In Historic First Woman Is Cured Of Stage 4 Breast Cancer
Across the globe, breast cancer is the most common cancer among women and it is ranked the fifth deadliest cancer. In the United States, around 155,000 women are living with metastatic breast cancer, also known as stage 4 breast cancer. This type of cancer means that the cancer has metastasized or spread to other areas of the body. According to the American Cancer Society, the 5-year survival rate for stage 4 breast cancer is 22%. Around 20-30% of women with stage 0 or stage 1 breast cancer the earliest stages of the cancer â go on to develop metastatic breast cancer.
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Although treatable, the cancer cannot be cured that is, up until recently when, for the first time in history, a woman battling advanced stage breast cancer was considered cured by an experimental new therapy.
How A Breast Cancers Stage Is Determined
Your pathology report will include information that is used to calculate the stage of the breast cancer that is, whether it is limited to one area in the breast, or it has spread to healthy tissues inside the breast or to other parts of the body. Your doctor will begin to determine this during surgery to remove the cancer and look at one or more of the underarm lymph nodes, which is where breast cancer tends to travel first. He or she also may order additional blood tests or imaging tests if there is reason to believe the cancer might have spread beyond the breast.
The breast cancer staging system, called the TNM system, is overseen by the American Joint Committee on Cancer . The AJCC is a group of cancer experts who oversee how cancer is classified and communicated. This is to ensure that all doctors and treatment facilities are describing cancer in a uniform way so that the treatment results of all people can be compared and understood.
In the past, stage number was calculated based on just three clinical characteristics, T, N, and M:
- the size of the cancer tumor and whether or not it has grown into nearby tissue
- whether cancer is in the lymph nodes
- whether the cancer has spread to other parts of the body beyond the breast
Numbers or letters after T, N, and M give more details about each characteristic. Higher numbers mean the cancer is more advanced. Jump to more detailed information about the TNM system.
Jump to a specific breast cancer stage to learn more:
Life Expectancy And Outlook
In the United States, its estimated that more than 42,000 women will die from breast cancer in 2020.
However, its important to know that aspects like life expectancy and your outlook can vary greatly based off many individual factors.
In the past, a diagnosis with HER2-positive breast cancer was associated with a poor outlook. Advances in drug therapies in recent years have improved the treatment options for HER2-positive breast cancer as well as the outlook for people with the disease.
According to the American Cancer Society, HER2-positive breast cancers are much more likely to respond to drugs that target the HER2 protein, despite the fact that they can grow and spread quickly.
This type of treatment is called targeted therapy. Well discuss it in more detail in a bit.
When considering your outlook, your doctor must analyze many other factors as well. Among them are:
Hormone treatments may be an option for cancer thats also HR positive.
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What Are The Complications Of Breast Cancer Recurrence
Breast cancer that comes back can be harder to treat. The same therapy isnt always effective again. Tumors can develop a tolerance to certain treatments like chemotherapy. Your healthcare provider will try other therapies. You may be able to try drugs under development in clinical trials.
If breast cancer spreads to other parts of the body, your healthcare providers still treat it like breast cancer. For instance, breast cancer cells that move to the lungs cause breast cancer in the lungs not lung cancer. Metastatic breast cancer is more difficult to treat than cancer in only one part of the body.
You may feel stressed, depressed or anxious. A mental health counselor and support groups can help.
Locally Advanced Breast Cancer Prognosis
If breast cancer has come back and spread to the tissues and lymph nodes around the chest, neck and under the breastbone, there may be an increased risk of cancer cells spreading to other areas of the body.
This means the overall prognosis can be harder to predict.
Treatments such as chemotherapy, hormone and targeted therapies are given for locally advanced breast cancer because they work throughout the whole body.
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Myth #: If An Earlier
Ninety percent of MBC diagnoses occur in people who have already been treated for an earlier-stage breast cancer. Many people are under the impression that remaining cancer-free for five years means that a metastatic recurrence cant happen. However, distant recurrences can occur several years or even decades after initial diagnosis. Factors such as original tumor size and the number of lymph nodes involved can help predict the risk of recurrence.
For example, a 2017 survey of 88 studies involving nearly 63,000 women diagnosed with early-stage, hormone-receptor-positive breast cancer found that the risk of distant recurrence within 20 years ranged from 13% to 41%, depending on tumor size and lymph node involvement.
As KatyK of Idaho comments: that you are cured if you are cancer-free five years after initial diagnosis. I fell for that one myself. When I was diagnosed with MBC 12 years after initial diagnosis I was shocked. I thought I was cured, which to me means all better. Nope! Not even sure medically what cured means.
Will The Nhs Fund An Unlicensed Medicine
It’s possible for your doctor to prescribe a medicine outside the uses it’s licensed for if they’re willing to take personal responsibility for this ‘off-licence’ use of treatment.
Your local clinical commissioning group may need to be involved, as it would have to decide whether to support your doctor’s decision and pay for the medicine from NHS budgets.
Page last reviewed: 28 October 2019 Next review due: 28 October 2022
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First What Exactly Does Stage Ii Mean
Breast cancer has traditionally been classified in five stages, from 0 to IV, based on how large the tumor is and how far it has spread in the rest of your body. Stage 0 generally means you have noninvasive cancer or pre-cancer that has not moved outside the breast as you go up the scale, the tumor generally gets larger and the cancer becomes more invasive all the way to Stage IV, which means the cancer has spread to other parts of the body, such as the liver, bones or brain.
Breast cancer stages have historically been based on three different factors, Dr. Larkin. explains. The first is the size of the tumor, the second is whether or not the tumor has metastasized to any lymph nodes and the third is whether the tumor has spread to any other places in the body, which is known as metastatic breast cancer. This staging system is known as TNM, for Tumor, Nodes and Metastasis.
Stage II breast cancer is broken down further into stage IIA and IIB, with these criteria:
Stage IIA: Either there is no tumor found in the breast, or there is a tumor up to 2 cm AND cancer has spread to 1 to 3 lymph nodes
There is a tumor of 2 to 5 cm , but the cancer has NOT spread to the lymph nodes
Stage IIB:
There is a tumor of 2 to 5 cm, AND cancer has spread to between 1 and 3 lymph nodes
There is a tumor larger than 5 cm, but cancer has NOT spread to the lymph nodes or reached the chest wall or skin.
What else do I need to know about cancer staging?
Regional Recurrence Within Three Years Carries A Less Favorable Prognosis But Overall Survival Statistics Are Still Good
Generally speaking, if the breast cancer returns regionally lymph nodes) within the first five years following original treatment, the overall likelihood of survival is thought to be somewhat poorer.
Five-year overall survival after an isolated chest wall recurrence is 68% and after intra-breast recurrence it is 81%.
In one 2010 medical research study, the ten year overall survival rate was estimated at 84% for women without recurrence. However, this figure goes down to 49% for women with a locoregional recurrence and 72% for women with a second primary tumour.
A large 2015 study examined the impact of the time of the disease free interval on survival rates. For women with a locoregional recurrence that happened in the first 18 months, the ten year overall survival rate is around 30%. The overall 10 year survival rate for those whose recurrence happened within 3 years goes up to 50%. Furthermore, for those who suffered a recurrence after 3 years the ten year overall survival rate increases to 70%.
This recent study clearly demonstrates that the longer the time span since the primary prognosis and treatment to the recurrence, the better the long-term prognosis.
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The rate of distance breast cancer metastasis and overall survival is most favorable for women in which the recurrence occurred locally and after five years.
However, women with a same-breast recurrence within five years have a distant metastasis rate of about 61%, which are slightly poorer odds.
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How Does Staging Relate To Types Of Breast Cancer
In addition to cancer stage, doctors will determine the tumor grade and subtype.
Tumors are graded on a scale of 1 to 3, based on how abnormal the cells appear compared to normal cells. The higher the grade, the more aggressive the cancer, meaning that it tends to be growing quickly.
The subtype is important because treatment and outlook will vary depending on which subtype of breast cancer that you have. Subtypes include:
There are three grades of invasive breast cancer:
- Grade 1 looks most like normal breast cells and is usually slow growing
- Grade 2 looks less like normal cells and is growing faster
- Grade 3 looks different to normal breast cells and is usually fast growing
Sometimes the grade given to a cancer after a biopsy can change after surgery. This is because after surgery theres more tissue for the pathologist to look at, which can give them more detailed information about the cancer.
What Is Stage 3 Breast Cancer
Also known as locally advanced breast cancer, the tumor in this stage of breast cancer is more than 2 inches in diameter across and the cancer is extensive in the underarm lymph nodes or has spread to other lymph nodes or tissues near the breast. Stage 3 breast cancer is a more advanced form of invasive breast cancer. At this stage, the cancer cells have usually not spread to more distant sites in the body, but they are present in several axillary lymph nodes. The tumor may also be quite large at this stage, possibly extending to the chest wall or the skin of the breast.
Stage 3 breast cancer is divided into three categories:
Stage 3A: One of the following is true:
- No tumor is found in the breast, but cancer is present in axillary lymph nodes that are attached to either other or other structures, or cancer may be found in the lymph nodes near the breast bone, or
- The tumor is 2 cm or smaller. Cancer has spread to axillary lymph nodes that are attached to each other or other structures, or cancer may have spread to lymph nodes near the breastbone, or
- The tumor is 2 cm to 4 cm in size. Cancer has spread to axillary lymph nodes that are attached to each other or to other structures, or cancer may have spread to lymph nodes near the breast bone, or
- The tumor is larger than 5 cm. Cancer has spread to axillary lymph nodes that may be attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone.
Stage 3C:
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Treatment To The Breast
Your surgeon might remove the cancerous area with a border of normal breast tissue. This is called breast conserving surgery or a wide local excision. After this you usually have radiotherapy to the rest of the breast.
Or you might have the whole breast removed. This is called a mastectomy. You can choose to have a new breast made . You might have radiotherapy to the chest wall after having a mastectomy. You might have treatment with radiotherapy to the lymph nodes under your arm or further surgery to remove the nodes if they contain cancer cells.
You can have a breast reconstruction at the same time as surgery to remove the cancer, or at a later time. Having a reconstruction at the same time should not affect you having radiotherapy after surgery if you need it. The plan to have radiotherapy after a reconstruction might affect the reconstruction options you have.
Your surgeon will discuss all the pros and cons with you.
You usually have other treatments too.
Radiation Therapy And Mastectomy
Most women who have a mastectomy dont need radiation therapy if theres no cancer in the lymph nodes.
In some cases, radiation therapy is used after mastectomy to treat the chest wall, the axillary lymph nodes and/or the lymph nodes around the collarbone.
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For a summary of research studies on mastectomy versus lumpectomy plus radiation therapy and overall survival in early breast cancer, visit the Breast Cancer Research Studies section. |
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For a summary of research studies on radiation therapy following mastectomy for invasive breast cancer, visit the Breast Cancer Research Studies section. |
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How Common Is Triple
About 10 to 20% of breast cancers are found to be triple-negative. However, triple-negative cancer cells are found more often in people under the age of 50. This is about 10 years younger than the average age of 60 or older for other types of breast cancer diagnoses. Triple-negative breast cancer is also found in higher percentages of Black and Hispanic patients and less often in Asian and non-Hispanic patients.
Another population that is more likely to be diagnosed with this type of breast cancer has an inherited mutation of the BRCA gene. About 70% of those with triple-negative breast cancer also test positive for having the BRCA mutation. You may qualify for genetic testing based on your family history. Learn more about genetic testing for breast cancer.
Treatment For Locally Advanced Breast Cancer
Treatment for locally advance breast cancer is likely to include a treatment that affects the whole body .
This might be chemotherapy, hormone therapy or targeted therapy.
Chemotherapy
If you have previously had chemotherapy, you may be offered different chemotherapy drugs this time.
Hormone therapy
If the cancer is oestrogen receptor positive you may be offered hormone therapy.
If you were already taking hormone therapy when your cancer returned, your doctor may consider switching you to a different drug.
Targeted therapy
Targeted therapies are a group of drugs that block the growth and spread of cancer.
The most widely used targeted therapies are for HER2 positive breast cancer. However, other targeted therapies are available to treat locally advanced breast cancer that is HER2 negative.
Radiotherapy and surgery
You may be offered radiotherapy if cancer cells are found in the lymph nodes above or below the collarbone, under the breastbone or between the ribs. Its not usually possible to remove the cancer using surgery in this situation.
If the recurrence has affected the muscles on the chest wall, surgery may be offered as well as radiotherapy.
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Myth #: The Mental And Emotional Experience Of People With Mbc Is The Same As That Of Earlier
People with MBC report hearing comments such as, At least you have a good type of cancer, Arent you glad so much research on breast cancer has been done?, Fortunately you have so many options. These might comfort people with early-stage breast cancer, who can look forward to one day finishing treatment and moving on but people with MBC dont have that luxury. They know they will be in treatment for the rest of their lives. They also know that their life is likely to be shorter than theyd planned.
Mentally and emotionally, people with MBC have a completely different experience. For them, the whole ringing the bell idea does not work, says Dr. Gupta. I have patients who are coming in once a week and have to plan their lives around their treatment. The whole pink brigade idea is very upsetting to them.
Fortunately, more and more people with MBC are speaking up and calling attention to how their experience differs from that of people with earlier-stage breast cancer. People with MBC live with cancer always in the background of their lives, but with new and emerging therapies, many are living longer and maintaining their quality of life.
Clearly, the experience of metastatic breast cancer is quite different from early-stage breast cancer. But there are so many patients who understand just what youre going through. Read more about Living with Metastatic Breast Cancer and join our discussion forum for people with stage IV/metastatic disease.
Biomarkers: Her2 And Hormone Receptor Status
Breast cancer staging and diagnosis also involve biomarker testing. Biomarkers are proteins on the cancer cells that can make the tumor behave in a certain way, such as being more likely to grow fast.
Knowing what biomarkers the cells make helps determine what other types of treatment your doctor can use to address the cancer and keep it from growing or spreading.
To identify the biomarkers, your surgeon collects a sample of cells during a or surgical procedure and performs tests on the cells.
Here is a summary of biomarkers:
- Estrogen receptor-positive means that the cells produce receptors for the hormone estrogen, which makes cancer cells grow.
- Progesterone receptor-positive means that the cells produce receptors for the hormone progesterone, which makes cancer cells grow.
- HER2-positive means that the cells produce receptors for the HER2 protein, which makes cancer cells grow fast.
If your cancer is positive for any of these three receptors, your doctor may use certain drugs that block the function of the specific receptor. Some people with stage 2 breast cancer may need these drugs to help prevent the cancer from returning.
means that the cells do not express any of the three common receptors: estrogen, progesterone, or HER2 protein.
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