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Hormone Therapy For Breast Cancer Stage 4

For The Population Studied As A Whole There Was An Overall Deterioration In The Quality Of Life At Two Years From Diagnosis This Deterioration Was Greater In Patients Who Had Received Hormone Therapy Especially After The Menopause By Contrast Chemotherapy Had A Bigger Effect On Quality Of Life In Non

Hormone Therapy & Advanced Therapies for Prostate Cancer, Celestia Higano, MD | 2021 Mid-Year Update

It is important in the future that we are able to predict which women are going to develop severe symptoms with anti-hormonal treatment so that we can support them, added Dr Vaz-Luis. While it has been shown that hormone therapy provides a real benefit in reducing the relapse rate of hormone-dependent cancers which represent 75% of all breast cancers, the deterioration in quality of life may also have a negative effect on patient adherence to treatment. It is, therefore, important to offer them symptomatic treatment, in particular for menopausal symptoms, musculoskeletal pain, depression, severe fatigue and cognitive dysfunction and to combine this with supportive measures such as physical exercise and cognitive behaviour therapy.

Stage 4 Breast Cancer Successfully Treatedwith Hormonal Therapy Alone

Dr. Suhas Aagre, Oncologist and Hemato-Oncologist at Asian Cancer Institute, said, “Hormonal therapy is a type of oral pill and doesn’t have side effects like chemotherapy.”

Dr. Aagre cited a case in which they successfully treated a 58-year-old Mumbai woman with stage-4 breast cancer with hormonal therapy alone.

Talking about the case, Dr. Aagre that the patient was obese, and her staging PET CT showed Nodal metastasis confirming advance stage IV disease, and her reports suggested that she would respond to hormonal therapy and chemotherapy can be avoided. Then, she was started on a single pill per day of hormonal therapy which she tolerated well with excellent response.

While, the woman continues to get the treatment, she is now leading a normal life and goes for regular follow-ups after every 3-6 months to ensure there is no problem.

The patient’s daughter stated her mother is cancer-free for the last 3 years even after having stage IV breast cancer.

“Not treating her promptly could have led to a loss of life,” Dr. Aagre noted.

Hormone Therapy After Surgery For Breast Cancer

After surgery, hormone therapy can be given to reduce the risk of the cancer coming back. Taking an AI, either alone or after tamoxifen, has been shown to work better than taking just tamoxifen for 5 years.

These hormone therapy schedules are known to be helpful for women who are post-menopausal when diagnosed:

  • Tamoxifen for 2 to 3 years, followed by an AI for 2 to 3 years
  • Tamoxifen for 2 to 3 years, followed by an AI for 5 years
  • Tamoxifen for 4½ to 6 years, followed by an AI for 5 years
  • Tamoxifen for 5 to 10 years
  • An AI for 5 to 10 years
  • An AI for 2 to 3 years, followed by tamoxifen for 2 to 3 years
  • For women who are unable to take an AI, tamoxifen for 5 to 10 years is an option

For most post-menopausal women whose cancers are hormone receptor-positive, most doctors recommend taking an AI at some point during adjuvant therapy. Standard treatment is to take these drugs for about 5 years, or to take in sequence with tamoxifen for 5 to 10 years. For women at a higher risk of recurrence, hormone treatment for longer than 5 years may be recommended. Tamoxifen is an option for some women who cannot take an AI. Taking tamoxifen for 10 years is considered more effective than taking it for 5 years, but you and your doctor will decide the best schedule of treatment for you.

These therapy schedules are known to be helpful forwomen who are pre-menopausal when diagnosed:

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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.

Local Or Regional Treatments For Stage Iv Breast Cancer

Figure 1 from Endocrine Therapy for Hormone Receptor

Although systemic drugs are the main treatment for stage IV breast cancer, local and regional treatments such as surgery, radiation therapy, or regional chemotherapy are sometimes used as well. These can help treat breast cancer in a specific part of the body, but they are very unlikely to get rid of all of the cancer. These treatments are more likely to be used to help prevent or treat symptoms or complications from the cancer.

Radiation therapy and/or surgery may also be used in certain situations, such as:

  • When the breast tumor is causing an open or painful wound in the breast
  • To treat a small number of metastases in a certain area, such as the brain
  • To help prevent or treat bone fractures
  • When a cancer is pressing on the spinal cord
  • To treat a blood vessel blockage in the liver
  • To provide relief of pain or other symptoms anywhere in the body

In some cases, regional chemo may be useful as well.

If your doctor recommends such local or regional treatments, it is important that you understand the goalwhether it is to try to cure the cancer or to prevent or treat symptoms.

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What Are Risk Factors For Breast Cancer Recurrence

Anyone with a breast cancer diagnosis can have a recurrence. Your risk of cancer recurrence depends on several factors:

  • Age: Women who develop breast cancer before age 35 are more likely to get breast cancer again.
  • Cancer stage: Cancer stage at the time of diagnosis correlates with the risk of the cancer being able to recur. Several factors determine cancer stage: tumor size, cancer grade and cancer spread to lymph nodes or other parts of the body. Cancer grade indicates how unusual cancer cells look in comparison to healthy cells.
  • Cancer type: Aggressive cancers like inflammatory breast cancer and triple-negative breast cancer are harder to treat. Theyre more likely to come back and spread.

How Much Hormone Therapy Costs

The cost of hormone therapy depends on

  • the types of hormone therapy you receive
  • how long and how often you receive hormone therapy
  • the part of the country where you live

Talk with your health insurance company about what services it will pay for. Most insurance plans pay for hormone therapy for their members. To learn more, talk with the business office where you go for treatment. You can also go to the National Cancer Institute database, Organizations that Offer Support Services and search “financial assistance.” Or call toll-free 1-800-4-CANCER to ask for help.

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Metastatic Breast Cancer Treatment

As hard as it is to hear, metastatic breast cancer cannot be cured today. Unlike breast cancer that remains in the breast or nearby lymph nodes, medical treatments cant get rid of all the cancer thats spread to other parts of the body.

However, metastatic breast cancer can be treated. Treatment focuses on extending life and maintaining quality of life.

Your treatment plan is guided by many factors, including:

  • The biology of the tumor
  • Where the cancer has spread
  • Your overall health, age, menopausal status and other medical issues
  • Personal goals and preferences

Learn more about getting a second opinion.

Susan G. Komen®s Metastatic Breast Cancer Impact Series

Susan G. Komens free MBC Impact Series provides people living with metastatic breast cancer and their loved ones a safe, space to gather information related to MBC and discover practical resources to help make decisions for improved physical and emotional health. To learn more and register visit www.komen.org/mbcseries.

A Disease No One Gets

Mayo Clinic Q& A podcast: Systemic therapies for breast cancer

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.

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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.

Treatments For Metastatic Breast Cancer

Metastatic breast cancer is not a specific type of breast cancer. Its the most advanced stage of breast cancer.

Metastatic breast cancer is breast cancer that has spread beyond the breast and nearby lymph nodes to other parts of the body .

Although metastatic breast cancer has spread to another part of the body, its still breast cancer and treated as breast cancer.

For example, breast cancer that has spread to the bones is still breast cancer . The breast cancer cells have invaded the bones. Its not the same as cancer that starts in the bones. So, its treated with breast cancer drugs rather than treatments for cancer that began in the bones.

If youve been diagnosed with metastatic breast cancer, youre not alone. Its estimated there were more than 168,000 women living with metastatic breast cancer in the U.S. in 2020 . Men can also get metastatic breast cancer.

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

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

A diagnosis of metastatic breast cancer is not your fault. You did nothing to cause the cancer to spread.

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What Causes Breast Cancer Recurrence

The goal of cancer treatments is to kill cancer cells. But, cancer cells are tricky. Treatments can reduce tumors so much that tests dont detect their presence. These weakened cells can remain in the body after treatment. Over time, the cells get stronger. They start to grow and multiply again.

Even surgery to remove a cancerous tumor isnt always 100% effective. Cancer cells can move into nearby tissue, lymph nodes or the bloodstream before surgery takes place.

Plans Have To Be Flexible

[PDF] Endocrine Therapy for Hormone Receptor

My energy is unpredictable, says Sendelbach. I literally never know how Im going to feel from one day to the next. Its so hard to make plans because if I say yes to something thats two weeks away, the day of, I could wake up and feel absolutely horrible.

When someone with metastatic breast cancer declines an invitation or cancels at the last minute, its most likely not because they dont want to be there. Says Sendelbach, We physically cant do it.

Silberman agrees. Ive been going through for a long time, she says, and Ive had friends drop away. Because of MBC and my treatments, its hard for me to be reliable.

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How Is Hormone Therapy Used To Treat Breast Cancer

There are three main ways that hormone therapy is used to treat hormone-sensitive breast cancer:

Adjuvant therapy for early-stage breast cancer:Tamoxifen is FDA approved for adjuvant hormone treatment of premenopausal and postmenopausal women with ER-positive early-stage breast cancer, and the aromatase inhibitorsanastrozole, letrozole, and exemestane are approved for this use in postmenopausal women.

Research has shown that women who receive at least 5 years of adjuvant therapy with tamoxifen after having surgery for early-stage ER-positive breast cancer have reduced risks of breast cancer recurrence, including a new breast cancer in the other breast, and reduced risk of death at 15 years .

Until recently, most women who received adjuvant hormone therapy to reduce the chance of a breast cancer recurrence took tamoxifen every day for 5 years. However, with the introduction of newer hormone therapies , some of which have been compared with tamoxifen in clinical trials, additional approaches to hormone therapy have become common .

Some premenopausal women with early-stage ER-positive breast cancer may have ovarian suppression plus an aromatase inhibitor, which was found to have higher rates of freedom from recurrence than ovarian suppression plus tamoxifen or tamoxifen alone .

Men with early-stage ER-positive breast cancer who receive adjuvant therapy are usually treated first with tamoxifen. Those treated with an aromatase inhibitor usually also take a GnRH agonist.

Treatment For Stage 1 Breast Cancer

Doctors can offer a variety of for stage 1 breast cancer, although surgery is the primary treatment.

Surgery

A lumpectomy or mastectomy are both viable surgical options for people with stage 1 breast cancer. A doctor will decide what surgery is most appropriate depending on the location of the primary tumor, how large it is, the size of the breast, family history, genetics, and the persons preference.

The doctor may also carry out a biopsy on one or more lymph nodes.

After removing the tissue, they will send it to a laboratory for further tests. The results will help inform decisions on the next stage of treatment.

Radiation therapy

Radiation therapy is a standard treatment for stage 1 breast cancer. However, the decision will depend on factors such the age of the person, the type of cancer, the size of the tumor, and whether there are cancer cells in the lymph nodes.

Hormone therapy

If the breast cancer is ER+ or PR+, hormone therapy may be effective. Hormone therapy works by preventing the growth of estrogen, which helps cancer grow, by blocking estrogen from attaching to tissue and fuelling cancer growth, or both.

Hormone therapy can reach cancer cells in the breast, as well as other areas of the body, and it can reduce the risk of cancer returning.

Chemotherapy

However, the

Stage 2 breast cancer also has subcategories known as 2A and 2B.

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Possible Side Effects Of Ais

The most common side effects of AIs are:

  • Bone and joint pain

AIs tend to have side effects different from tamoxifen. They don’t cause uterine cancers and very rarely cause blood clots. They can, however, cause muscle pain and joint stiffness and/or pain. The joint pain may be similar to a feeling of having arthritis in many different joints at one time. Options for treating this side effect include, stopping the AI and then switching to a different AI, taking a medicine called duloxetine , or routine exercise with nonsteroidal anti-inflammatory drugs . But the muscle and joint pain has led some women to stop treatment. If this happens, most doctors recommend using tamoxifen to complete 5 to 10 years of hormone treatment.

Because AIs drastically lower the estrogen level in women after menopause, they can also cause bone thinning, sometimes leading to osteoporosis and even fractures. If you are taking an AI, your bone density may be tested regularly and you may also be given bisphosphonates or denosumab , to strengthen your bones.

What Questions Should I Ask My Healthcare Provider

Should You Get off of Anti-Hormone Therapy for Breast Cancer?

You may want to ask your provider:

  • What type of breast cancer recurrence do I have?
  • Has the cancer spread outside the breast?
  • What stage is the breast cancer?
  • What is the best treatment for this type of breast cancer?
  • What are the treatment risks and side effects?
  • Should I look out for signs of complications?

A note from Cleveland Clinic

Most breast cancer recurrences respond well to treatments. You may be able to try new drugs or combination therapies in development in clinical trials. Your healthcare provider can discuss the best treatment option based on your unique situation.

Last reviewed by a Cleveland Clinic medical professional on 03/24/2021.

References

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How Hormone Therapy Is Used Against Cancer

Hormone therapy is used for two main reasons.

  • Treat cancer. Hormone therapy can stop or slow cancer’s growth and reduce the chance it will return.
  • Ease cancer symptoms. Hormone therapy may be used to reduce or prevent symptoms in men with prostate cancer who are not able to have surgery or radiation therapy.

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