Living With Metastatic Breast Cancer
The View from the IVth Floor
One woman shares some hard-won wisdom from years of living with metastatic cancerand encourages laughter along the way.
Borrowed timetechnically, thats what Im living on. Diagnosed a second time with Stage IV breast cancer metastases to brain, liver, lung and bones, research told me I had two years to live. Fortunately for me, new treatments and good doctors have kept me alive beyond the two years and have inspired the hope of many more. The reality is I can still get hit by a bus tomorrow regardless of my cancer diagnosis, so how has a cancer diagnosis changed my perspective?
For me cancer has been both a blessing and a curse. It has allowed me to get back to things I love, like painting, which is the most relaxing and gratifying thing I can do for myself. I also keep busy with civic groups, ballroom dancing classes, seeing friends, and writing in other words, living my life. In my journey the important thing has been to focus on what I really love and to make time to do itlike traveling and eating ice cream for breakfast! Cancer has taught me what is important to me and how I want to live the rest of my life, regardless of how long it is.
I have also learned that though I havent chosen the journey Im on, I can choose to share the discoveries Ive made along the way. In some small way, these experiences may help someone else struggling to find their path.
How Many Patients Were Cured
Despite reports of individual recoveries or remissions, most cancer patients did not fare well. In 1854, the Cancer Hospital in London reported that
out of 650 cases to the end of last year, something like 90 of the out-patients have had their disease arrested or relieved and of the in-patients about 56. It also appears that but a few cases have been successfully operated on.
This did not stop people from getting rich peddling cures. In 1885, an American paper complained.
What To Do If Your Breast Cancer Comes Back
This can be a shock and you might need time to deal with the information your team gives you. If the breast cancer comes back in the same breast its called local recurrence. The cancer might be picked up at one of your follow up scans or appointments. Or you might notice a small pink or red lump called a nodule in the:
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Treatments For Breast Cancer
If you have breast cancer, your healthcare team will create a treatment plan just for you. It will be based on your health and specific information about the cancer. When deciding which treatments to offer for ductal carcinoma and lobular carcinoma, your healthcare team will consider:
- the stage
- if you have reached menopause
- the hormone receptor status of the cancer
- the HER2 status of the cancer
- the risk that the cancer will come back, or recur
- your overall health
How Is Chemotherapy For Breast Cancer Given
Chemo drugs for breast cancer are typically given into a vein , either as an injection over a few minutes or as an infusion over a longer period of time. This can be done in a doctors office, infusion center, or in a hospital setting.
Often, a slightly larger and sturdier IV is required in the vein system to administer chemo. These are known as central venous catheters , central venous access devices , or central lines. They are used to put medicines, blood products, nutrients, or fluids right into your blood. They can also be used to take out blood for testing.
There are many different kinds of CVCs. The most common types are the port and the PICC line. For breast cancer patients, the central line is typically placed on the side opposite of the breast cancer. If a woman has breast cancer in both breasts, the central line will most likely be placed on the side that had fewer lymph nodes removed or involved with cancer.
Chemo is given in cycles, followed by a rest period to give you time to recover from the effects of the drugs. Chemo cycles are most often 2 or 3 weeks long. The schedule varies depending on the drugs used. For example, with some drugs, chemo is given only on the first day of the cycle. With others, it is given one day a week for a few weeks or every other week. Then, at the end of the cycle, the chemo schedule repeats to start the next cycle.
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History Of Cancer Treatments: Surgery
Ancient physicians and surgeons knew that cancer would usually come back after it was surgically removed. The Roman physician Celsus wrote, After excision, even when a scar has formed, none the less the disease has returned.
Galen was a 2nd-century Greek doctor whose books were preserved for centuries. He was thought to be the highest medical authority for over a thousand years. Galen viewed cancer much as Hippocrates had, and considered the patient incurable after a diagnosis of cancer had been made. His views set the pattern for cancer management for centuries.
Even though medicine progressed and flourished in some ancient civilizations, there was little progress in cancer treatment. The approach to cancer was Hippocratic for the most part. To some extent the belief that cancer cannot be cured has persisted even into the 21st century. This has served to fuel the fear people have of the disease. Some people, even today, consider all cancer incurable and put off seeing a doctor until its too late for optimal treatment.
There were great surgeons before the discovery of anesthesia. John Hunter, Astley Cooper, and John Warren achieved lasting acclaim for their swift and precise surgery. But when anesthesia became available in 1846, the work advanced so rapidly that the next hundred years became known as the century of the surgeon.
Menstrual Changes And Fertility Issues
For younger women, changes in menstrual periods are a common side effect of chemo. Premature menopause and infertility may occur and could be permanent. If this happens, there is an increased risk of heart disease, bone loss, and osteoporosis. There are medicines that can treat or help prevent bone loss.
Even if your periods stop while you are on chemo, you may still be able to get pregnant. Getting pregnant while on chemo could lead to birth defects and interfere with treatment. If you have not gone through menopause before treatment and are sexually active, its important to discuss using birth control with your doctor. It is not a good idea for women with hormone receptor-positive breast cancer to take hormonal birth control , so its important to talk with both your oncologist and your gynecologist about what options would be best for you. When women have finished treatment , they can safely go on to have children, but it’s not safe to get pregnant while being treated.
If you think you might want to have children after being treated for breast cancer, talk with your doctor soon after being diagnosed and before you start treatment. For some women, adding medicines, like monthly injections with a luteinizing hormone-releasing hormone analog, along with chemo, can help them have a successful pregnancy after cancer treatment. To learn more, see Female Fertility and Cancer.
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Breast Cancer: Now And Then
Breast cancer is among the most well-known and researched cancers in the medical world today. A diagnosis of breast cancer in the 21st century, while certainly terrifying, is no long the death sentence it was years ago. In fact, women who detect breast cancer early in its development have a very good chance of a cancer-free future. But this was not always the case.
The History Of Cancer: A Timeline
The etymology of cancer
3000 BC The earliest known description of cancer is in an ancient Egyptian textbook on trauma. Known as the Edwin Smith Papyrus, it describes eight cases of tumours or ulcers of the breast that were removed by cauterisation with a tool called the fire drill. The document says of the disease: There is no treatment
460-370 BC The origin of the word cancer is credited to the Greek physician Hippocrates, who is considered to be the Father of Medicine. Hippocrates used the terms carcinos and carcinoma to describe non-ulcer forming and ulcer-forming tumours
28-50 BC Roman physician Celsus translates the Greek term into cancer, the Latin word for crab
130-200 AD Greek physician Galen uses the word oncos to describe tumours. Although the crab analogy of Hippocrates and Celsus is still used to describe malignant tumours, Galens term is now used as a part of the name for cancer specialists oncologists
Early history of cancer research
1628 Post-mortem examinations by English physician William Harvey lead to an understanding of the circulation of blood through the heart and body that had until then been a mystery
1665 Robert Hooke publishes Micrographia, which presents several accounts of observations through the use of the microscope
1676 Anton van Leeuwenhoek, a Dutch trader, scientist and pioneer of microscopy, observes water and was surprised to see tiny organisms the first bacteria observed by man
Radical cancer surgery becomes possible
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The First Modern Breast Cancer Treatments
Modern breast cancer treatments only became commonplace once
- Scientists began to establish the relationship between breast cancer and genesA sequence in the DNA which can be passed down from parent to child. Genes helps determine physical and functional traits for the body.
- Surgeons started viewing breast cancer as a localized disease which could be removed before it spreads
Both of these theories meant shifting away from beliefs about breast cancer relating to bodily fluids, viral contagion or sexual psychology. It now meant that breast cancer could be treated by isolating specific cells or removing affected areas the beginning of the treatment known today as the mastectomyAn operation removing all or part of the breast..
Around the 1750s a number of surgeons, including Jean Louis Petit, Henri Le Dran, Claude-Nicolas Le Cat and Benjamin Bell, began performing breast cancer surgery removing lymph nodesSmall, bean-shaped collections of immune tissue that filter out cell fluid and bacteria that may be circulating in the body. They help fight infections and play a role in fighting cancer. and underlying muscle along with breast tissue.
Which Treatment Is Right For Me
Choosing the treatment that is right for you may be hard. Talk to your cancer doctor about the treatment options available for your type and stage of cancer. Your doctor can explain the risks and benefits of each treatment and their side effects. Side effects are how your body reacts to drugs or other treatments.
Sometimes people get an opinion from more than one cancer doctor. This is called a second opinion. Getting a second opinionexternal icon may help you choose the treatment that is right for you.
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History Of Cancer Treatments: Chemotherapy
During World War II, naval personnel who were exposed to mustard gas during military action were found to have toxic changes in the bone marrow cells that develop into blood cells. During that same period, the US Army was studying a number of chemicals related to mustard gas to develop more effective agents for war and also develop protective measures. In the course of that work, a compound called nitrogen mustard was studied and found to work against a cancer of the lymph nodes called lymphoma. This agent served as the model for a long series of similar but more effective agents that killed rapidly growing cancer cells by damaging their DNA.
Not long after the discovery of nitrogen mustard, Sidney Farber of Boston demonstrated that aminopterin, a compound related to the vitamin folic acid, produced remissions in children with acute leukemia. Aminopterin blocked a critical chemical reaction needed for DNA replication. That drug was the predecessor of methotrexate, a cancer treatment drug used commonly today. Since then, other researchers discovered drugs that block different functions in cell growth and replication. The era of chemotherapy had begun.
- New drugs, new combinations of drugs, and new delivery techniques
- Drugs to reduce side effects, like colony-stimulating factors, chemoprotective agents , and anti-emetics
- Agents that overcome multi-drug resistance
History Of Breast Cancer
Breast cancer is the most common cancer in women around the world. It has been widely studied throughout history.
In fact, research on breast cancer has helped pave the way for breakthroughs in other types of cancer research.
How we treat breast cancer has changed in many ways from the cancers first discovery. But other findings and treatments have remained the same for years.
Read on to learn how breast cancer treatments have evolved to what we know today.
describes cases of breast cancer . This medical text dates back to 3,000-2,500 B.C.E.
In ancient Greece, people made votive offerings in the shape of a breast to the god of medicine. And Hippocrates described the stages of breast cancer in the early 400s B.C.E.
In the first century, doctors experimented with surgical incisions to destroy tumors. They also thought that breast cancer was linked with the end of menstruation. This theory may have prompted the association of cancer with older age.
In the beginning of the Middle Ages, medical progress was intertwined with new religious philosophies. Christians thought surgery was barbaric and were in favor of faith healing. Meanwhile, Islamic doctors reviewed Greek medical texts to learn more about breast cancer.
Lumpectomies were also performed by surgeons, but there was no anesthesia yet. Surgeons had to be fast and accurate to be successful.
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How Is Breast Cancer Recurrence Managed Or Treated
Your treatment depends on the type of cancer recurrence, as well as past treatments. If cancer develops in a reconstructed breast, your surgeon may want to remove the breast implant or skin flap.
Treatments for local and regional breast cancer recurrence may include:
- Mastectomy: Your surgeon removes the affected breast and sometimes lymph nodes.
- Chemotherapy:Chemotherapy circulates in blood, killing cancer cells.
- Hormone therapy:Tamoxifen and other hormone therapies treat cancers that thrive on estrogen .
- Immunotherapy:Immunotherapy engages your bodys immune system to fight cancer.
- Radiation therapy: High-energy X-ray beams damage and destroy cancer cells.
- Targeted therapy: Treatments target specific cancer cell genes or proteins.
Which Treatment Method Is Suitable For Me
Choosing the treatment that is suitable for you may be hard. Discuss to your cancer doctor about the treatment solutions available for your type and stage of cancer. Your doctor can clarify the risks and positive aspects of each treatment and their side effects.
Often people get an opinion from more than one cancer doctor. This is called a second opinion. Having a second opinion may help you choose the treatment that is right for you.
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Is Breast Cancer A Modern Illness
To the contrary: cancer has probably been around as long as humans. Skeletal remains of a 2,700 year old Russian King and a 2,200 year old Egyptian mummy have both been diagnosed with prostate cancers.
Breast cancer can also be traced right back to ancient Egypt, with the earliest recorded case described on the 1600 BC Edwin Smith Papyrus. Because breast cancer is quite outwardly visible in its most advanced state it frequently captured the vision and imagination of our ancestors enough for them to record it.
What Questions Should I Ask My Healthcare Provider
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.
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How Breast Cancer Treatment Has Evolved Since The 1950s
Treating breast cancer with a very high dose of chemotherapy doesnt improve survival any more than if using a standard dose. A recent Cochrane review has put the final nail in the coffin of decades of research debunking the antiquated idea that, if only we could give a high enough dose of chemotherapy, we could cure breast cancer.
Cochrane investigators evaluated 14 randomized controlled trials showing treatment outcomes for women given very high-dose chemotherapy, compared with those given a standard dose. The studies involved 5,600 women with early but poor prognosis breast cancer, some of whom were followed for up to 12 years.
The definitive review found that not only are side-effects greater with higher doses, some women actually died from high-dose treatments the worst kind of lose-lose situation.
High-dose chemotherapy aggressively attacks cancer cells as well as damaging normal blood cells. It is only technically feasible when used together with bone-marrow transplants that restore healthy blood cells to the body. The transplantation procedure is in itself a very traumatic and expensive experience.
Our new understanding that more isnt better when it comes to chemotherapy is familiar, mirroring the evolution of surgery approaches to breast cancer that, a few decades ago, were far more radical than now.
We compared 14 studies involving over 5,000 women.Via shutterstock.com