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How Fatal Is Stage 4 Breast Cancer

Can Metastatic Breast Cancer Be Cured

What Are the Treatment Options for Stage 4 Breast Cancer?

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.

Relieving Symptoms Of Advanced Breast Cancer

Treatment to relieve symptoms depends on where the cancer has spread. For example, pain from bone metastases may be treated with radiation therapy, drugs called bisphosphonates such as pamidronate or zoledronic acid , or the drug denosumab . For more, see our information about the treatment of bone metastases.

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 .

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Factors Influencing Survival Rates

The variability in survival rates highlights one key reality about stage 4 lung cancer: no two people have the same disease. Arguably more than any other stage of the disease, stage 4 lung cancer survival is influenced by multiple factors, some of which are fixed and others of which can be changed .

There are seven factors known to influence survival times in people with stage 4 NSCLC.

How Is Metastatic Breast Cancer Treated

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The main treatment for metastatic breast cancer is systemic therapy. These therapies treat the entire body. Systemic treatments may include a combination of:

Your care team will plan your treatment based on:

  • Body parts cancer has reached.
  • Past breast cancer treatments.
  • Tumor biology, or how the cancer cells look and behave.

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Mortality Rates Versus Number Of Breast Cancer Deaths

Sometimes its useful to have an estimate of the number of people expected to die from breast cancer in a year. This numbers helps show the burden of breast cancer in a group of people.

Numbers, however, can be hard to compare to each other. To compare mortality in different populations, we need to look at mortality rates rather than the number of breast cancer deaths.

How Do You Get It

Researchers dont yet know exactly how or why malignancies start, but they do know that certain events can trigger them or increase the likelihood of development. Many of these triggers can be related to some lifestyle factors, such as smoking or getting too much sun exposure without skin protection . Others may be inadvertent, such as being exposed to carcinogenic chemicals.

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Myth #: If Youre Diagnosed With Metastatic Breast Cancer You Did Something Wrong Or Didnt Get The Right Treatment The First Time

When some people hear stage IV breast cancer, they assume something must have been missed along the way to let the cancer get that far. There is a misconception that breast cancer always develops in orderly steps from stages I to II, III, and then IV and that theres plenty of time to catch it early. People with MBC can face misguided assumptions that they must have skipped mammograms or self-exams, or they didnt control risk factors such as not exercising enough, watching their weight, or eating healthy. But a person can do everything right and still get MBC. Although regular screenings increase the odds of diagnosing breast cancer at an earlier stage, they cant guarantee it.

Another major misconception: If youre diagnosed with metastatic cancer after being treated for an early-stage breast cancer, you must have chosen the wrong treatment regimen or it wasnt aggressive enough. But between 20% and 30% of people with an earlier-stage breast cancer will eventually go on to develop MBC and theres often no good explanation as to why. And it can happen to anyone. Treatments can reduce the risk of recurrence, but they cant eliminate it.

As Illimae of Houston notes: that a stage IV diagnosis equals negligence on the part of the patient. In my case, it had spread before I ever felt a lump. I felt it Saturday and saw my doc on Monday, I ignored nothing, sometimes it just happens that fast.

What Should A Person With Stage 4 Breast Cancer Expect From Treatment

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Treatment options vary widely depending on where you live, your access to specialists and sub-specialists, and your willingness to try therapies that are still in the experimental phase.

Seek out oncology specialists who specialize in Stage 4 breast cancer. Discuss with your treatment team what clinical trials may be available for your clinical situation.

During this time, be sure to surround yourself with a support system of friends and family.

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What Is Stage Iii Breast Cancer

In stage III breast cancer, the cancer has spread further into the breast or the tumor is a larger size than earlier stages. It is divided into three subcategories.

Stage IIIA is based on one of the following:

  • With or without a tumor in the breast, cancer is found in four to nine nearby lymph nodes.
  • A breast tumor is larger than 50 millimeters, and the cancer has spread to between one and three nearby lymph nodes.

In stage IIIB, a tumor has spread to the chest wall behind the breast. In addition, these factors contribute to assigning this stage:

  • Cancer may also have spread to the skin, causing swelling or inflammation.
  • It may have broken through the skin, causing an ulcerated area or wound.
  • It may have spread to as many as nine underarm lymph nodes or to nodes near the breastbone.

In stage IIIC, there may be a tumor of any size in the breast, or no tumor present at all. But either way, the cancer has spread to one of the following places:

  • ten or more underarm lymph nodes
  • lymph nodes near the collarbone
  • some underarm lymph nodes and lymph nodes near the breastbone
  • the skin

What Is A 5

A relative survival rate compares women with the same type and stage of breast cancer to women in the overall population.For example, if the 5-year relative survival rate for a specific stage of breast cancer is 90%, it means that women who have that cancer are, on average, about 90% as likely as women who dont have that cancer to live for at least 5 years after being diagnosed.

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What Is Stage 0

Stage 0 is the least invasive stage of breast cancer and usually detected early in patients, according to the American Cancer Society. In this stage, cancer cells or non-cancerous abnormal cells are only in the part of the breast in which they formed and haven’t spread.

“At this stage of breast cancer, we tell patients not to be too worried. Stage 0 is extremely treatable and we ask people not to shed a tear over the diagnosis just yet,” said Cruz.

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Survival Rates For Metastatic Breast Cancer

Stages 0 &  1

According to the American Cancer Society , the 5-year survival rate after diagnosis for people with stage 4 breast cancer is 28 percent. This percentage is considerably lower than earlier stages. For all stages, the overall 5-year survival rate is 90 percent.

Because survival rates are higher in the early stages of breast cancer, early diagnosis and treatment is crucial. But remember: The right treatment for stage 4 breast cancer can improve quality of life and longevity.

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Stage 4 Survival Rates

To get a perspective on the difference in survival rates during different stages of cancer, according to the American Cancer Society the rate of survival after diagnosis is:

  • For those at stage 2 there is an expected five-year survival rate of over 90%.
  • For those at stage 3 there is an expected five-year survival rate of 72%.
  • For stage 4 there is an expected five-year survival rate of 22%.

Because the earlier stages of breast cancer have much longer survival rates, early detection and treatment are important.

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

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Being Your Own Advocate

While there aren’t currently any studies looking at self-advocacy and survival, being your own advocate can’t hurt in maximizing your survival. Oncology is changing rapidly and it’s difficult for any oncologisteven those who specialize in breast cancerto stay aware of all of the latest research and clinical trials taking place.

It can be helpful to research your cancer yourself. Becoming involved via social media such as Twitter is also an excellent way to learn about the latest research, using the hashtag #bcsm, which stands for breast cancer social media.

Getting a second opinion can be helpful as well, especially from one of the larger cancer centers such as a National Cancer Institute-designated cancer center.

There are ways to learn about opportunities, however, that don’t require traveling for opinions. There are now clinical trial matching services in which a nurse navigator can help to match your particular tumor and characteristics with clinical trials in progress all over the world.

Several of the larger cancer centers are now also offering remote second opinions, in which an oncology team can review your medical information and talk to you on the phone about whether there are any opportunities for treatment for you that may not be available elsewhere.

What Does This Mean If You’ve Been Diagnosed With De Novo Metastatic Breast Cancer

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First, there is now evidence that local treatment to the breast should not be offered with the hope of lengthening life. Sometimes there are good reasons to recommend breast surgery or radiation to manage discomfort caused by the tumor. Secondly, the study confirmed the value of ongoing chemotherapy and targeted therapies in this situation.

It is easy to find this study disappointing and discouraging. However, this study confirmed the value of the existing standard of care and helps us understand what works and what does not work. No one wants to put anyone through surgery, radiation, or any treatment that will be stressful and maybe painful unless there is a good chance of it being helpful.

Although we all continue to hope for new and better ways to treat metastatic breast cancer, we now know that adding local treatment will not bring a benefit. Sometimes continuing on with the standard course of care is truly the best choice.

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Systemic Treatments For Stage Iv Breast Cancer

Treatment often continues until the cancer starts growing again or until side effects become unacceptable. If this happens, other drugs might be tried. The types of drugs used for stage IV breast cancer depend on the hormone receptor status and the HER2 status of the cancer:

Hormone receptor-positive cancers

Women with hormone receptor-positive cancers are often treated first with hormone therapy . This may be combined with a targeted drug such as a CDK4/6 inhibitor, everolimus or a PI3K inhibitor.

Women who havent yet gone through menopause are often treated with tamoxifen or with medicines that keep the ovaries from making hormones along with other drugs. Because hormone therapy can take months to work, chemo is often the first treatment for patients with serious problems from their cancer spread, such as breathing problems.

Hormone receptor-negative cancers

Chemo is the main treatment for women with hormone receptor-negative cancers, because hormone therapy isnt helpful for these cancers.

HER2-positive cancers

Trastuzumab may help women with HER2-positive cancers live longer if its given along with chemo or with other medications such as hormonal therapy or other anti-HER2 drugs. Pertuzumab , another targeted drug, might be added as well. Other options might include targeted drugs such as lapatinib or ado-trastuzumab emtansine .

HER2-negative cancers in women with a BRCA gene mutation

HER2-negative breast cancers in women with a PIK3CA mutation

Characteristics Of Stage 4 Lung Cancers

Lung cancer is staged to classify the severity of the disease. The staging of NSCLC helps doctors choose the most appropriate course of treatment based on the likely outcome, referred to as the prognosis.

The stage of lung cancer is determined using the TNM classification system, which categorizes the severity of the disease based on three conditions:

  • The size and extent of the primary tumor
  • Whether nearby lymph nodes have cancer cells in them
  • Whether distant metastasis has occurred

With stage 4 lung cancer, all three of these conditions will have occurred. With that said, the extent of metastasis can vary along with the prognosis.

For this reason, stage 4 NSCLC was broken down into two substages with the release of the new TNM classification system in 2018:

  • Stage 4a lung cancer, in which cancer has spread within the chest to the opposite lung or to the lining around the lungs or the heart or to the fluid around the lungs or heart
  • Stage 4b lung cancer, in which cancer has spread to one area outside of the chest, including a single non-regional lymph node
  • Stage 4c lung cancer, in which cancer has spread to one or multiple places in one or more distant organs, such as the brain, adrenal gland, bone, liver, or distant lymph nodes.

Stage 4 lung cancer is incurable. Treatments, therefore, are focused on slowing the progression of the disease, minimizing symptoms, and maintaining an optimal quality of life.

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Staging And Grading For Stage 4 Cancer

Most cancers are staged using some form of the TNM system. Doctors may also use the TNM system to help determine the extent of certain cancers in each stage. The TNM system stands for:

  • T , or the size of the original tumor
  • N , or whether the cancer is present in the lymph nodes
  • M , or whether the cancer has spread to other parts of the body

Not all cancers are staged using the TNM system, though. Some cancers, especially liquid cancers, are staged through different established protocols. The Binet and Rai systems, for example, are used to stage certain types of leukemia. Female reproductive system cancers, such as cervical cancer, are staged with a separate staging system created by the International Federation of Gynecology and Obstetrics .

As your care team gathers information about your cancer for the purposes of staging, they may need to order several tests, including:

Your care team may likely also need to perform a biopsy, a procedure that involves removing a sample of cells and analyzing it for signs of cancer. Imaging scans may be able to tell your care team where your cancer is, but looking at the cancer cells specifically tell them how fast they are likely to growor what grade they are.

Grading is different from staging and is done for most, but not all, cancers.

The grade of your cancer is part of how your cancer care team stages your cancer and determines your prognosis, or outlook.

Advanced Cancer That Progresses During Treatment

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Treatment for advanced breast cancer can often shrink the cancer or slow its growth , but after a time, it tends to stop working. Further treatment options at this point depend on several factors, including previous treatments, where the cancer is located, and a woman’s age, general health, and desire to continue getting treatment.

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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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