Removing Fewer Lymph Nodes For Some Breast Cancer Patients Does Not Impair Survival
Two large clinical trials confirm that less extensive lymph node surgery in women with early-stage disease does not reduce their likelihood of survival. Specifically, researchers find that removing additional underarm lymph nodes to look for breast cancer in women with limited or no disease spread in the “sentinel” node where cancer is most likely to spread does not make a significant difference in survival, compared to removing fewer nodes. Removing fewer nodes decreases the risk of side effects, such as pain and swelling in the affected arm.
Less Invasive And Less Toxic Techniques
The sentinel lymph node technique identified the first lymph nodes where the cancer could spread. This allows for the removal of fewer lymph nodes.
Studies have also found that shorter courses of radiation and more targeted forms of radiation therapy can be just as effective as longer courses of radiation. This includes delivery radiation therapy during surgery for some patients.
Additionally, targeted and biologic therapies may allow doctors to avoid chemotherapy in certain situations. A large 2018 study indicated that adjuvant endocrine therapy and chemoendocrine therapy were similarly effective in certain types of breast cancer.
Weve come a long way since ancient Greece, but we still have a lot to learn about how breast cancer forms and how to treat it.
According to the American Cancer Society,
What Is Stage Iv Breast Cancer
Stage IV is the most advanced stage of breast cancer. It has spread to nearby lymph nodes and to distant parts of the body beyond the breast. This means it possibly involves your organs such as the lungs, liver, or brain or your bones.
Breast cancer may be stage IV when it is first diagnosed, or it can be a recurrence of a previous breast cancer that has spread.
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Stage 3 Breast Cancer
What is Stage 3 breast cancer?
Stage 3 breast cancer is when tumors are larger than earlier stages or are growing into nearby tissues, and the cancer has spread to nearby lymph nodes. There are three categories of Stage 3 breast cancer:
- Stage 3A breast cancer In some cases, Stage 3A breast cancer indicates that the cancer spread to four to nine area lymph nodes, and there may or may not be a tumor in the breast. In other cases, it can describe a cancer that has spread less but the tumor is larger than 5 centimeters.
- Stage 3B breast cancer Stage 3B breast cancer can mean that the cancer has spread to the chest wall or to the breasts skin, causing swelling or an ulcer. It may also mean that cancer has spread to up to nine axillary lymph nodes or lymph nodes near the breast bone.
- Stage 3C breast cancer Stage 3C breast cancer means the cancer may have spread to the chest wall or breasts skin, or it has spread to 10 or more nearby lymph nodes. It can also mean the cancer has also spread to lymph nodes above or below the collarbone.
What are the options for Stage 3 breast cancer treatment?
What is the Stage 3 breast cancer treatment timeline?
The treatment timeline for Stage 3 breast cancer depends greatly on the severity, extent of spreading, the type of treatment youre undergoing and how youre responding to those treatments. For most Stage 3 cases, treatment can last anywhere from six to 12 months with hormone therapy lasting many years after.
There Are Good Days And Bad Days
There are days when I say to myself, Ive had enough. I cant take it anymore, says Rosen. But I want to keep on living. I love my life. Overall, I have a great life except for the cancer.
Rosen has a few mantras she uses when things get tough. A lot of the tough times are treatment related, she says. I refer to those as bumps in the road, and , This too shall pass.
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What Is A Primary Tumor
The primary tumor refers to the original breast tumor. So, any metastases are either secondary tumors, or simply metastatic breast cancer.
Note, when breast cancer spreads to the bones, it is not bone cancer, it is metastatic breast cancer in the bones.
Metastatic describes a breast cancer that has already spread to distant areas and organs of the body. Metastatic cancer is the most advanced stage of breast cancer. Furthermore, the most common sites for breast cancer to metastasize to are the:-
Once breast cancer is at this most advanced metastatic stage, the odds of completely curing the breast cancer are quite low. .
The treatment of metastatic breast cancer, after a reasonable effort, will often focus on the quality of life and relieving symptoms rather than a cure.
Targeted Therapy Ribociclib Added To Endocrine Therapy Improves Survival In Young Women With Certain Types Of Breast Cancer
The combination of the CDK4/6 inhibitor ribociclib with endocrine therapy provided an overall survival advantage for pre- and perimenopausal women with advanced HR+, HER2- breast cancer, compared to standard endocrine therapy plus placebo. Results from the MONALEESA-7 trial showed 42-month survival with ribociclib of 70.2%, compared with 46% for women who received placebo plus standard endocrine treatment. The treatment combination is an important step forward for the treatment of younger women with this disease, who tend to have more aggressive disease with worse survival than those who are postmenopausal.
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Avoid Family Food Battles
It can be very upsetting to family if you start eating less. Some of them may think your interest in food represents your interest in life. By refusing food or not eating much, it may seem to your family that youre choosing to shorten your life or that you will starve.
Its important that you and your loved ones talk about issues around eating. The last stage of your life doesn’t have to be filled with arguments about food. Again, loss of appetite and being unable to eat happens to many people with advanced cancer. When you feel like eating less, its not a sign that you want to leave life or your family. Its often a normal part of the processes that can happen in the last stage of life. If you’re getting into arguments with your loved ones, try to let them know that you appreciate their concern and understand their attempts are acts of love. You can let them know youre not rejecting their love, but your body is limiting what it needs at this time.
You can learn more in Eating Problems.
What Treatments May I Be Offered
Treatment for secondary breast cancer in the lung aims to relieve symptoms and slow down the growth of the cancer.
Treatments can be given on their own 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 lung
- 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. They will 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.
You may also be referred to the respiratory team, which specialises in treating people with breathing difficulties. They can help plan your treatment or manage your symptoms. Your care will continue under your usual breast oncologist, but with involvement or advice from the other team.
Hormone therapy is used to treat breast cancers that are oestrogen receptor positive.
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 having a biopsy to retest for hormone receptors.
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Other Ways To Help Cancer Pain
With certain types of pain, doctors can do special procedures such as nerve blocks, targeted radiation treatments, or even surgical procedures to control pain. Sometimes physical therapy may help. If your pain isnt well controlled, your doctor might also refer you to an expert in pain management. The pain specialist might have some different options to help you.
Medicines and medical procedures are not the only ways to help lessen your pain. There are other things you can do. Some people find distractions like music, movies, conversation, or games help. Using heat, cold, or massage on a painful area can help. Relaxation exercises and meditation can help lessen the pain and lower anxiety for some people. Keep in mind that for most people with cancer pain these measures alone are not enough to control pain. But, they may help improve comfort when used along with pain medicines.
You can learn more in Cancer Pain.
In The Last Days Of Life Patients And Family Members Are Faced With Making Decisions About Treatments To Keep The Patient Alive
Decisions about whether to use life-sustaining treatments that may extend life in the final weeks or days cause a great deal of confusion and anxiety. Some of these treatments are ventilator use, parenteral nutrition, and dialysis.
Patients may be guided by their oncologist, but have the right to make their own choices about life-sustaining treatments. The following are some of the questions to discuss:
- What are the patients goals of care?
- How would the possible benefits of life-sustaining treatments help reach the patient’s goals of care, and how likely would this be?
- How would the possible harms of life-sustaining treatments affect the patient’s goals of care? Is the possible benefit worth the possible harm?
- Besides possible benefits and harms of life-sustaining treatments, what else can affect the decision?
- Are there other resources, such as palliative care, a chaplain, or a medical ethicist, that could help the patient or family decide about life-sustaining treatments?
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Standard Chemotherapy Is An Option For Older Women
Researchers find that chemotherapy with capecitabine alone is less effective and is associated with more serious side effects among older women with early-stage breast cancer than the three-drug chemotherapy regimen that younger women typically receive. The finding resolves a long-running debate about whether a single oral drug would be more tolerable or more effective than a combination of drugs for older patients, showing that otherwise healthy elderly patients can tolerate and benefit from the standard treatment regimen.
What Are The Signs That The Person Has Died
- The person is no longer breathing and doesnt have a pulse.
- Their eyes dont move or blink, and the pupils are dilated . The eyelids may be slightly open.
- The jaw is relaxed and the mouth is slightly open.
- The body releases the bowel and bladder contents.
- The person doesnt respond to being touched or spoken to.
- The persons skin is very pale and cool to the touch.
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White Blood Cell Growth Factors
White blood cell growth factors are proteins that help the body produce white blood cells. They are also called hematopoietic, meaning blood-forming, colony-stimulating factors . White blood cells help fight infection and can be destroyed during some types of cancer treatment. Your doctor may recommend that you receive treatment with CSFs such as filgrastim to help you avoid infections.
Prognosis For Metastatic Breast Cancer
Metastatic breast cancer isnt the same for everyone who has it. According to the National Breast Cancer Foundation, your symptoms at stage 4 will depend on the degree to which the cancer has spread in your body.
Although metastatic breast cancer has no current cure, it can be treated. Getting the right treatment can increase both your quality of life and longevity.
Life expectancy for breast cancer is based on studies of many people with the condition. These statistics cant predict your personal outcome each persons outlook is different.
The following factors can affect your life expectancy with metastatic breast cancer:
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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.
Last Days Of Life Health Professional Version
On This Page
Despite progress in developing treatments that have improved life expectancies for patients with advanced-stage cancer, the American Cancer Society estimates that 609,360 Americans will die of cancer in 2022. People with cancer die under various circumstances. A report of the Dartmouth Atlas Project analyzed Medicare data from 2007 to 2010 for cancer patients older than 65 years who died within 1 year of diagnosis. Across the United States, 25% of patients died in a hospital, with 62% hospitalized at least once in the last month of life. In addition, 29% of patients were admitted to an intensive care unit in the last month of life. Approximately 6% of patients nationwide received chemotherapy in the last month of life. Conversely, about 61% of patients who died used hospice service. However, the average length of stay in hospice was only 9.1 days, and 11% of patients were enrolled in the last 3 days of life. Significant regional variations in the descriptors of end-of-life care remain unexplained.
This summary provides clinicians with information about anticipating the EOL the common symptoms patients experience as life ends, including in the final hours to days and treatment or care considerations. The decisions commonly made by patients, families, and clinicians are also highlighted, with suggested approaches. The goal of this summary is to provide essential information for high-quality EOL care.
References
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How Will Hospice Help
Many people are amazed at the help available when hospice is instituted. In addition to care from the team, hospice most often provides a hospital bed, oxygen, and any equipment or medications needed. This can save a lot of running around for your family and make you as comfortable as possible.
Many people want to spend their last days at home, surrounded by loved ones. With hospice care, the police do not need to be called, as they typically do with any “unattended death.” Your family can spend time with you until they wish to call the funeral home.
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.
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Can Stage 4 Breast Cancer Go Into Remission
Stage 4 breast cancer can go into remission, meaning that it isnt detected in imaging or other tests. Pathological complete remission indicates a lack of cancer cells in tissues removed after surgery or biopsy.
But its rare to take tissue samples while treating stage 4 breast cancer. This could mean that although treatment has been effective, it hasnt completely destroyed the cancer.
Advances in stage 4 breast cancer treatments are helping to increase the length of remission.
Parp Inhibitors Show Promise For Difficult
Researchers share the first encouraging findings on a new class of targeted drugs PARP inhibitors for difficult-to-treat “triple-negative” breast cancers and those that involve BRCA1 and BRCA2 gene mutations. PARP inhibitors are designed to disable key enzymes that cancer cells use to repair DNA damage, including damage inflicted by chemotherapy, and to promote cancer cell death. They may also make cancer cells more sensitive to other chemotherapy agents. Triple-negative breast cancers lack receptors for estrogen, progesterone and HER2, and therefore do not respond to targeted drugs that block these proteins.
Further long-term, randomized clinical trials are needed to determine whether PARP inhibitors truly benefit patients with breast cancer, and if so, which specific types of breast tumors are most likely to respond to the drugs.
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When Do People Get A Metastatic Breast Cancer Diagnosis
Metastatic breast cancer can occur at different points:
- De novo metastatic breast cancer: About 6% of women and 9% of men have metastatic breast cancer when theyre first diagnosed with breast cancer.
- Distant recurrence: Most commonly, metastatic breast cancer is diagnosed after the original breast cancer treatment. A recurrence refers to the cancer coming back and spreading to a different part of the body, which can happen even years after the original diagnosis and treatment.
Coping With Advanced Breast Cancer
Being told that you have advanced or metastatic breast cancer may be very confronting or overwhelming. Some women also find the news that their cancer has spread or come back is more devastating than their original diagnosis.
There are many resources available online to help you further understand the meaning of your diagnosis and how to manage the emotional, physical and practical issues arising from metastatic breast cancer. Below are some links where these resources can be accessed:
Although support groups can provide a safe place for people to express their feelings amongst others who share a similar experience, some people are more comfortable talking one-on-one, such as with a counsellor, therapist or trained volunteer . Your GP can also refer you to a psychologist, social worker or other trained therapist. Every person is different and it is important to find a healthy support system that works for you.
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