Muscle metastases

stride

Hello everyone,

This is my first post as a metastatic breast cancer patient.

I have widespread tumors, but the only one causing pain so far is in the strap muscle in my neck. My oncologist prescribed a fentanyl patch, but Tylenol seems to be more effective, I assume because the muscle is inflamed and needs and Tylenol is an anti-inflammatory. Breast cancer metastis to muscles in distant locations is a new concept to me. I did not even know that could happen.

I am wondering what others with muscle mets have experienced and what you have found useful for pain relief. Have you found it helpful to use hot and cold packs, like people do for a strained muscle? Is it OK to apply a heating pad to a tumor? Would that increase the tumor's blood supply?

I am starting chemo on Tuesday and hopefully that will shrink the tumor. But I am wondering what to expect if it does not. Does the muscle become weaker? I have been having pain when the muscle gets jostled, like on a car ride. I am considering asking for a neck brace to support my neck and keep my head from wobbling. Have other people used things like that to support their muscles?

Thanks for sharing any experiences you have with this!

Rosevalley

I have read about breast cancer attacking the muscle, usually I thought  it was lobular breast cancer that did that.  I think it's pretty unusual. I am sure someone on this forum will come along and help you out. I can't offer any advice or experience,  good luck with your treatment. I hope it works. I am curious how did they dignose the muscle mets? I would think that would be tricky.

Mzmerz

I have never heard of it either!  I hope you find something to help soon.

Skream

Good luck! I have never heard of muscle mets. Muscle cancers themselves must be very rare. Maybe you could consult with a rehab or palliative care doc, or a PT or OT at your cancer clinic? Another thought is at a large university cancer center that had an onc who specializes in muscle cancers. One of those folks will steer you toward less pain. I don't recall anyone on these boards mentioning mets to the muscle, but maybe there is someone.

dawny

Welcome stride, I am no help either, just wanted to say hi

Dawn

marianelizabeth

Stride, I hope you don't mind my asking how this was diagnosed? I think all of us fear metasteses and often the knowledge that we don't know it is happening. I wrote on the 2013 Survivors thread this past week about the intense neck/head pain I have been experiencing and when you mentioned pain when in a car I thought of my own neck as same for me. But I am on a drug called arthrotec which is a really strong anti inflammatory and has helped a lot. I had a CT scan of brain and neck on Wed. and it ruled out arthritis, disc issues and mets apparently but I am wondering if a CT scan would see muscle mets? Did you have an MRI? Or a PET total body scan? You seem to be taking it in "Stride" but I cannot help but think what a mind/body blow this must be right now and you did not have any positive nodes nor lymphovascular invasion either?

I am off to a early Sunday mornig gentle yoga class that does not require much neck movement!

hugs,

Marian

EnglishMajor

Sorry can't offer any firsthand insights. Topic was discussed on Inspire:

https://www.inspire.com/groups/advanced-breast-cancer/discussion/muscle-mets-1/

One person on that thread did say she had muscle mets (but not in the neck)

Hang in there

EnglishMajor

Dr. Google yielded the following

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3625758/#B7

...which doesn't really answer your question but I am passing it along...

one key thing here...they say that tumor status can change from your first (early stage diagnosis) to metastatic diagnosis. It's important to have a biopsy to confirm what kind of breast cancer it is.

Skeletal muscle metastasis is relatively rare compared with bone metastases. A few cases of radiologically apparent or clinically symptomatic skeletal muscle metastases have been reported in different tumor types [2-4]. It has been suggested that skeletal muscle is relatively resistant to metastatic disease because of its hostile microenvironment. Factors that make skeletal muscle hostile include muscle motion resulting in mechanical tumor destruction, inhospitable muscle pH, the muscle's ability to remove tumor-produced lactic acid associated with angiogenesis, and the activation of lymphocytes and natural killer cells in skeletal muscle [5,6]. However, according to data from a large autopsy series, subclinical metastases to skeletal muscle may be more common than generally thought, and the incidence has been reported to range from 0.2% to 17.5% [5,7]. The underdiagnosis of skeletal muscle metastases in clinical practice may be related to the observation that they are often manifested as part of the disseminated disease and furthermore, in some cases, it is difficult to detect skeletal muscle metastasis with the generally used CT scans.

Skeletal muscle metastasis from breast cancer is also uncommon, and is often manifested as disseminated disease with multiple organ metastasis [8]. Ogiya et al. [8] reported a case of breast cancer with an isolated metastasis into the abdominal wall muscle, with a review of 13 previously reported cases of which four presented as an isolated skeletal muscle metastasis without other distant metastases. The metastatic sites were the paraspinal muscle, scalene muscle, iliopsoas muscle, and extraocular muscle. In our patients, one relapsed with an abdominal wall muscle metastasis without other distant organ metastasis, and the other showed gluteal muscle metastasis with involvement of iliac lymph nodes. We performed a muscle biopsy for proper diagnosis, and a pathological examination revealed diffuse infiltration by cancer cells with disruption of the muscle fascicles.

Recently, several studies have reported a discordant HER2 status between primary and metastatic sites in breast cancer. Niikura et al. [9] reported that the incidence of discordance for ER, PR, and HER2 between primary and metastatic tumors was 18.4%, 40.3%, and 13.6%, respectively. However, to the best of our knowledge, no previous reports examined the hormone receptor or HER2 status of the primary tumor and metastatic skeletal muscle lesions. In our patients, we confirmed discordant ER, PR, and HER2 status between the primary breast cancer and the metastatic skeletal muscle lesions. Therefore, our cases support the need for the biopsy of metastatic skeletal muscle lesions to determine accurate diagnosis and proper management.

Skeletal muscle metastasis generally manifests itself as a painful mass in the involved area; our patients also complained of mild muscular pain [10]. However, skeletal muscle metastasis may be an incidental finding in imaging studies without symptoms [10]. Therefore, more careful monitoring of imaging results for musculoskeletal structures is required when evaluating the response. CT is generally used for staging and response evaluation, and provides information about the extent of the mass in skeletal muscle and its relationship with adjacent structures. However, most of the body's musculature is outside the scanned region of the chest and abdominal CT, and some lesions may be isodense compared with the surrounding muscle, making it difficult to differentiate the metastatic lesion from the surrounding muscle [5,7]. Magnetic resonance imaging (MRI) is the gold standard for imaging muscle disease; it shows features of muscle metastases that are relatively typical, consisting of round or oval intramuscular masses with well-defined margins and marked enhancement [7]. However, MRI is not commonly used in daily practice because it has high cost, long scanning times, and a limited field of view. The number of intramuscular metastases detected has increased since the introduction of PET/CT [11,12]. A recent study, in which unsuspected intramuscular metastases were found by PET/CT in 20 of 39 cases, showed that PET/CT has higher sensitivity than MRI for detecting skeletal muscle metastases [7]. In our second patient, we found a gluteal muscle metastasis by PET/CT that was initially missed on CT. Therefore, PET/CT may be a sensitive tool for detecting skeletal muscle metastases.

stride

Thank you all for responding.

An early-stage sister sent me a PM saying that tumors in muscles are sarcomas. That could be what's happening with me. My breast tumor ended up as triple-negative IDC with areas of carcinosarcoma after neoadjuvant TAC. I did not put the carcinosarcoma in my signature line before because I was focused on hormone receptor and Her2 status. But now I am wondering if the tumors in the muscles could be sarcoma cells that metastasized from the breast. I will ask my MO. It probably does not matter for treatment, but that could be why muscle tumors are so rare for breast cancer patients.

All of my tumors, other than the original breast tumor last year and the rib masses, were found on a CT scan last week. The rib tumors were found on a bone scan.

So far the only new mass I have had biopsied is a lump in the contralateral axilla, which was triple-negative. That lump was the reason I went back to the oncologist. I had no idea I metastases to all these other locations. The report from a PET/CT scan I had in December said "no evidence of metastasis."

I am having my port put in tomorrow, and my oncologist has told the surgical technician to biopsy whichever tumor he feels he can get the best sample from to send for hormone receptor and Her2 testing. Originally I was supposed to have a suspected skin met in my scalp biopsied, but the CT scan shows there are a lot of places that can be biopsied.

EnglishMajor, when there are a large number of tumors, do they assume the results from one or two biopsies are accurate for all of the tumors? Obviously they cannot biopsy everything. So how do they know? And can sarcomas have hormone receptors and Her2 overexpression? 

Marian, my 2013 Survivor comrade and friend, the responses to this post indicate you can probably rule out muscle metastasis. 

I have seen the words "lymphovascular invasion" on BCO before, but not on my pathology reports. I don't even know what it means. I had a suspicious lymph node on a PET scan before I started chemo, but the pathology report from surgery said I was node negative. An MRI before mastectomy showed the cancer had spread to my skin and chest muscle, but the post-surgical pathology report said it had not. I did not have IBC, but my breast was swollen and red by the time I had my mastectomy. It had been swelling and shrinking, swelling and shrinking. All of that fluid had to drain somewhere.

I think I have been taking this in "stride" (as you guessed, that is exactly why I chose that name) because I have not been able to grasp all of this. I have tumors in a bazillion places, and my only symptoms are a little bit of neck pain and a cough. The whole situation is unreal, and I just can't take it in.

My oncologist is confident the cancer will respond to carboplatin and gemcitabine. I sure hope so, because I think I will run out of time quickly if it fails.

EnglishMajor

Hi Stride,

Sorry, I don't the answer to your question about biopsies--the best I can respond is I think it is reasonable to pick the most accessible area to biopsy.  I'm sure your doc can explain. Hang in there and let us know how it goes.

IAmACat

Tonight, I was rubbing my neck and felt a pea-sized, hard lump under the skin of the back of my neck. I internet searched for breast cancer metastases in muscle, thinking that was not possible. However, on pubmed, there are two case studies of two very unlucky ladies who had muscle metastases--one in her abdomen, another in her buttock muscle. That's when breast cancer literally becomes a pain in the a**.

I am going to call my cancer hospital tomorrow and ask them to set me up with someone who can look at it.

mlc96

I have something similar. I am triple positive, became metastatic in 2016 after right arm swelling, that the Drs assumed was lymphedema, was an underarm lymph node tumor that spread into my shoulder and upper back, wrapped around brachial plexus nerves, and spread into bones in my neck, scapula, lumbar and hip. The nerve pain in my arm and shoulder was unbearable, I did get relief from heating pad and hydrocodone. Thankfully I had good response to Taxol, with Herceptin & Perjeta, and was NEAD for a year. I did a lot of arm/shoulder PT with a lymphedema therapist as I quickly lost motion and strength in my right arm. I get PET scans 2-3 times a year, and the bone mets have not returned, which is great, but the swelling came back in my shoulder, presses on the nerves and creates pain in my shoulder, neck and up to my ear, so it feels like an earache. My onc says my cancer is "infiltrating the soft tissue". I don't know if this is good or bad? I've been on chemo regularly for a year now, one scan will show reduction, then the next shows more activity. Fortunately I feel the pain and swelling so I guess I can diagnose myself. My chemo changed twice this past year, was on Navelbine and now Kadcyla.