Surgery For Breast Cancer
Most women with breast cancer have some type of surgery. Common types of breast surgery are lumpectomy, mastectomy, and taking out lymph nodes from the underarm. Women who have a mastectomy may also decide to have the breast shape rebuilt, either at the same time or later on.
Choosing between lumpectomy and mastectomy
Lumpectomy only takes out the lump and a little bit around it. It lets you keep most of your breast. The downside is that youll most likely need radiation treatment after surgery. But some women who have a mastectomy also need radiation afterward.
When choosing between a lumpectomy and mastectomy, be sure to get all the facts. At first you may think that a mastectomy is the best way to get it all out. Some women tend to choose mastectomy because of this. But in most cases, lumpectomy is just as good as mastectomy. Talk to your cancer care team. Learn as much as you can to make the right choice for you.
If you have a mastectomy, you may want to think about having your breast shape rebuilt. This is called breast reconstruction. Its not done to treat the cancer. Its done to build a breast shape that looks a lot like your natural breast.
If youre going to have a mastectomy and are thinking about having reconstruction, you should talk to a plastic surgeon before the mastectomy is done. Your breast can be rebuilt at the same time the mastectomy is done or later on.
Side effects of surgery
Local Or Regional Treatments For Stage Iv Breast Cancer
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 wound in the breast
- To treat a small number of metastases in a certain area, such as the brain
- To help prevent bone fractures
- When an area of cancer spread is pressing on the spinal cord
- To treat a blood vessel blockage in the liver
- To provide relief of pain or other symptoms
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 their goalwhether it is to try to cure the cancer or to prevent or treat symptoms.
Abemaciclib Palbociclib And Ribociclib And Hormone Therapy
The CDK4/6 inhibitors FDA-approved for metastatic breast cancer treatment are:
CDK4 and CDK6 are enzymes important in cell division. CDK4/6 inhibitors are a class of drugs designed to interrupt the growth of cancer cells.
Although the CDK4/6 inhibitors abemaciclib, palbociclib and ribociclib have not been compared directly to one another, studies show similar results with each drug .
A CDK4/6 inhibitor in combination with hormone therapy can be used to treat hormone receptor-positive, HER2-negative metastatic breast cancers. Compared to treatment with hormone therapy alone, this combination can give people more time before the cancer spreads and increase overall survival .
The CDK4/6 inhibitor abemaciclib may also be used alone to treat hormone receptor-positive, HER2-negative cancers that have progressed during past hormone therapy and chemotherapy .
Abemaciclib, palbociclib and ribociclib are pills.
The table below lists some possible side effects for CDK4/6 inhibitors.
For a summary of research studies on the use of CDK4/6 inhibitors in treating metastatic breast cancer, visit the Breast Cancer Research Studies section.
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Stop To Smell The Roses
I mostly consider myself a thriver. says Terlisa Sheppard, an author and patient advocate from Orlando, FL. Shes had MBC since 2001, with metastasis to her bones, lungs, liver, spine, abdomen, and brain. I am still waging forward, making the best out of each day. Her secret:
I just focus on living in the moment to my best potential, she says. I do stop to take random pictures of flowers or objects that might be in my path. I love going to the beach to watch the mesmerizing sunrises or sunsets. I laugh often and enjoy meeting and chatting with new people, especially cancer survivors that I can possibly offer hope to in their journey.
Treatment For Stage 0 Breast Cancer
There is a variety of treatment options for stage 0 breast cancer, including:
A lumpectomy involves removing cancerous cells from the breast. It is an option when the cells remain in one area. This is a relatively short and simple procedure, and a person should be able to go home after the surgery on the same day.
If cancerous cells appear throughout the breast, the doctor may recommend a mastectomy, which involves removing the entire breast. Plastic surgeons can rebuild the breast at the same time or a later date.
Radiation therapy can help kill cancer cells and inhibit them from spreading. A person will typically undergo radiation therapy once the breast surgery site has healed. This is usually 4-6 weeks after surgery.
The hormone estrogen, found naturally in the body, can impact some types of breast cancer. If a person has estrogen receptor-positive or progesterone receptor-positive breast cancer, a doctor may suggest hormone treatment in addition to surgery.
The person may also require radiation therapy to manage the levels of these hormones in the body.
People with stage 1A breast cancer have breast cancer with:
- A tumor measuring no more than 2 centimeters in diameter that has not spread outside the breast.
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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.
Myth #: If An Earlier
Ninety percent of MBC diagnoses occur in people who have already been treated for an earlier-stage breast cancer. Many people are under the impression that remaining cancer-free for 5 years means that a metastatic recurrence cant happen. However, distant recurrences can occur several years or even decades after initial diagnosis. Factors such as original tumor size and the number of lymph nodes involved can help predict the risk of recurrence.
For example, a 2017 survey of 88 studies involving nearly 63,000 women diagnosed with early-stage, hormone-receptor-positive breast cancer found that the risk of distant recurrence within 20 years ranged from 13% to 41%, depending on tumor size and lymph node involvement.1
As KatyK of Idaho comments: that you are cured if you are cancer-free 5 years after initial diagnosis. I fell for that one myself. When I was diagnosed with MBC 12 years after initial diagnosis I was shocked. I thought I was cured, which to me means all better. Nope! Not even sure medically what cured means.
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I Might Not Look Sick But I Do Still Have Advanced Cancer
I may look normal, but my body fights every day every single day, writes Community member SandiBeach57. People with MBC often look like their former selves, especially as initial treatments give way to longer-term maintenance treatments. This can mislead friends and acquaintances into thinking everythings just fine and they might react accordingly, either questioning or minimizing what youre going through.
As nowaldron relates, looking well can be a double-edged sword: I find that most people forget that I am fighting cancer, which can be great. I sometimes have to remind people that I am not cured and the best I will ever be is stable … Also, when I was first diagnosed I was pretty sick with mets to liver, and almost all bones including skull, ribs, spine, pelvis, and femur. People wonder how I could really have been in such a bad way when I seem perfectly fine today. Sometimes, it is exhausting to explain exactly what MBC is and how the disease progresses sometimes very quickly and other times slowly or not at all.
My Partner Needs Your Support Too
Friends often put all of their focus on the person with cancer, but many of our Community members point out that their partners need support, too. A husband, wife, or life partner is often playing the role of primary caregiver and support person and that can take its toll.
I wish my friends would give my husband a hug once in a while, notes SandiBeach57. He silently suffers as he knows the real possibility of life without me. He told me he was jealous when I spend time with girlfriends, volunteer activities, even grandchildren, as that is less time he has with me.
Elderberry agrees: Our husbands need hugs too. They are frightened by our diagnosis. They get exhausted trying to do whatever they think is right for us. Sometimes they are at a loss as to what to say or do.
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How Common Is Breast Cancer Recurrence
Most local recurrences of breast cancer occur within five years of a lumpectomy. You can lower your risk by getting radiation therapy afterward. You have a 3% to 15% chance of breast cancer recurrence within 10 years with this combined treatment. Based on genetic testing, your provider may recommend additional treatments to further reduce your risk.
Recurrence rates for people who have mastectomies vary:
- There is a 6% chance of cancer returning within five years if the healthcare providers didnt find cancer in axillary lymph nodes during the original surgery.
- There is a one in four chance of cancer recurrence if axillary lymph nodes are cancerous. This risk drops to 6% if you get radiation therapy after the mastectomy.
Treatment For Stage 4 Breast Cancer
Typically, treatment for stage 4 breast cancer includes a combination of chemotherapy, radiation therapy, and hormone therapy .
Targeted therapy is a treatment that targets the protein that allows cancer cells to grow and this type of therapy may also be an option for people with stage 4 breast cancer.
Sometimes, surgeons will operate to try and remove tumors though this is not usually the first option for treatment.
Doctors, however, may recommend surgery to help with pain relief by treating some of the issues that may develop as a result of having stage 4 breast cancer. These include spinal cord compression, removing single masses caused by metastasis, and fixing any broken bones.
A doctor may also prescribe medication to treat related symptoms such as:
- antidepressants to help mood
- anticonvulsants to manage pain or neurologic conditions
- local anesthetics to manage pain
New treatments and therapies are emerging all the time, and anyone who has breast cancer at any stage can volunteer to try out these new treatments. People considering this should talk to their doctor to see whether any trials are available in their area.
Trials for a new treatment called immunotherapy are currently taking place. Immunotherapy works by raising the bodys natural ability to fight off cancer and has fewer side effects than chemotherapy.
As well as numbers, a zero or an X often follow the letters T, N, and M. According to the AJCC, the meanings are as follows:
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Triple Negative Breast Cancer
With this type of breast cancer, the breast cancer cells dont have ER+ or PR+ receptors. They dont overproduce the HER2 protein, so hormone therapy isnt very effective.
Instead, triple negative stage 4 breast cancer is usually treated with chemotherapy. Radiation therapy may also be an option, depending on the site of metastasis.
Symptoms Of Metastatic Breast Cancer
The symptoms of stage 4 breast cancer depend on the location of the cancer and where it has spread in your body.
- If breast cancer has spread to your bones, you may notice a sudden new bone pain. Breast cancer most commonly spreads to your ribs, spine, pelvis, or arm and leg bones.
- If it has spread to your brain, you may experience headaches, vision or speech changes, or memory problems.
- Breast cancer that has spread to your lungs or liver usually causes no symptoms.
The main treatments for stage 4 breast cancer are targeted drug therapies that destroy cancer cells wherever they are in your body.
These treatments may include:
- hormone therapy, which stops or slows the growth of tumors by preventing your body from producing hormones or interfering with the effect of hormones on breast cancer cells
- chemotherapy, where drugs given orally or through an IV travel through your bloodstream to fight cancer cells
- immunotherapy, which uses drugs that stimulate your immune system to destroy cancer cells
- a combination of these therapies
The following are the common treatment options for different types of stage 4 breast cancer.
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When Can Metastatic Breast Cancer Occur
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.
Metastatic breast cancers come from breast cancer cells that remained in the body after treatment for early breast cancer. The breast cancer cells were always there but were dormant and could not be detected. For some unknown reason, the cancer cells began to grow again. This process is not well-understood.
Alpelisib And Hormone Therapy
Alpelisib is a PI3 kinase inhibitor.
PI3 kinase is an enzyme important in cell growth. The PIK3CA gene helps control PI3 kinase enzyme activity. Some breast cancers have a PIK3CA gene mutation. This gene mutation is in the genes of breast cancer, not the person.
PI3 kinase inhibitors are a class of drugs designed to interrupt PI3 kinase signals and stop the growth of breast cancer cells with PIK3CA gene mutations.
Alpelisib in combination with the hormone therapy fulvestrant is FDA-approved to treat hormone receptor-positive, HER2-negative metastatic breast cancers with a PIK3CA gene mutation that have been treated with hormone therapy in the past.
The combination of alpelisib and fulvestrant can give more time before the cancer spreads compared to fulvestrant alone .
If alpelisib is being considered for your treatment plan, your tumor will be checked to see if it has a PIK3CA gene mutation. This can be done by testing tumor tissue or testing for tumor DNA in your blood .
Alpelisib is a pill.
Some possible side effects include high blood sugar, diarrhea, nausea, decreased appetite, rash, vomiting, fatigue and hair loss.
Blood sugar levels are monitored while taking alpelisib because nearly everyone who takes it gets high blood sugar levels.
Its recommended you take an antihistamine, such as cetirizine , to lower the risk of rash.
Adapted from select sources .
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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 I Wish People Knew About Metastatic Breast Cancer
Women with metastatic breast cancer think about fighting cancer very differently than women who don’t have a stage 4 diagnosis. If you have advanced cancer, these women understand what youre going through.
The term metastatic breast cancer describes breast cancer that has spread beyond the breast to the bones, liver, brain, or another organ. Even if the cancer is found in another organ, its still referred to as breast cancer and is treated as such.
While metastatic breast cancer is terminal and cannot be cured, because of improved treatments more women are living longer than ever with it. Even so, a lack of information and many misconceptions about this diagnosis persist.
Here are several things you should know about metastatic breast cancer and the women who are living with it.
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