Where Breast Cancer Tends To Go
Breast cancer most often spreads to these organs:
Bones. Breast cancer travels to the bones through the bloodstream. The ribs, spine, pelvis, and long bones of the arms and legs are the most common bones that breast cancer reaches. Bone pain and tenderness are signs the cancer is in your bones. Breast cancer cells can also get into bone marrow — the spongy tissue inside bones where blood cells are made.
Liver. Cancer cells can get into the liver through the bloodstream because the liver filters the blood.
Lungs. The lungs are another common site for metastatic breast cancer to spread because your blood flows through them to pick up oxygen.
Brain. Any type of breast cancer can spread to the brain, but HER2-positive and triple-negative cancers are most likely to reach this organ. Signs of cancer in the brain include headaches, seizures, vision changes, and dizziness.
Understanding Her2+ Status And Survival
Doctors use three markers to help define breast cancers and guide treatment. One of those is the HER2 protein. The other two are hormone receptors . When a cancer has none of these, doctors call it triple negative. Until recently, there wasnât much information about how these markers changed survival rates for breast cancer.
A recent study looked at the National Cancer Institute data to see if there were differences in survival for women based on these markers. The study shows there are. Overall, women who have HR+ and HER2- breast cancer do best. But in the later stages, those who have the HER2+ type have better survival rates than those with HER2-. Breast cancers that are triple negative have the lowest survival rates. The 4-year survival rates are as follows:
- HR+/HER2-: 92.5%
- HR-/HER2-: 77.0%
Minimal Residual Disease Mrd
Targeted agents Targeted agents have been designed to reduce or block very specific pathways that are implicated in the growth of cancer. Currently, there are targeted agents that block the HER2 pathway for patients who have HER2-positive MBC.
The term precision therapy does not yet have an official definition and at present may be used in different ways. In general, precision therapy refers to treatment that is individualized based on patient and cancer characteristics and continues to be an area of extensive research.
Clinical Trials Patients with MBC are often eligible to participate in a clinical trial when they have exhausted available treatment options or when available treatments might not provide the quality of life they seek.
Patients may decide against treatment with approved options due to their side effects, or they may not have any other treatment options available to them, Dr. Nichols says. These patients may be good candidates for participation in a clinical trial and should speak with their physician about the possible trials available at their treatment center. If theyre being treated at a center where there are no trials, patients should ask for a referral or for other resources to further pursue trial participation if thats something theyre interested in.
Many patients share their experiences about clinical trial participation in social communities designed specifically for cancer patients, such as the community at CancerConnect.com.
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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.
Will I Need More Than One Treatment For Metastatic Breast Cancer
Medications are important for metastatic breast cancer to help control its spread. Resistance to therapies may develop, which can lead your care team to recommend a change in treatment.
When you start a treatment regimen, you and your care team will see how:
- The cancer responds to the therapy.
- The side effects impact you.
If the treatment isnt working or the side effects are unbearable, your care team can discuss switching the treatment method. They may recommend a different drug, dosage or schedule.
There are many treatments available. If one therapy isnt working for you for whatever reason, there is usually another one you can try.
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How Long Do People Live With Secondary Breast Cancer
One of the first things many people with secondary breast cancer want to know is how long theyve got to live.
Life expectancy is difficult to predict as each persons case is different and no two cancers progress in the same way. However, as treatments have improved, more and more people are living longer after a diagnosis of secondary breast cancer.
Your specialist will have an understanding of the likely progression of your secondary breast cancer and can talk to you about what you might expect. You may worry if their answers are vague but it isnt possible to accurately predict how each persons cancer will respond to treatment.
Thermal Ablation Or Cryoablation
Thermal ablation or cryoablation can be used alone or in combination with surgery. These procedures involve destroying cancer cells by either heating or freezing them. For example, radiofrequency ablation involves inserting a needle into individual tumours in the liver and destroying them with heat. RFA is a specialist treatment and not widely available. Your treatment team can tell you if it may be suitable for you.
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Treatment For Advanced Breast Cancer
Treatment of metastatic breast cancer aims to control the growth and spread of the cancer, to relieve symptoms, reduce pain, and improve or maintain quality of life.
The treatment recommended by doctors will depend on which treatments are likely to control the breast cancer and what side effects the person can cope with. Treatment options may involve:
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I Have To Prioritize And Try Not To Sweat The Small Stuff
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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Diagnosis Of Stage 4 Breast Cancer
If you are diagnosed with breast cancer, you may have further tests to determine the extent that the cancer has spread throughout the body. This is called staging. It helps you and your doctors decide on the best treatment options for you.
In addition the numbered staging system, the TNM staging system is also commonly used for breast cancer staging.
What Is Stage 4 Breast Cancer
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.
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Why Does My Provider Need To Test The Metastatic Tumor
Your care team will test the metastases to figure out the biology of the tumor, which can help guide your treatment plan. Providers may test tumors for:
- Hormone receptor status: If the cancer is hormone receptor-positive, hormonal therapy may be your first treatment.
- HER2 status: Human epidermal growth factor receptor 2 is a protein that is overexpressed on some breast cancer cells. HER2-positive cancer responds to specific HER2-targeted therapies.
- PIK3CA gene mutation: If a tumor is hormone receptor-positive and HER2-negative, your provider may test for this gene mutation. Specific targeted therapies can be used to treat tumors with this mutation.
- PD-L1 status: Tumors that are hormone receptive-negative and HER2-negative may be tested for PD-L1 status. If the PD-L1 test is positive, you may be recommended to receive a combination of immunotherapy and chemotherapy.
Can Metastatic Breast Cancer Go Into Remission
Metastatic breast cancer may never go away completely. But treatment can control its spread. Cancer may even go into remission at some points. This means you have fewer signs and symptoms of cancer.
A treatment break may be considered in certain situations, including if remission occurs or if someone is experiencing intolerable side effects. A pause in treatment can help you feel your best and improve your quality of life.
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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.
Treatment Options For Metastatic Breast Cancer
Treatment for metastatic breast cancer often is based on systemic therapies, which use drugs rather than surgery or radiation. Metastases treatments are designed to shrink tumors and slow their growth, help ease symptoms and improve quality of life. Treatment may change, such as when one therapy stops working, or the side effects become too uncomfortable. Rather than having only one treatment, most patients undergo several treatments combined to help fight the cancer.
The four broad categories of drug-based treatments are:
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The Tnm System For Staging Breast Cancer
The AJCCs addition of the letters T, N, and M for anatomic breast cancer staging adds more information to a breast cancer diagnosis. Heres what they mean:
- T : The tumor grade shows a higher number for a larger size or density.
- N : Nodes refers to lymph nodes and uses the numerals 0 to 3 to give information about how many lymph nodes are involved in the cancer.
- M : This refers to how the cancer has spread beyond the breast and lymph nodes.
The AJCC also added clarifications in staging for ER, PR, and HER2 expression and also genetic information.
Ultimately, this means someone diagnosed with stage 3 breast cancer can receive more information from their breast cancer staging than ever before.
No matter the stage, the best source of information about your individual outlook is your own oncology team.
Getting the right treatment and the support you need can help you navigate the challenges of being diagnosed with stage 3 breast cancer.
When Metastatic Cancer Can No Longer Be Controlled
If you have been told your cancer can no longer be controlled, you and your loved ones may want to discuss end-of-life care. Whether or not you choose to continue treatment to shrink the cancer or control its growth, you can always receive palliative care to control the symptoms of cancer and the side effects of treatment. Information on coping with and planning for end-of-life care is available in the Advanced Cancer section of this site.
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Treatment Starts With Hope
Sofia Merajver, M.D., Ph.D., medical oncologist and scientific director of the Rogel Cancer Centers breast oncology program, approaches each patients cancer individually and does not think predictions make sense until treatment begins.
Joses treatment plan included four rounds of chemotherapy, which reduced her 5-centimeter tumor to undetectable.
I wanted to immediately convey to Heather that wed have a long road together, including the medical center helping her family get through this challenge. Thats why I wanted to know about her husband and family members, says Merajver. In addition to giving her confidence that weve seen her disease before, a first step is to begin to recruit the social support the patient needs.
Because Joses cancer had spread, she knew not to expect to be cured. She had a double mastectomy, received radiation therapy and joined a clinical trial to receive two stem cell transplants. There have been several recurrences over the years, but each has been managed as treatment progresses for metastatic breast cancer.
The goal for me is to hear that my scans are stable. Stable means good, Jose says.
Mbc: A Unique Type Of Breast Cancer
Treatment for early-stage breast cancer is aimed at a cure. In fact, patients in the earliest stages of breast cancer have cure rates reaching more than 95 percent. After Georgi finished treatment for early breast cancer, her medical team told her that they wouldnt be seeing her againthey all thought the cancer was gone.
At that point I thought I was done with breast cancer, Georgi says. When I was first diagnosed with early-stage breast cancer, I was willing to do anything in terms of treatment. My thought was Throw it all at me because the aim was to get rid of all the cancer and then get on with life.
A diagnosis of MBC, however, brings a different and unique perspective compared with a diagnosis of earlier stages of the disease. Unlike early-stage breast cancer, you dont just get through a period of difficult treatment to get rid of cancer and move on with your life, Georgi says. With metastatic breast cancer, its different.
The goal of treatment for MBC is typically not curative but rather aims to improve the duration of survival while maintaining a good quality of life. Often early-stage breast cancer is referred to as a sprint whereas MBC is referred to as a marathon.
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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.
Intrahepatic Chemotherapy And Chemoembolisation
Intrahepatic chemotherapy and chemoembolisation involve giving chemotherapy directly into the liver. This is done through a thin tube, called a catheter, into the main blood supply to the liver.
Giving chemotherapy directly into the liver means a higher concentration of the drug can be delivered to the area of cancer.
In chemoembolisation, the chemotherapy is delivered along with an oily liquid or foam which blocks the blood supply to the cancer. The cancer is deprived of oxygen and nutrients, and the chemotherapy stays in the area for longer. The liver continues to be supplied with blood in the normal way.
These treatments may not be routinely available on the NHS but may be offered as part of a clinical trial.
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Metastatic Breast Cancer Is Terminal
Metastatic breast cancer cant be cured and it is terminal. One thing I didnt know when I was first diagnosed is that breast cancer can only kill you if you have metastatic breast cancer, says Rosen, who explains that if your cancer remains in the breast, the tumor can be removed, but metastatic means it has spread outside the breast.
MBC is almost like a different disease than early-stage breast cancer, adds Ann Silberman, 60, from Sacramento, California, who was diagnosed in 2009. We are going to die. Our concerns are much different from those of a person who has a treatment that will be over . Someone in an earlier stage may worry about losing their hair which is understandable but they will return to their normal life at some point.
People with metastatic breast cancer expect to be on treatment for the rest of their lives. I dont think everyone understands that, Silberman says. I still get, When will your treatment be over? Well, its never going to be over.
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Emotional And Spiritual Care
End-of-life care also includes emotional, mental, and spiritual therapy. A personâs healthcare team may include social workers, counselors, mental health professionals, and religious or spiritual advisors.
According to the Anxiety and Depression Association of America, up to 40 percent of people with cancer experience serious mental distress. This may include anxiety, depression, panic attacks, and post-traumatic stress disorder .
Medications, therapy, religious or spiritual rituals, and support groups can help a person cope with mental health issues and stress during this difficult time.
Caregivers may also need help with stress, anxiety, and depression. The palliative care team can usually also provide support and advice to caregivers for their emotional needs.
The Breast Cancer Healthline app provides people with access to an online breast cancer community, where users can connect with others and gain advice and support through group discussions.
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