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Can You Survive Stage 4 Metastatic Breast Cancer

Stage 4 Breast Cancer Life Expectancy

Miracle Survivor author talks about surviving stage 4 breast cancer

Stage four of any type of cancer implies that the cancer has moved to other parts of the body and is not limited to the body part that was initially diagnosed. The cancer will have moved to the brain, lungs, liver and even the bones. Stage 4 breast cancer has usually been regarded as incurable. But recent advancements in research and medical science have resulted in the disease being treated as a chronic condition. This means more and more women are able to live longer lives when they are given better care and support and have high levels of personal motivation. When the cancer responds to the treatments, it allows its sufferers to live several years longer than expected.

How Quickly Breast Cancer Develops

You may have heard remarks that cancer has been present for five years before it is diagnosed, and this may sometimes be true.

The actual time it takes for breast cancer to grow from a single cancer cell to a cancerous tumor is unknown, as estimates based on doubling time assume that this is constant throughout the duration of tumor growth.

If doubling time were constant, cancer with a doubling time of 200 days would take 20 years to develop into a detectable tumor, and a doubling time of 100 days would take 10 years to be evident on exam.

In contrast, a breast tumor with a doubling time of 20 days would take only 2 years to develop.

Since the majority of studies have found the average doubling time to be between 50 days and 200 days, itâs likely that most breast cancers that are diagnosed began at least 5 years earlier .

Dear World You’re Not Going To Have The Year You Thought You’d Have

Her gloom began to lift when she began doing her own research. Loniewska is a Ph.D. toxicologist.She put that expertise to work, and made a welcome discovery.

“I realized that a lot of MBC patients were doing well and the treatments work for a while. And then you switched treatments. You know, there’s always these hopeful stories of people, living five years, 10 years, 15 years.”

Or even more. We all hope to be one of those. But since the 5-year survival rate is just 28% for women and 22% for men, we know many of us won’t be.

There’s a saying in the MBC community: It’s the worst diagnosis, but you meet the best people. I’ve met some good ones. And since a 2020 National Cancer Institute study estimates that 168,000 women in the U.S. are living with metastatic breast cancer, I don’t think I’ll be running out of new friends any time soon.

Correction Dec. 12, 2021

In a previous version of this story, the name of Margaret Loniewska’s daughter was misspelled as Mariana. Her name is Marianna.

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Where Do These Numbers Come From

The American Cancer Society relies on information from the Surveillance, Epidemiology, and End Results database, maintained by the National Cancer Institute , to provide survival statistics for different types of cancer.

The SEER database tracks 5-year relative survival rates for breast cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages . Instead, it groups cancers into localized, regional, and distant stages:

  • Localized: There is no sign that the cancer has spread outside of the breast.
  • Regional: The cancer has spread outside the breast to nearby structures or lymph nodes.
  • Distant: The cancer has spread to distant parts of the body such as the lungs, liver or bones.

I Have To Prioritize And Try Not To Sweat The Small Stuff

LIVING WITH STAGE IV BREAST CANCER  Medicals Plan

For Sendelbach, each week begins with a list of her priorities. Obviously, getting to my doctors appointments is very important, she says. But if the clothes arent folded, is that a dire situation? Absolutely not!

Sendelbach has learned to make compromises: If her husband and son have to pick up their clean clothes from the couch, she can live with that.

I have learned, she says, to look at every situation and ask if this is going to truly make a difference in my day or my familys day for better or worse. If the answer is no, then that task might be left undone.

It wasnt always this way for Sendelbach, though. When she was first diagnosed with cancer, her son was just a year old and she had been married for only two and a half years. You know how it is when you first have a baby if everything isnt perfect, then the world is falling apart! she laughs. Now, to us we ate, were all still alive, the house is acceptable if were good, its all okay.

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What Is Stage Iv Cancer

Stage IV cancer is the most severe form of cancer in which cancer has spread to a distant part of the body from its origin. Thus, testicular cancer may have spread to the lungs and bones, thyroid cancer may have spread to the brain, and so on. It is also known as metastatic or advanced disease.

The staging system often used for most types of cancer is the American Joint Committee on Cancer TNM system. In these staging systems, three types of key information are used.

  • T : It refers to the size of the original tumor.
  • N : It describes whether cancer has spread to the lymph nodes.
  • M : It refers to the spreading of cancer to other parts of the body.

A number or the letter X is allocated to each factor. A higher number means the cancer is advanced. For instance, a T1 score refers to a smaller tumor than a T2 score. The letter X indicates that information could not be assessed. M1 indicates that cancer has spread to a distant part of the body.

The physician combines T, N, and M results and other factors specific to cancer to determine the stage of cancer for each person. Most cancer types have four stages: stages I-IV, with stages I and IV being the least severe and most severe forms of cancer, respectively. Some types of cancer also have a stage 0 .

De Novo Metastatic Breast Cancer And Recurrent Breast Cancer

It is important to understand the two types of Stage IV Breast Cancer and the differences between them:-

  • De Novo metastatic breast cancer: This term refers to women who are Stage IV at the initial diagnosis of breast cancer. That is, cancer has already spread to other parts of the body. De novo metastatic breast cancer accounts for only around 6% of cases at diagnosis in the US.
  • Recurrent Breast Cancer: More often, breast cancer returns or spreads after the initial diagnosis and treatment of breast cancer. This recurrence can happen months, or even years, after the first presentation and treatment.
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    Breast Cancer Subtypes Hormonal And Her2 Status And Survival Rates

    Many research studies over the years have shown that Estrogen-positive breast cancers have better survival rates than all of the Estrogen-negative subtypes.

    Progesterone-positive breast cancer also appears to have improved survival rates in comparison to progesterone-negative cases.

    A recent research study combines hormone receptivity, HER2 status and stage and found some interesting results:-

    For ER+ sub-types survival rates were significantly better than all other subtypes. For example, at stage 1b,

    ER+ PR+ HER2- 5-year survival rates were 98.6%ER+ PR- HER2+ 5-year survival rates were 97.3%

    The subtype triple negative breast cancer had the worst survival rates over all three stages. At stage I the 5-year survival rate was 92.9% and at stage III 48.9%.

    Myth #: If An Earlier

    Metastatic Breast Cancer Awareness with Susan G. Komen

    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 5 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.1

    As KatyK of Idaho comments: that you are cured if you are cancer-free 5 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.

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    Our Advice To Other Women With Metastatic Breast Cancer: Be Nice To Yourself

    Give yourself a break! is the advice that Sendelbach offers. Stop negative self-talk about what you should have done but didnt do, she says. If you have MBC, you need to be kind and loving to yourself.

    The body has only so much energy to offer per day, and managing metastatic breast cancer requires a lot of it. So it doesnt make sense to try to compare what youre able to do with what your cancer-free friends are accomplishing.

    Just getting through the day can be hard, Sendelbach says. Getting rid of those not good enough feelings can lift a huge weight off you.

    Life Expectancy Of Stage 4 Breast Cancer

    According to the American Cancer Society, 22% of the patients live five years after being diagnosed of stage 4 breast cancer. Compared to earlier stages of the cancer, this rate is considerably lower. At stage two, the five year survival rate is at 90% and at stage three, it is 72%. This shows that an early diagnosis is important for better chances of survival.

    Predicting survival rates for patients are never really accurate. Your age, general health, hormone receptors on cells with cancer, the type of tissue the cancer has affected and your general outlook on life all affect your stage 4 breast cancer life expectancy.

    About 50% percent of women who are diagnosed with stage four breast cancer are still alive 18 months after their diagnosis. Over the years, life expectancy for stage four cancer has been steadily and slowly improving. This has been mainly due to combination treatment of surgery, radiation, multiple medications, and a much more positive support network.

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    Basis Of Reservation On Removal Of The Primary Tumor In Metastatic Breast Cancer

    Historically, the role of removal of the primary tumor, mastectomy vs. lumpectomy, in patients with metastatic disease has been relegated to palliation alone because it may contribute substantially to palliation but not to survival of the patient. Because patients with metastatic disease are immune compromised, the surgical stress of the operation has been thought to promote metastatic proliferation. In addition, because the primary lesion is thought to inhibit angiogenesis in metastatic lesions, resection of the primary tumor has been thought to remove that inhibition and thus promote the progression of metastatic lesions. However, these theories are based on animal studies of metastatic cancer utilizing models that have not been critically evaluated. Because of the importance of these theories in the management of patients with metastatic breast cancer, it is important to briefly review the data on which these theories are based.

    Over the past few decades, interest in this topic has increased, with recent reports that surgical injury enhances the expression of genes to promote breast cancer metastasis to the lung and that removal of the primary tumor in breast cancer increases cancer cell presence in sentinel lymph nodes. However, these studies never evaluated translational clinical endpoints, such as disease-free or overall survival nor did they discuss the clinical reports that contradicted the results of their animal experiments.

    What Is Stage 4 Breast Cancer

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    Stage 4 breast cancer is also called metastatic breast cancer or advanced breast cancer. In this stage, cancer that developed in your breast has spread to other areas of your body.

    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.

    Breast Cancer Healthline is a free app for people who have faced a breast cancer diagnosis. The app is available on the App Store and . Download here.

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    When Can Metastatic Breast Cancer Occur

    Most often, metastatic breast cancer arises months or years after a person has completed treatment for early or locally advanced breast cancer. This is sometimes called a distant recurrence.

    Some people have metastatic breast cancer when they are first diagnosed . This is called de novo metastatic breast cancer.

    Komen Perspectives

    Many Women Live For Decades With Metastatic Breast Cancer

    A stage 4 diagnosis is not an instant death sentence, says Renee Sendelbach, 40, from Austin, Texas, who was diagnosed seven years ago, when she learned that her breast cancer had moved into her lungs, bones, and lymph nodes.

    Ive had metastatic breast cancer for five years and Im still kicking, says Susan Rosen, 53, from Franklin, Massachusetts.

    According to a 2017 article in the journal Cancer Epidemiology, Biomarkers & Prevention, 34 percent of women diagnosed with metastatic breast cancer have been living with the disease for five years or longer.

    The goal of treatment is to keep patients on their feet as long as possible so that they can continue to do what they want to do, says Gretchen Kimmick, MD, associate professor of medicine at the Duke Cancer Institute in Durham, North Carolina.

    In recent years, treatment for breast cancer has vastly improved, largely because doctors are able to more accurately target therapy to the type of breast cancer a woman has. The discovery of the HER2 protein and medicines that block it has revolutionized treatment for women with cancers that overexpress this protein, Dr. Kimmick says. This cancer was pretty deadly two decades ago, and now we are starting to debate if weve cured it in some women.

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    Why Are Black Women Less Likely To Stick With A Breast Cancer Follow

    Now Chrysalis intervenes on behalf of Black women, like one who’d just had surgery.

    “They were trying to send her home that same day,” Rivers says. “They did not want to provide her with an at home nurse or to provide care. And this was all just based off an assumption that she’s Black, so she must be poor. She must not have sufficient insurance.”

    Rivers has expanded her advocacy by becoming president of Metavivor, a non-profit that raises money for metastatic breast cancer research. Rivers figures she’s helped thousands of women, including herself. She’s been NED no evidence of disease for a couple of years now. So she hopes to have the strength and the determination to help thousands more Black breast cancer patients going forward.

    We get answers to stopping this disease.

    Michael Kovarik

    Poor Appetite And Weight Loss

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    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.

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    Progression During Hormone Therapy

    For hormone receptor-positive cancers that were being treated with hormone therapy, switching to another type of hormone therapy sometimes helps. For example, if either letrozole or anastrozole were given, using exemestane, possibly with everolimus , may be an option. Another option might be using fulvestrant or a different aromatase inhibitor, along with a CDK inhibitor. If the cancer has a PIK3CA mutation and has grown while being treated with an aromatase inhibitor, fulvestrant with alpelisib might be considered. If the cancer is no longer responding to any hormone drugs, chemotherapy immunotherapy, or PARP inhibitors might be options depending on specific features of the cancer or any gene changes that might be present.

    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

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