Stage 4 Breast Cancer
Advanced breast cancer refers to cancer that has spread beyond the breast to other parts of the body. This process of spreading from the original location to a new location is known as metastasis.
The most common places of breast cancer spread include the bones, liver, lung, and brain. However, breast cancer may also spread to other organs.
The majority of women who are diagnosed with metastatic breast cancer have been diagnosed with an earlier stage of breast cancer before. In this instance, the original cancer in the breast is called the primary cancer. However, for some women, a diagnosis of metastatic breast cancer may be their first diagnosis of cancer .
Triple Negative Breast Cancer
With this type of breast cancer, the breast cancer cells dont have ER+ or PR+ receptors. They dont overproduce the HER2 protein, so hormone therapy isnt very effective.
Instead, triple negative stage 4 breast cancer is usually treated with chemotherapy. Radiation therapy may also be an option, depending on the site of metastasis.
Metastatic Breast Cancer Is Terminal
Metastatic breast cancer cant be cured and it is terminal. One thing I didnt know when I was first diagnosed is that breast cancer can only kill you if you have metastatic breast cancer, says Rosen, who explains that if your cancer remains in the breast, the tumor can be removed, but metastatic means it has spread outside the breast.
MBC is almost like a different disease than early-stage breast cancer, adds Ann Silberman, 60, from Sacramento, California, who was diagnosed in 2009. We are going to die. Our concerns are much different from those of a person who has a treatment that will be over . Someone in an earlier stage may worry about losing their hair which is understandable but they will return to their normal life at some point.
People with metastatic breast cancer expect to be on treatment for the rest of their lives. I dont think everyone understands that, Silberman says. I still get, When will your treatment be over? Well, its never going to be over.
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Why Does Metastatic Breast Cancer Happen
Most often, metastatic cancer occurs because treatment didnt destroy all the cancer cells. Sometimes, a few cells remain dormant, or are hidden and undetectable. Then, for reasons providers dont fully understand, the cells begin to grow and spread again.
De novo metastatic breast cancer means that at the time of initial diagnosis, the breast cancer has already spread to other parts of the body. In the absence of treatment, the cancer spreads.
There is nothing you can do to keep breast cancer from metastasizing. And metastatic breast cancer doesnt happen because of something you did.
I May Not Feel Like A Fighter Theres No Final Victory
The language used to describe cancer and its treatment is often the language of war: fighting cancer, battling cancer, being a warrior. But those words may not resonate with women who have metastatic breast cancer.
Sendelbach recalls using fighting words when she was first diagnosed with stage 1 breast cancer. I was 30 years old, and I was in fight mode, she says. I was like, Hell yeah, I can kick cancers ass and so on. When she was diagnosed with stage 4, though, she realized there would be no end in sight, no final victory for her.
Theres not a finish line, she says, so to be in fight mode doesnt really work. There has to be an end in sight to stay in that place.
For her, metastatic breast cancer is something she deals with day to day. She describes her journey as a marathon, not a sprint. If you have to stop sometimes to walk and take water breaks, she says, you should. If you try to run as fast as you can all the time, its inevitable that youre going to fail.
Poor Appetite And Weight Loss
Sometimes people with secondary breast cancer cannot eat as much as usual. This means they may have difficulty maintaining their weight as well as providing the body with energy.
Poor appetite can be due to the effects of the cancer, treatment or anxiety. You might find it easier to eat little and often instead of having set meals. If you still feel youre not eating enough, or are losing weight, talk to your doctor or nurse about dietary supplements or ask to speak to a dietician for specialist advice. In some circumstances you may be prescribed medication to help stimulate your appetite.
Things Doctors Wish You Knew About Metastatic Breast Cancer
For starters, dont read about survival rates on the internet.
Breast and cancer are never two words you want to hear together, but discovering you have metastatic, or stage IV, breast cancer can make a bad situation feel impossibly worse. A lot of this fear stems from some common misunderstanding about what metastatic breast cancer is, how it spreads, what the prognosis is, and available treatments.
The word metastatic simply means that the cancer has spread to other parts of the body beyond the original location of the tumor. The cancer originates in the breast, but the cells can travel to any other part of your body, leading to tumors in your lymph nodes, lungs, liver, bones, brain, or other places. Nearly 30 percent of women who are diagnosed with early-stage breast cancer will ultimately develop metastatic disease, according to The National Breast Cancer Foundation.
Each year about 255,000 people are diagnosed with stage IV breast cancer. While the majority are women, men can get the disease too. Approximately 41,000 people die of breast cancer each year and metastatic breast cancer is responsible in the majority of the cases, according to NBCF. The five-year survival rate is about 25 percent for women and 20 percent for men.
1. Metastatic breast cancer is not a death sentence
2. Metastatic breast cancer isnt necessarily like other metastatic cancers
3. Metastatic breast cancer cant turn into another cancer
4. A lot of factors go into cancer survival rates
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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.
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.
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A Disease No One Gets
Sadly, people donât âgetâ mets. In fact, a recent survey sponsored by Pfizer Oncology shows just how misunderstood it is. Sixty percent of the 2,000 people surveyed knew little to nothing about MBC while 72 percent believed advanced breast cancer was curable as long as it was diagnosed early. Even more disheartening, a full 50 percent thought breast cancer progressed because patients either didnât take the right treatment or the right preventive measures.
âTheyâve built an industry built on four words â early detection equals cure â and that doesnât even begin to define breast cancer,â said Schoger, who helped found Breast Cancer Social Media, a virtual community for breast cancer patients, caregivers, surgeons, oncologists and others. âWomen are blamed for the fate of bad biology.â
The MBC Alliance, a consortium of 29 cancer organizations including the biggest names in breast cancer , addressed this lack of understanding and support as well as what many patient advocates term the underfunding of MBC research in a recently published landmark report.
More Women Are Living With Metastatic Breast Cancer And Living Longer
According to research from the National Cancer Institute , the number of women living with metastatic breast cancer in the United States is increasing at the same time, women with metastatic disease are living longer, especially younger women.
The research was published online on May 18, 2017 by the journal Cancer Epidemiology, Biomarkers & Prevention. Read the abstract of Estimation of the Number of Women Living with Metastatic Breast Cancer in the United States.
Metastatic breast cancer is breast cancer that has spread to parts of the body away from the breast, such as the bones or liver. Metastatic breast cancer is stage IV cancer. A woman can be diagnosed with metastatic disease when first diagnosed. Breast cancer also can come back in a part of the body away from the breast. This is called metastatic recurrence.
“Even though this group of patients with metastatic breast cancer is increasing in size, our findings are favorable,” said Angela Mariotto, Ph.D., chief of the Data Analytics Branch of the Division of Cancer Control and Populations Sciences at the NCI. “This is because, over time, these women are living longer with metastatic breast cancer. Longer survival with metastatic breast cancer means increased needs for services and research. Our study helps to document this need.”
The study compared 5-year survival rates from 1992 to 1994 and from 2005 to 2012:
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Can Metastatic Breast Cancer Be Cured
There is no cure for metastatic breast cancer. Once the cancer cells have spread to another distant area of the body, its impossible to get rid of them all. However, the right treatment plan can help extend your life and improve its quality.
Metastatic breast cancer treatment aims to shrink tumors, slow their growth and improve your symptoms.
What Is Stage 4 Breast Cancer
Cancer cells might have traveled through your lymphatic system to your lungs, bones, liver, brain, or other organs.
Stage 4 is the most serious and life threatening stage of breast cancer. Most often, stage 4 breast cancer develops long after a person has first been diagnosed with cancer. In rare cases, the cancer may have progressed to stage 4 at the time a person is first diagnosed.
Facing stage 4 breast cancer can be challenging. But following your doctors recommended treatment plan and practicing healthy lifestyle habits can help to improve your outcome. It may significantly increase your lifespan and improve your quality of life.
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Living With Metastatic Breast Cancer
‘I think its been a good thing to change the way I live my life I find it much easier to focus on what is really important to me.’ Fiona
The women talk about how priorities shift after a metastatic breast cancer diagnosis. Some women share how work continues to bring meaning and purpose to their lives, while another speaks of how the diagnosis prompted her to spend more time with family.
New Study: Metastatic Breast Cancer And A Decade Of Survivorship
- New Study: Metastatic Breast Cancer and a Decade of Survivorship
Researchers were pleased to discover that some women with metastatic breast cancer were still alive 10 years after being treated with radiotherapy to the sites where their cancer had spread. The study results are being used to guide treatment decisions at UR Medicines Wilmot Cancer Institute.
The prognosis for metastatic breast cancer is generally poor, so this is remarkable, said corresponding author Michael Milano, M.D., Ph.D., a professor of Radiation Oncology at Wilmot. Ideally, we will want to know what factors predict who will do better.
Metastatic breast cancer means the cancer has spread beyond the original tumor to other parts of the body. Common sites of metastases include the bones, lungs, liver, and brain. For this study, Milano and colleagues investigated the long-term outcomes of 48 patients who had oligometastases, meaning that they only had a few spots of metastatic cancers as opposed to widespread disease.
The standard care for this stage of breast cancer is often hormonal therapy and/or chemotherapy or targeted medications, with radiation considered for symptom control. The use of radiation to prolong survival was not yet a standard option when the
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Will I Need More Than One Treatment For Metastatic Breast Cancer
Medications are important for metastatic breast cancer to help control its spread. Resistance to therapies may develop, which can lead your care team to recommend a change in treatment.
When you start a treatment regimen, you and your care team will see how:
- The cancer responds to the therapy.
- The side effects impact you.
If the treatment isnt working or the side effects are unbearable, your care team can discuss switching the treatment method. They may recommend a different drug, dosage or schedule.
There are many treatments available. If one therapy isnt working for you for whatever reason, there is usually another one you can try.
Does Anyone Survive Stage 4 Cancer
Stage 4 cancer, also known as metastatic cancer, is the most advanced stage. It is the least likely to be cured and is unlikely to end up in remission. That doesnt mean its automatically a death sentencemany stage 4 cancer patients live for many yearsbut the prognosis is not likely to be good.
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Probability Of Cancer Progression
How long the remission period can last is one of the most frequently asked questions by patients with stage 4 breast cancer. The answer to this question depends on a number of factors that come in.
First, tumors may have a different tendency to grow. Slowly growing tumors mean longer remission and longer life expectancy. Second, age is important. In young patients, cancer tends to be more aggressive and resistant to treatment. Third, the localization of metastases plays an important role. Metastasis to bone or lymphatic tissue is a more prognostic option for treatment than lung, liver, and especially brain damage.
Another very important factor is the tumors responsiveness to the therapy. In women with hormone-positive breast cancer, in which the tumor reacts well to hormone therapy, life expectancy can be 10-15 years, even taking into account the 4th stage of the disease. For comparison, the life expectancy of patients with metastatic triple-negative breast cancer is only one year.
What Treatments May I Be Offered
Treatment for secondary breast cancer in the liver aims to relieve symptoms and slow down the growth of the cancer.
Treatments can be given alone or in combination.
When making decisions about how best to treat you, your treatment team will consider factors such as:
- how extensive the cancer is within the liver
- whether the cancer has spread to other organs
- any symptoms you have
- what treatment youve had in the past
- the features of the cancer
- whether youve been through the menopause
- your general health
Your specialist should discuss any recommendations for treatment with you and take into account your wishes. Theyll talk with you about your options, explain what the aim of your treatment will be and help you weigh up the potential benefits against the possible side effects you may have.
If you had a biopsy or surgery for primary breast cancer, the tissue removed will have been tested to see if it is ER+. However, in some people the oestrogen receptors change during the development of secondary breast cancer. Because of this, your doctor may discuss performing a biopsy to retest for hormone receptors.
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Clinical Trials Are A Promising Treatment Option
For people with advanced stages of cancer, clinical trials can be considered the gold standard of treatment. I recommend clinical trials highly, says Rosen. You get access to medication and treatment that you normally wouldnt have.
A clinical trial could even have positive results on your cancer. We are living in an exciting time for cancer treatment, says Kimmick. There are myriad new drugs coming out that will improve the lives of all women with breast cancer, both metastatic and early stage.
However, its important to be realistic about the potential outcome of your trial. Rosen was recently enrolled in a clinical trial in which the medication proved toxic for her. But she has no regrets about participating. It feels like Im helping researchers who are working on cures for cancer, she says. When I had a bad reaction to the drug, they were able to put my side effects in their study. I feel like I did help, and that makes me happy.
People interested in joining a clinical trial for treatment should talk to their doctor about options that might be good for them.