From Cured To Stage 4
Others, like Teri Pollastro, a 54-year-old stage 4 patient from Seattle, respond surprisingly well.
Diagnosed with early stage ductal carcinoma in situ in 1999, Pollastro underwent a mastectomy but did not receive chemotherapy, radiation or tamoxifen, since her cancer was ER negative.
âThey used the C-word with me, they told me I was cured,â she said. âEvery time I went back to my oncologist, he would roll his eyes at me when I had questions.â
In 2003, Pollastro switched to Seattle Cancer Care Alliance where she saw Dr. Julie Gralow, a breast cancer oncologist and clinical researcher at Fred Hutchinson Cancer Research Center. Gralow discovered Pollastroâs cancer had metastasized to her liver.
âMy husband and I were in shock,â said Pollastro of her mets diagnosis. âYou donât go from being cured to stage 4.â
Pollastro went on Herceptin, a type of immunotherapy for women with HER2-positive metastatic breast cancer, and did six months of chemotherapy.
âI felt better right away with the treatment,â she said. âBut the problem is, it stopped . Thatâs what you can expect with mets. And thereâs always some residual cancer. And that starts percolating.â
And along with mets, she also had to deal with many misconceptions regarding her disease.
The Mercer Island, Washington, mother of two, who often counsels newly diagnosed patients, sometimes even found it difficult to relate to early stage breast cancer survivors.
What Is The Grade Of A Tumor
Tumor grade is a number that describes the aggressiveness of a tumor. Pathologists look at the cancer cells from a biopsy and/or surgery under a microscope to determine things such as how actively cells are dividing. Tumors are then given a grade of 1, 2, or 3, with 1 being the least aggressive and 3 being the most aggressive.
How Big Is A Stage 1b Breast Tumor
The tumor is less than 20 mm in size and there is no spread to lymph nodes. Stage 1B: T1N1miM0. The tumor is less than 20 mm in size and there are micrometastases in a nearby lymph node. Stage 1B: T0N1miM 0. There is no evidence of a primary tumor in the breast but there are micrometastases in a lymph node .
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Diagnostic Tests That Inform The Clinical Stage
Many methods are used to detect and stage cancer. Some of the common tests include:
Biopsy: The doctor uses a needle to extract breast tissue or fluid, which is then sent to a lab. There, various techniques are used to examine different attributes, such as hormone receptor or HER2 status.
Tumor markers: Rapidly dividing cancerous cells interrupt some of the normal mechanisms of cell growth. This causes the cell to overproduce certain molecules. Lab tests detect these compounds, known as tumor markers, in blood or tissue samples.
Imaging techniques: Several different scans are used to examine characteristics of your cancer. Below are some of the noninvasive imaging techniques you might encounter:
- MRI scans use magnets and radio waves to generate detailed pictures of your tissues.
- CT scans use X-rays to look at your organs. Nuclear scans trace the flow of an injected safe radioactive dye in your body.
- PET scans are similar to nuclear scans but specifically examine glucose consumption in the bodysince cancer cells use more glucose than normal cells.
- Ultrasound imaging uses sound waves to see inside your body.
Living With Stage : The Breast Cancer No One Understands
Editor’s note: We’re bringing back this piece from October 2014 for Metastatic Breast Cancer Awareness Day and to honor Jody Schoger, featured in the story. Schoger died of metastatic breast cancer in May. Want to learn more about MBC? Look for our tweets at the Northwest Metastatic Breast Cancer Conference this Saturday at Fred Hutch.
A no-nonsense Texan of 60 years, Jody Schoger* has a very no-nonsense way of educating people about her metastatic breast cancer.
âSomeone will say, âWhen are you done with treatment?â and Iâll tell them, âWhen Iâm dead,ââ said Schoger, a writer and cancer advocate who lives near Houston. âSo many people interpret survivorship as going across the board. That everybody survives cancer now. But everybody does not survive cancer.â
An estimated 155,000-plus women in the U.S. currently live with âmets,â or metastatic breast cancer. This type of cancer, also called stage 4 breast cancer, means the cancer has metastasized, or traveled, through the bloodstream to create tumors in the liver, lungs, brain, bones and/or other parts of the body. Between 20 and 30 percent of women with early stage breast cancer go on to develop metastatic disease. While treatable, metastatic breast cancer cannot be cured. The five-year survival rate for stage 4 breast cancer is 22 percent median survival is three years. Annually, the disease takes 40,000 lives.
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Inclusion And Exclusion Criteria
The inclusion criteria were as follows: the study subjects were diagnosed with BC, and patients with bone metastases were diagnosed by imaging or pathology complete data could be extracted, and the hazard ratio and 95% confidence interval could be directly or indirectly obtained more than 1 index was included and the number of patients with bone metastases from BC was not fewer than 10.
The exclusion criteria were as follows: duplicates, reviews, and case reports or studies for which the full text versions were unavailable the included patients had other tumors at the same time the data could not be extracted or were incomplete and studies with a Newcastle-Ottawa scale score 5.
The indicators of interest were as follows: estrogen receptor expression progesterone receptor expression HR expression, with positive ER or PR expression indicating positive HR expression human epidermal growth factor receptor-2 expression luminal A, luminal B, HER2 overexpression, and triple-negative breast cancer subtypes premenopausal and postmenopausal status histological grades I, II, and III positive or negative lymph node metastasis status, where negative status indicated that the number of lymph node metastases was 0 or the N stage was N0, and positive status indicated that the number of lymph node metastases was 1 or the N stage was N1N4 tumor size TNM T stage and histological types determined by pathology, including ductal, lobular, and others
What Are The Symptoms Of Bone Metastasis In Breast Cancer
All three doctors say that new, progressive pain in your bones or joints is the most common symptom of metastatic breast cancer in bones. “I always tell patients to inform me if there’s pain that’s not getting better,” says Dr. Tsarwhas. This can sometimes be confused with arthritis or other pre-existing chronic pain issues, he says, which is why it’s important for breast cancer patients to be proactive about any new pain they encounter.
New fractures or unexplained fractures can also be a sign of bone metastasis, Dr. Tsarwhas adds. Cancer can weaken bones and make them break more easily. “New lumps or bumps in the lymph node area…could be a sign of recurrent breast cancer as well,” he says.
A person with metastatic breast cancer in their bones may also experience more general cancer symptoms, such as fatigue, lack of appetite, and extreme, unexplained weight loss.
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Medications For More Severe Bone Pain
Tramadol or opioids, such as morphine or oxycodone, can be added if the ibuprofen, naproxen or acetaminophen alone dont relieve the pain.
All of these drugs can cause constipation, so you may need to change your diet or take medications to promote regular bowel movements. For example, your health care provider may recommend eating high-fiber foods, such as fruits and vegetables, and drinking plenty of liquids to manage constipation.
Other side effects of these drugs include sleepiness and nausea. These usually go away after about a week. If they dont, tell your health care provider. These side effects can be treated.
If youre prescribed opioid medications, your health care provider will carefully monitor the amount prescribed so you dont take too much. People may worry about taking opioid medications, fearing side effects or addiction. However, when used as prescribed, these drugs can offer a great deal of pain relief.
Learn more about opioids and other pain medications, their side effects and fear of addition.
Study Screening And Evaluation
Literature screening and evaluation were performed independently by 2 evaluators. First, irrelevant documents were excluded by reading the title and abstract. Then the full texts of the remaining documents were read, and the final selection was made based on the inclusion and exclusion criteria. The quality of the included studies was evaluated with the NOS as recommended by the Cochrane Collaboration Network . The maximum score was 9, and studies with scores 6 were high-quality studies, while those with scores 5 were low-quality studies. In cases of disputes, the evaluations were negotiated or assessed by an experienced third party.
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Symptoms And Diagnosis Of Bone Metastasis
A sudden, noticeable new pain is the most common symptom of breast cancer that has spread to the bone. The pain may come and go at first but can become constant over time. It can be hard to tell the difference between bone metastasis pain and arthritis pain or exercise strain. If the pain feels just as bad or even worse when you rest or lie down, it can be a sign of a problem. Its a good idea to see your doctor right away if it is bone metastasis, prompt treatment can prevent a fracture down the road.
Complications of bone metastasis are called skeletal-related events and can include the following:
Too Much Calcium In The Blood
Too much calcium in the blood can cause symptoms such as:
- Passing large amounts of urine
Hypercalcaemia is a medical emergency and can be serious if not diagnosed quickly. Its important to know who to report these symptoms to if they occur, so check this with your treatment team.
To relieve symptoms you might be told to drink plenty of water. However, many people will need to be given fluids into a vein to help flush the calcium out of the body.
If youre not already having bone-strengthening drugs, your treatment team will prescribe these.
Eating foods that contain calcium or taking prescribed calcium supplements does not cause hypercalcaemia.
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What To Do If You Have Breast Cancer
When you learn about such an unpleasant diagnosis, the first thing to do is to avoid panic in any way. Try to pull yourself together. After that, be sure to look for an experienced doctor who will tell you what to do and how to proceed. Only an experienced doctor will be able to give you the right diagnosis, assess your overall condition, and be able to provide assistance that will lead to a positive result.
The main thing, in this case, is to see a professional doctor. Unfortunately, many countries have adopted a radical fight against this disease. Therefore, the question, whether it is possible to cure without surgery, the answer is a resounding no. But in the USA, such treatment can be carried out much more gently. Clinics here offer to conduct surgery for breast cancer, but try to keep as much healthy tissue as possible. In addition, after surgery in such centers, you will certainly be offered plastic surgery to restore the breast.
So, if you or your loved one was diagnosed with breast cancer, even if it is stage 4, do not panic. Find a great oncologist, select the best treatment option, and start it immediately. With this approach, the probability of a positive outcome increases many times. Remember even the worst and most difficult diagnosis can be a thing of the past if you start the right treatment on time and believe in the best outcome.
Why Does My Provider Need To Test The Metastatic Tumor
Your care team will test the metastases to figure out the biology of the tumor, which can help guide your treatment plan. Providers may test tumors for:
- Hormone receptor status: If the cancer is hormone receptor-positive, hormonal therapy may be your first treatment.
- HER2 status: Human epidermal growth factor receptor 2 is a protein that is overexpressed on some breast cancer cells. HER2-positive cancer responds to specific HER2-targeted therapies.
- PIK3CA gene mutation: If a tumor is hormone receptor-positive and HER2-negative, your provider may test for this gene mutation. Specific targeted therapies can be used to treat tumors with this mutation.
- PD-L1 status: Tumors that are hormone receptive-negative and HER2-negative may be tested for PD-L1 status. If the PD-L1 test is positive, you may be recommended to receive a combination of immunotherapy and chemotherapy.
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Survival Rates Of Bone Metastases
Survival rates for people with bone metastases vary greatly by cancer type and stage. Your general health condition and the type of treatment you received for the primary cancer are additional factors.
Discuss your particular situation with your doctor. Remember that survival rates are averages gathered from large numbers of people. Also, survival data may reflect statistics from a period before the most recent treatment advances.
A large-scale 2017 study of the 10 most common cancers with bone metastasis found:
- Lung cancer had the lowest 1-year survival rate after bone metastasis .
- Breast cancer had the highest 1-year survival rate after bone metastasis .
- Having metastases in bone and also in other sites was found to decrease the survival rate.
Here are some typical figures from a 2018 study of common cancers and bone metastasis:
| Type of cancer |
Youre likely to have a combination of therapies that may include:
- radiation to slow metastasis growth and reduce pain
- chemotherapy to kill cancer cells and reduce tumor size
- hormone therapy to reduce the hormones known to be involved with breast and prostate cancer
- painkillers and steroids for pain relief
- drugs that specifically target bones
- surgery if necessary to stabilize your bone, fix a break, and help with pain
- physical therapy to strengthen your muscles and help you with mobility
- extreme heat or cold that targets cancer cells and may relieve pain
Exploring Mechanisms Of Metastasis
In humans, breast cancer can recur in patients more than a decade after the disease has been treated. In most of these cases, the cancer has metastasized to bone.
Our study addresses a difficult clinical problemthe disease can recur in patients who thought they had been cured of breast cancer years earlier, explained Dorothy A. Sipkins, M.D., Ph.D., of the Duke Cancer Institute, who led the research.
Past work had suggested that these late recurrences may be caused by the emergence of breast cancer cells that had previously spread to the boneknown as micrometastasesbut had remained dormant. But the mechanisms involved in the spread of breast cancer to bone are poorly understood.
E-selectin is an adhesion proteina protein that helps cells bind to other cells and to their surroundingsthat is present on the surfaces of cells lining blood vessels. Because the protein has been associated with the homing of hematopoietic stem cells into the bone marrow at certain regions, or niches, where it is highly expressed, the researchers investigated whether breast cancer cells could co-opt E-selectin to also mediate their movement into the bone.
E-selectin is a sticky protein expressed by certain blood vessels that serves as a portal into the bone marrow, explained Cynthia Dunbar, M.D., of the Hematology Branch at the National Heart, Lung, and Blood Institute, who was not involved in the research. The bone marrow seems to provide a protective home for breast cancer cells.
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What Should I Ask My Healthcare Provider About Metastatic Breast Cancer
If youve been diagnosed with metastatic breast cancer, ask your provider:
- What are my treatment options?
- What is my prognosis?
- What side effects can I expect?
- Will complementary therapy help me feel better?
- What if I want to stop treatment?
- How can I feel my best during treatment?
A note from Cleveland Clinic
Metastatic breast cancer is advanced breast cancer. Providers classify it as stage 4 breast cancer. It happens when cancer cells, often left behind after previous breast cancer treatment, start to spread to other parts of the body. While there is no cure for metastatic breast cancer, treatment can prolong your life and help you feel better. There are many medications available, so if one treatment isnt working, your care team can try a different approach. If you notice any symptoms or dont feel your best, especially if youve undergone breast cancer treatment in the past, talk to your healthcare provider.
Last reviewed by a Cleveland Clinic medical professional on 04/14/2021.
References
Metastatic Breast Cancer: What You Should Know
What does it mean to have metastatic, or stage 4, breast cancer? A Rogel Cancer Center oncologist explains the diagnosis and how its treated.
After hearing a diagnosis of metastatic breast cancer, a rush of questions emerges. But often, its not until long after leaving the doctors office.
Metastatic means the cancer has spread beyond the breast and immediate lymph nodes to other organs or tissues in the body, most often the bones, brain, lungs or liver. Its considered stage 4 breast cancer, which means the cancer has progressed to its most advanced stage.
But even though its moved to other organs, it still behaves like breast cancer and is treated with breast cancer therapies.
More than 154,000 U.S. women are estimated to have metastatic breast cancer, according to the Susan G. Komen organization. Men can have metastatic breast cancer too, but its rare.
To help patients fill in information gaps, N. Lynn Henry, M.D., Ph.D., the breast oncology disease lead for the University of Michigan Rogel Cancer Center, explains the nuances of stage 4 metastatic breast cancer.
What are the differences between metastatic breast cancer, stage 4 breast cancer and advanced cancer?
If any doctor uses the term advanced, ask for clarification, Henry adds.
When does metastatic breast cancer appear?
What are the symptoms?
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