What Is The Prognosis For Stage Iv Breast Cancer
Whether a patients metastatic breast cancer is the oligometastatic type or the most challenging, widespread sort, the best possible care addresses the patient as a unique individual. And according to Habibi, there are more reasons for hope than ever before.
Advancements in treatment options have extended the survival of patients with metastatic breast cancer, which had a stigma of being untreatable just a generation ago.
Even within the last decade, all aspects of care have seen a good amount of progress. Better diagnostic tests such as improved PET and CT scans are helping us find cancers faster and initiate treatment. And targeted therapies such as radiation, surgery and systemic treatments have seen improvements as well.
When Hospice Care Is Appropriate
It can be a difficult decision, but the earlier hospice care begins, the more benefit a person receives. Its important not to wait too late to begin hospice care if its needed.
When hospice workers have longer to get to know a person and their unique situation, the hospice worker can create a better individualized plan for care.
What Can You Do About Appetite Changes
Its important to recognize changes in appetite so that you can get help when its needed. Talk to your medical team about how much youve been eating and whether you need to do something about it. For example:
- Some causes of poor appetite can be managed with medical treatment. There are medicines that can help stimulate your appetite, decrease nausea, and help food move through your stomach more quickly.
- A nutritionist might be able to offer tips on how to get the most out of each bite you take.
- Supplemental drinks or shakes can sometimes help you get needed nutrition more easily.
- You might find that youre able to eat more when others are at the table.
- You might find it easier to eat small frequent meals or snacks during the day instead of trying to eat full meals 3 times a day.
These measures may work for some, but they wont help most people who are very close to the end of life. At later stages, these efforts can even make the person feel worse.
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Symptoms And Diagnosis Of Metastatic Breast Cancer
The most common parts of the body where breast cancer tends to spread are the bones, lungs, brain, and liver. But metastatic breast cancer can affect other parts of the body, as well.
Metastatic breast cancer symptoms can be very different depending on the cancers location, but may include:
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biopsy of any suspicious area
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a tap, removal of fluid from the area with symptoms to check for cancer cells a pleural tap removes fluid between the lung and chest wall a spinal tap removes fluid from around the spinal cord and a tap of fluid in the abdomen removes fluid in the abdominal cavity
These tests may also be used if you have no history of breast cancer and your doctor is having trouble determining the cause of your symptoms.
When breast cancer spreads to other parts of the body, its important to confirm whether the cancer has certain characteristics that may influence your treatment options, such as HER2 status and hormone receptor status. If you have been diagnosed with metastatic breast cancer years after an early-stage breast cancer diagnosis, it may seem logical to assume that the hormone receptor status and HER2 status are the same. But research has shown that the hormone receptor status and HER2 status of early-stage breast cancer can be different than that of a metastatic recurrence.
A biopsy may be done to determine these factors that can influence your treatment, which will be listed in your pathology report.
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.
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What To Expect Emotionally
This can be a time of big emotions — for you and your loved ones. You may feel peaceful and ready to go. You may feel sad, angry, scared, or withdrawn. You may be worried about the loved ones youâll leave behind or have feelings — good or bad — about your life.
The only right emotion to feel is whatever youâre feeling.
Expect to grieve losses on many levels over the course of this stage: loss of function, independence, hope of recovery, and the way you thought your life would look.
Hospital rules during COVID-19 have changed things: You may not be able to see children, grandchildren, or people who bring you joy in person. This can feel particularly hard if you have to say goodbye through your phone or computer screen. Keep in mind that you have options, including hospice, which can help you address any emotional, relational, and spiritual issues that are on your mind.
Additional Tools For Diagnosing Advanced Breast Cancer
The additional tools below are often used specifically for diagnosing advanced cancer:
Sentinel lymph node biopsy: This procedure removes sentinel lymph node cells during surgery for examination. When breast cancer spreads, it often heads first to the lymph nodes.
Chest X-ray: This detailed image of the chest may help doctors see whether cancer has spread to the bones.
Computed tomography scan: Also known as a CAT scan, this procedure takes detailed pictures of internal areas of the body using a computer linked to an X-ray machine. A dye may be used to help the organs show up more clearly in the images.
Bone scan: This procedure looks for bone metastasis, or cancer cells that have spread to the bone. A small amount of radioactive material is injected into the blood, then detected with a scanner.
Positron emission tomography scan: A PET scan is a detailed imaging tool that uses a radioactive drug, known as a tracer, to search for cancer cells within your body.
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Alternative And Complementary Therapies
Some patients with metastatic breast cancer opt to try alternative therapies that are claimed to achieve healing effects similar to scientifically-tested medical approaches, but lack scientific evidence to support those claims. Approaches that are considered alternative therapies when applied to cancer treatment include vitamin therapies, homeopathic treatments, extreme diets, chiropractic treatment and acupuncture.
Some alternative treatments are harmful or even life-threatening. Amygdalin, an extract derived from apricot kernels, exposes the patient to cyanide. Bee venom can cause a life-threatening allergic reaction. Severe dietary restrictions such as Macrobiotic diets can disrupt the bodyâs metabolism and cause dangerous weight loss. People should be aware that foods, vitamins, and other treatments may interfere with the effectiveness of surgery, chemotherapy or radiation. It is essential that patients work with their doctors and openly discuss possible effects of any treatment they are considering. Alternative and complementary therapies are not regulated by the U.S. federal government and may lack quality controls.
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Survival For All Stages Of Breast Cancer
Generally for women with breast cancer in England:
- Around 95 out of every 100 women survive their cancer for 1 year or more after diagnosis
- Around 85 out of every 100 women will survive their cancer for 5 years or more after diagnosis
- Around 75 out of every 100 women will survive their cancer for 10 years or more after diagnosis
Cancer survival by stage at diagnosis for England, 2019Office for National Statistics
These statistics are for net survival. Net survival estimates the number of people who survive their cancer rather than calculating the number of people diagnosed with cancer who are still alive. In other words, it is the survival of cancer patients after taking into account that some people would have died from other causes if they had not had cancer.
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Where Is Hospice Care Given
Hospice care is most often given at home, where the patient is usually the most comfortable.
Sometimes, hospice care is in-patient care at a freestanding hospice house or at a hospital with hospice services. Some people prefer to get hospice care in these settings and sometimes, certain situations prevent someone from staying at home.
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.
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How Does Cancer Spread Or Metastasize
The spread of cancer usually happens through one or more of the following steps:
- Cancer cells invade nearby healthy cells. When the healthy cell is taken over, it too can replicate more abnormal cells.
- Cancer cells penetrate into the circulatory or lymph system. Cancer cells travel through the walls of nearby lymph vessels or blood vessels.
- Migration through circulation. Cancer cells are carried by the lymph system and the bloodstream to other parts of the body.
- Cancer cells lodge in capillaries. Cancer cells stop moving as they are lodged in capillaries at a distant location and divide and migrate into the surrounding tissue.
- New small tumors grow. Cancer cells form small tumors at the new location
Its Not About Giving Up
Both palliative and hospice care are important parts of caring for someone with stage 4 breast cancer. These types of care having nothing to do with giving up and everything to do with helping people feel comfortable and comforted while living the best life they possibly can.
The process of palliative or hospice care will usually begin with a referral from your oncologist. It may also come from a caseworker or social worker in your oncologists office.
These referrals are often needed for insurance purposes. Each individual palliative or hospital care organization will likely have their own requirements in terms of paperwork or information needed following this referral.
Communication in all aspects is so important when deciding on hospice or palliative care. This includes communication with your doctor, family, and loved ones so you can live out your life on your terms.
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You May Not Know Im Sick By Looking At Me
I may look perfectly healthy, but Im sick, says Silberman. Treatment is hard. I sleep a lot. I still travel, but its difficult. I just visited a friend in Utah for four days, and it wore me out for two weeks.
Just because someone doesnt look like she has advanced-stage cancer, she can be very sick. It can be an invisible illness, says Silberman. You tell somebody you have cancer, but if you have hair, sometimes they dont believe you.
End Of Life Concerns With Metastatic Breast Cancer
Despite encouraging advances in breast cancer treatment that have dramatically prolonged survival even when diagnosed at a metastatic stage, there still is a significant group of less fortunate patients that die from this condition every year.
The usual scenario goes like this: People with metastatic breast cancer want to talk about these concerns, but are afraid to upset their loved onesso they stay quiet. On the other side, loved ones are afraid of upsetting you by talking about the end of life issuesso they say nothing.
The same holds true even for patients and oncologists, and studies tell us that these conversations take place much less often than they should.
Many people fear these discussions are a sign of giving up. However, talking about your wishes does not mean you are giving up at all. It does not mean that you have lost hope that you will be one of the people who live for decades with stage 4 breast cancer. What it means, instead, is that you want your decisions to be thought out, and not left to chance. It’s a way to communicate your wishes before circumstances may force you to do so.
The best place to start is with the most important step. How can you begin these discussions with your loved ones?
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Phase : The Pretrajectory Phase Of Metastatic Breast Cancer
Women’s narratives began by describing events before metastatic disease was diagnosed. This included life before their diagnosis of primary disease, and life after completing treatment for early stage disease. Reflecting back, women tried to identify the cause of their disease progressing, a common theme was to attribute this to previous life stress or lifestyle women felt personal responsibility for their disease progression.
I just kind of thought I had to be superwoman…and that was a really stupid thing to do and I had three different jobs and I was doing between 5060hours a weekI just couldn’t see the bigger picture and I do think that contributed to, to sort of the speed up of my condition I am sure. Dawn
Women identified other life events which they feared as possible causes of progressive disease, such as marital breakdown.
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.
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Knowing What To Expect In The Final Days Or Hours Helps Comfort The Family
Most people dont know the signs that show death is near. Knowing what to expect can help them get ready for the death of their loved one and make this time less stressful and confusing. Healthcare providers can give family members information about the changes they may see in their loved one in the final hours and how they may help their loved one through this.
Clinical Manifestations Of Stage 4
The main classification signs of breast cancer stage 4 are its spread to remote organs or lymph nodes. The size of the tumor at this stage is no longer important moreover, it may no longer be detected at the primary site.
It is the metastases that most often develop in the liver, lungs, and bones that give information about the development of the oncological process. They are painful and cause vivid symptoms. Metastases in the liver give jaundice and increase abdominal size. Metastases in the lungs give shortness of breath, and in the bones severe pain and frequent fractures.
- severe intoxication
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