast cancer. These tumor markers can also be used to monitor response to therapy, though they are not necessarily the best predictor of clinical outcomes.6

In addition to elevated tumor markers, there may be other evidence of metastasis on labs and imaging. Lung metastases can be detected on plain chest radiograph, although a computed tomography (CT) of the chest may be more specific. Patients with bone metastases may have elevated alkaline phosphatase levels and an abnormal bone scan and/or magnetic resonance imaging (MRI). Patients with liver metastases may have elevated liver function tests (LFTs), which should prompt additional imaging of the liver and biliary system.

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When reviewing the abdominal imaging studies in the setting of possible biliary obstruction secondary to metastases, it is important to note whether there are focal lesions affecting the bile ducts, which have the potential for an endoscopic intervention.

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The workup for potential metastatic disease with bloodwork and imaging must be individualized for each patient. The individual’s unique symptoms and physical exam findings are critical factors for decision-making.

References

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin. 2017;67(1):7-30. doi: 10.3322/caac.21387
  2. Yamamoto N, Watanabe T, Katsumata N, et al. Construction and validation of practical prognostic index for patients with metastatic breast cancer. J Clin Oncol. 1998;16(7):2401-8.
  3. Greenberg PA, Hortobagyi GN, Smith TL, Ziegler LD, Frye DK, Buzdar AU. Long-term follow-up of patients with complete remission following combination chemotherapy for metastatic breast cancer. J Clin Oncol. 1996;14(8):2197-205.
  4. Robertson JF, Dixon AR, Nicholson RI, Ellis IO, Elston CW, Blamey RW. Confirmation of a prognostic index for patients with metastatic breast cancer treated by endocrine therapy. Breast Cancer Res Treat. 1992;22(3):221-7.
  5. Stuart-Harris R, Shadbolt B, Palmqvist C, Chaudri Ross HA. The prognostic significance of single hormone receptor positive metastatic breast cancer: an analysis of three randomized phase III trials of aromatase inhibitors. Breast. 2009;18(6):351-5. doi: 10.1016/j.breast.2009.09.002
  6. Harris L, Fritsche H, Mennel R, et al. American Society of Clinical Oncology 2007 update of recommendations for the use of tumor markers in breast cancer. J Clin Oncol. 2007;25(33):5287-312.

Topics:

Breast Cancer