How Is Metastatic Breast Cancer Treated
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.
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.
Why You May Need Treatment While In Remission
Because there are still cancer cells in your body even when youre in remission, you might have treatment during remission. This reduces the risk that the remaining cancer cells will start growing again.
Whether or not you have treatment during remission, youll be watched closely to make sure that your cancer doesnt become active again.
The most common type of treatment during remission is maintenance chemotherapy. This is chemo thats given regularly to stop the cancer from spreading.
Maintenance therapy shouldnt make you feel worse. If you find that the side effects start to become too much for you, talk to your doctor. They may take you off maintenance therapy.
Maintenance therapy may also become less effective over time, in which case your doctor may stop the therapy to help ensure your cancer doesnt become resistant to chemo.
For some people, cancer remission can last a lifetime. Others may have their cancer come back, which is called a recurrence.
types of cancer recurrence
- Local. The cancer comes back in the place it was originally found.
- Regional. The cancer comes back in lymph nodes and tissues near the original cancer site.
- Distant. The cancer comes back in other places throughout the body .
The chance of recurrence depends on many things, including the type of cancer you had, what stage the cancer was found in, and your overall health.
The outlook for the five most common types of cancers is:
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What Are The Differences Between Metastatic Breast Cancer Stage 4 Breast Cancer And Advanced Cancer
“Most of us use the names stage 4 and metastatic interchangeably,” Henry says. “Advanced is a little more complicated. Sometimes you will see the word ‘advanced’ used to describe metastatic cancer. But sometimes you will see the term ‘locally advanced.’ That means there’s a lot of cancer in the surrounding lymph nodes, but it doesn’t necessarily mean we see cancer that has spread outside of the area. We tend to stay away from the word ‘advanced’ because there can be confusion.”
If any doctor uses the term “advanced,” ask for clarification, Henry adds.
Every patient is different. In most cases, it arises months or years after a person has completed treatment for the initial breast cancer diagnosis, Henry says.
But some patients will learn they have metastatic breast cancer when first diagnosed, a term known as de novo metastatic breast cancer, Henry says. Only 6% of women and 8% of men receive a de novo metastatic diagnosis, according to Komen.
Progression During Hormone Therapy
For hormone receptor-positive cancers that were being treated with hormone therapy, switching to another type of hormone therapy sometimes helps. For example, if either letrozole or anastrozole were given, using exemestane, possibly with everolimus , may be an option. Another option might be using fulvestrant or a different aromatase inhibitor, along with a CDK inhibitor. If the cancer has a PIK3CA mutation and has grown while being treated with an aromatase inhibitor, fulvestrant with alpelisib might be considered. If the cancer is no longer responding to any hormone drugs, chemotherapy immunotherapy, or PARP inhibitors might be options depending on specific features of the cancer or any gene changes that might be present.
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Other Factors That Can Affect A Cancer’s Stage
For some cancers, the values for T, N, and M arent the only things that determine the stage. Some other factors that may be taken into account include:
Grade: For most cancers, the grade is a measure of how abnormal the cancer cells look under the microscope. This is also called differentiation. Grade can be important because cancers with more abnormal-looking cells tend to grow and spread faster.
The grade is usually assigned a number, with lower numbers used for lower grade cancers.
- In low-grade cancers, the cancer cells look fairly normal. In general, these cancers tend to grow slowly and often have a better outlook.
- In high-grade cancers, the cancer cells look more abnormal. High-grade cancers often tend to grow quickly, so they may need different treatments than low-grade cancers.
Even when the grade doesnt affect a cancers stage, it might still affect a persons outlook and/or treatment.
Cell type: Cancers in some parts of the body can start in different types of cells. Because the type of cancer cell can affect treatment and outlook, it can be a factor in staging. For example, cancers of the esophagus are mainly either squamous cell cancers or adenocarcinomas. Squamous cell esophageal cancers are staged differently from esophageal adenocarcinomas.
A persons age: For some types of cancer, such as thyroid cancer, a persons age at the time of diagnosis can affect their outlook, so it is taken into account when assigning a stage.
Treatment Options For Stage Iv Breast Cancer
For women with stage IV breast cancer, systemic therapies are the main treatments. These may include:
- Some combination of these
Surgery and/or radiation therapy may be useful in certain situations .
Treatment can often shrink tumors , improve symptoms, and help women live longer. These cancers are considered incurable.
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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, the HER2 status of the cancer, and sometimes gene mutations that might be found.
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.
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Coping With The Shock Of Diagnosis
A diagnosis of secondary breast cancer often comes as a very big shock.
In the days or weeks after your diagnosis, you may feel in turmoil and find it hard to think clearly.
You may experience many different emotions, including disbelief, denial, shock, anger, fear, numbness and helplessness. Your emotions may swing from one extreme to the other or change from one day to the next.
Many people go through this stage before reaching a point where theyre able to start taking some control of their situation. However difficult it may seem, you can have some control over how you manage the illness and deal with the emotional and practical issues it brings.
The Advocate Steps Up
She didn’t start out as an advocate for Black patients with cancer. Jamil Rivers was a breast cancer patient herself, and doing well. Other patients would drop by the chemo infusion room and ask her for advice.
“They were saying, ‘Hey, you seem to be doing OK. You know, can you share what you know?’ And then it just kind of grew from there” into a nonprofit Rivers founded, called the Chrysalis Initiative.
“I would always hear that the reason why Black women were dying at such a higher rate from breast cancer was social and biological differences and poverty and all these different rationales,” Rivers says. “But then, as I started finding out more, I found that the biggest contributor was actually the racism.”
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Plans Have To Be Flexible
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.
What Happens If Immunotherapy Doesnt Work
If youve tried every treatment for your cancer and nothing has worked, you might want to take part in a clinical trial. Scientists use them to test new ways to treat cancer to see if theyre safe and if they work. A clinical trial gives you a chance to try a new cancer treatment that isnt available to everyone.
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What Does It Mean To Have Stage 4 Breast Cancer
Stage 4 breast cancer means that the cancer has spread to other areas of the body, such as the brain, bones, lung and liver.
Although Stage 4 breast cancer is not curable, it is usually treatable and current advances in research and medical technology mean that more and more women are living longer by managing the disease as a chronic illness with a focus on quality of life as a primary goal. With excellent care and support, as well as personal motivation, Stage 4 breast cancer may respond to a number of treatment options that can extend your life for several years.
What Are The Symptoms Of Stage 4 Breast Cancer
Women with stage four breast cancer can experience symptoms in the spine, hip, ribs, skull, pelvis, arms and legs. Walking, even for short distances, can become difficult and extremely painful. When the cancer reaches the lungs it can cause shortness of breath, difficulty breathing and a chronic, painful cough. Cancer cells in the liver do not display observable symptoms for a considerable amount of time. As the disease progresses, women can experience jaundice, fever and exaggerated weight loss as a result of the cancer spreading to the liver.
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Why Are Black Women Less Likely To Stick With A Breast Cancer Follow
Now Chrysalis intervenes on behalf of Black women, like one who’d just had surgery.
“They were trying to send her home that same day,” Rivers says. “They did not want to provide her with an at home nurse or to provide care. And this was all just based off an assumption that she’s Black, so she must be poor. She must not have sufficient insurance.”
Rivers has expanded her advocacy by becoming president of Metavivor, a non-profit that raises money for metastatic breast cancer research. Rivers figures she’s helped thousands of women, including herself. She’s been NED no evidence of disease for a couple of years now. So she hopes to have the strength and the determination to help thousands more Black breast cancer patients going forward.
We get answers to stopping this disease.
Michael Kovarik
What Is Metastatic Cancer
Cancer that spreads from where it started to a distant part of the body is called metastatic cancer. For many types of cancer, it is also called stage IV cancer. The process by which cancer cells spread to other parts of the body is called metastasis.
When observed under a microscope and tested in other ways, metastatic cancer cells have features like that of the primary cancer and not like the cells in the place where the metastatic cancer is found. This is how doctors can tell that it is cancer that has spread from another part of the body.
Metastatic cancer has the same name as the primary cancer. For example, breast cancer that spreads to the lung is called metastatic breast cancer, not lung cancer. It is treated as stage IV breast cancer, not as lung cancer.
Sometimes when people are diagnosed with metastatic cancer, doctors cannot tell where it started. This type of cancer is called cancer of unknown primary origin, or CUP. See the Carcinoma of Unknown Primary page for more information.
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Pregnant With Cancer: One Woman’s Journey
“She was tiny, but was ready to go home,” says Loniewska. “Now I’m 42 and feel like I’m much, much older.”
But she’s hung in there. She taking five different drugs, some hormonal, some for her bones, some chemo. And continuously running through her mind have been worries about the future.
“Like, what type of life will I be able to get give her and for how long? It has been a very dark time.”
Where Did Everybody Go
Tiffany Hawkins is 52 years old, and says she’s always been a fighter. She was diagnosed with MBC in 2017.
“The doctors are truly amazed at how long I’ve been going. I’m spoiled I almost forgot that I had this.”
It’s all the more surprising because Hawkins has triple negative MBC, which means you can’t treat it with hormonal therapy, as you can with most Stage 4s. It’s most common among Black women, like Hawkins, and the death rates are higher in this group than for any U.S. racial or ethnic group, at 26.8 per 100,000 annually.
But lately her tumors have been progressing.”From maybe less than a centimeter to five in like a month,”says Hawkins.
Meanwhile, as her cancer has grown, she notices, her friends have been dwindling away. She has two grown sons, and they’re supportive, but her boyfriend of 5 years ghosted her. Other friends have stopped calling.
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Surviving Stage 4 Breast Cancer: Is It Possible
Understanding survival rates of stage 4 breast cancer
According to the National Cancer Institute , an estimated 27 percent of people in the United States live at least 5 years after being diagnosed with stage 4 breast cancer.
Many factors can affect your longevity and quality of life. Different subtypes of breast cancer behave differently. Some are more aggressive than others, and some have far fewer treatment options than others. For this reason, your subtype may affect your outlook.
Higher survival rates are also associated with the extent and location of metastasis. In other words, your long-term outlook may be better if your cancer has only spread to your bones than if its found in your bones and lungs.
Immediately seeking treatment, like chemotherapy, surgery, or hormone therapy, can help improve your outlook. Making healthy lifestyle choices might also improve your chances of survival.
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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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.
But Don’t Abandon Chemotherapy Quite Yet
While we have discovered that chemotherapy does not always deliver desired outcomes, it should be pointed out that most chemotherapeutic drugs are not customized or matched to patient-specific cancer/tumor or biopsy. Instead, pharmaceutical drugs are developed to fit a model that promotes certain drug regimens for certain cancer types. Sadly, these Chemo-regimens are constructed through pharmaceutical sponsorship in partnership with prestigious cancer doctors and hospitals working together to politically position protocols as standards of care. The end result means such protocols are moved through the FDA with quantities of sales pre-approved and guaranteed by Medicare.
As a result, chemotherapy drugs are often miss-matched to the patient’s actual tumor. Amazingly, we have found this to be true for more than 75 percent of our patients, determined through molecular and genetic testing. For example, if someone has colon cancer, it is entirely possible that their specific biopsy or tumor would respond best to a chemotherapy drug typically used for breast cancer. These observations become increasingly important for those with advanced and stage 4 cancers.
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