I May Not Feel Like A Fighter Theres No Final Victory
The language used to describe cancer and its treatment is often the language of war: fighting cancer, battling cancer, being a warrior. But those words may not resonate with women who have metastatic breast cancer.
Sendelbach recalls using fighting words when she was first diagnosed with stage 1 breast cancer. I was 30 years old, and I was in fight mode, she says. I was like, Hell yeah, I can kick cancers ass and so on. When she was diagnosed with stage 4, though, she realized there would be no end in sight, no final victory for her.
Theres not a finish line, she says, so to be in fight mode doesnt really work. There has to be an end in sight to stay in that place.
For her, metastatic breast cancer is something she deals with day to day. She describes her journey as a marathon, not a sprint. If you have to stop sometimes to walk and take water breaks, she says, you should. If you try to run as fast as you can all the time, its inevitable that youre going to fail.
Myth #: Metastatic Breast Cancer Is Curable
Whether metastatic breast cancer is someones first diagnosis or a recurrence after treatment for earlier-stage breast cancer, it cant be cured. However, treatments can keep it under control, often for months at a time. People with MBC report fielding questions from family and friends such as, When will you finish your treatments? or Wont you be glad when youre done with all of this? The reality is they will be in treatment for the rest of their lives.
A typical pattern is to take a treatment regimen as long as it keeps the cancer under control and the side effects are tolerable. If it stops working, a patient can switch to another option. There may be periods of time when the cancer is well-controlled and a person can take a break. But people with MBC need to be in treatment for the rest of their lives.
As Breastcancer.org Community member Vlnprh of Wisconsin comments: The vast majority of people have no idea what MBC treatment involves. They somehow think that you will undergo something similar to early-stage patients surgery, radiation, chemo, whatever and then be done. They want to see you as a pink-tutu-wearing cheerleader jumping up and down declaring that you have beaten this disease
Amarantha of France writes: The one I get over and over is, How long will you be on this chemo? I mean doesn’t it end sometime? Yes, it ends when it stops working and then we go on to another treatment lather, rinse, repeat I guess until we run out of options.
How Prostate Cancer Spreads
- The cells escape into the bloodstream, initially by invading small blood vessels around the tumor, then traveling to larger blood vessels that enable the cells to circulate around the body .
- The cells are filtered through the bodys lymph system although some are captured in lymph nodes, others may travel elsewhere in the body.
- The cells migrate along the length of a nerve, escaping from the prostate into adjacent soft tissue .
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Dont Be Afraid Breast Cancer Is Curable
Weve come a long way in the fight against breast cancer, and additional progress is made each year to better understand the enemy.
While theres still much work to be done, the good news is breast cancer is curable, if caught early enough.
Doctor John West, medical director with the Tampa Bay Oncology Center in Largo, said about 90 percent of breast cancer cases are curable when found in the early stages.
Even better news is that fewer women are being diagnosed with advanced stages of breast cancer these days, which West credits to aggressive education campaigns about the importance of breast self-exams and mammograms.
West has 30 years of experience as a radiation oncologist. An oncologist is a physician who studies all cancers and specializes in different areas of treatment radiation, surgery and chemotherapy. In some cases, treatment is coordinated between all three.
It can be a team effort, he said.
Women who are diagnosed in the early curable stage will first consult with their doctor to decide if they should have a mastectomy or not. West said the vast majority of women prefer lump removal, lumpectomy, followed by radiation therapy, if there has been no spread of the cancer.
He said radiation therapy is time consuming, but it allows women to preserve their breasts the contour, shape and texture. He said the results of the biopsy, which determines the type of tumor, most often determines the best treatment method.
How Can I Take Care Of Myself While Living With Metastatic Breast Cancer
Living with metastatic breast cancer can be challenging. Your care team can help provide physical and emotional support. Talk to them about how you can:
- Eat the most nutritious diet for your needs.
- Exercise regularly.
- Get emotional support, including finding support groups.
- Reach out for help from friends, family and loved ones.
- Find mental health services.
- Find complementary therapies.
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Treatment Of Local Recurrence After Previous Mastectomy
Most commonly the lesion is removed surgically and followed by radiation to the chest wall if the woman has not previously had radiation Treatment of local recurrence after mastectomy can involve a variety of different approaches, including surgery to remove the recurrence if it is confined to a limited area. Other options for treatment include radiation, chemotherapy, and endocrine therapy, or a combination of these.
Despite aggressive local treatment, many women with an isolated local recurrence following mastectomy eventually develop distant metastases. This is not because the local recurrence spreads, but rather because it is a sign that things have changed and dormant cells in other organs may also be waking up.
Am I Still At Risk Of Local Recurrence If I Have Had A Mastectomy
Yes. Local recurrence can also happen after a mastectomy, although the likelihood is usually low.
Some of the signs of local recurrence after mastectomy include
- A lump or raised bump in or under the skin, especially near the previous mastectomy scar
- Changes to the skin, including redness or thickening
After reconstruction a local recurrence can appear at the suture line of the flap or in front of the implant. When its in the skin itself, it is red and raised. Reconstruction rarely if ever hides a recurrence. With implants, the recurrences are in front of the implant. With a flap, the recurrences are not in the flap itself but along the edge of the breast skin.
Local recurrence after mastectomy is often described as a chest wall recurrence, which isnt entirely accurate because it implies that the cancer is in the muscle or bone. But usually such a recurrence appears in the skin and fat where the breast was before, and only rarely does it include the muscle.
Ninety percent of local recurrences following mastectomy happen within the first five years after the mastectomy. Approximately 20 to 30 percent of women with local recurrences after mastectomy have already been diagnosed with metastatic disease, and another 20 to 30 percent will develop it within a few months of diagnosis. Therefore, just as with local recurrences after breast conservation, tests should be done to look for distant disease.
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Table 1 Why A Low Psa Does Not Mean You Are Cancer
The Prostate Cancer Prevention Trial included a provision that men randomized to receive placebo undergo a prostate biopsy at the end of the study, even if they had normal PSA levels and digital rectal exams. To their surprise, investigators found that many of these men had prostate cancer in some cases, high-grade prostate cancer.
PSA level 13 *Note: A PSA level over 4.0 ng/ml traditionally triggers a biopsy. Adapted with permission from I.M. Thompson, et al. Prevalence of Prostate Cancer Among Men with a Prostate-Specific Antigen Level 4.0 ng per Milliliter. New England Journal of Medicine, May 27, 2004, Table 2.
This study inadvertently provided evidence not only that prostate cancer occurs more often than once believed, but also that PSA levels may not be a reliable indicator of which cancers are most aggressive. Both findings add weight to the growing consensus that many prostate tumors currently being detected may not need to have been diagnosed or treated in the first place.
What Is Stage 0 Dcis
Stage 0 breast cancer, ductal carcinoma in situ is a non-invasive cancer where abnormal cells have been found in the lining of the breast milk duct. In Stage 0 breast cancer, the atypical cells have not spread outside of the ducts or lobules into the surrounding breast tissue. Ductal Carcinoma In Situ is very early cancer that is highly treatable, but if its left untreated or undetected, it can spread into the surrounding breast tissue.
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Survival Rates Of Stage 1 And Stage 2 Breast Cancer
According to data from the Australian Institute of Health and Welfare, the earlier breast cancer is first diagnosed, the better the outcome. The survival rates of people diagnosed with breast cancer have also improved over time due to earlier detection and improvements in treatment. Most people with early stage breast cancer can be treated successfully.
You may wish to discuss your prognosis and treatment options with your doctors. However, it is not possible to predict the exact course of your cancer and how long you will live. The length of survival can vary from person to person. Factors that influence this include:
- Response to treatment
- The type of breast cancer that you have
- The rate of tumour growth
- Other factors such as your age, medical history and overall health.
Prognosis And Survival For Breast Cancer
If you have breast cancer, you may have questions about your prognosis. A prognosis is the doctors best estimate of how cancer will affect someone and how it will respond to treatment. Prognosis and survival depend on many factors. Only a doctor familiar with your medical history, the type, stage and characteristics of your cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis.
A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together. They both play a part in deciding on a treatment plan and a prognosis.
Doctors use different prognostic and predictive factors for newly diagnosed and recurrent breast cancers.
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The Stages Of Breast Cancer And Your Treatment Options
Compared to most other cancers, staging breast cancer is more complex. And when it comes to treating breast cancer, there isnt a one-size-fits-all approach. Your treatment plan should be created especially for you and be coordinated across specialists and thats where your cancer care team comes in.
At HealthPartners, we believe cancer treatment and care is best managed by a group of doctors and specialists in whats known as multidisciplinary conferences. This is where breast surgeons, oncologists, radiologists, pathologists and other members of your care team gather to discuss the best treatment sequence for you.
Below we dive into the treatment options your care team might recommend at various breast cancer stages.
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What Is Stage 3 Breast Cancer
Also known as locally advanced breast cancer, the tumor in this stage of breast cancer is more than 2 inches in diameter across and the cancer is extensive in the underarm lymph nodes or has spread to other lymph nodes or tissues near the breast. Stage 3 breast cancer is a more advanced form of invasive breast cancer. At this stage, the cancer cells have usually not spread to more distant sites in the body, but they are present in several axillary lymph nodes. The tumor may also be quite large at this stage, possibly extending to the chest wall or the skin of the breast.
Stage 3 breast cancer is divided into three categories:
Stage 3A: One of the following is true:
- No tumor is found in the breast, but cancer is present in axillary lymph nodes that are attached to either other or other structures, or cancer may be found in the lymph nodes near the breast bone, or
- The tumor is 2 cm or smaller. Cancer has spread to axillary lymph nodes that are attached to each other or other structures, or cancer may have spread to lymph nodes near the breastbone, or
- The tumor is 2 cm to 4 cm in size. Cancer has spread to axillary lymph nodes that are attached to each other or to other structures, or cancer may have spread to lymph nodes near the breast bone, or
- The tumor is larger than 5 cm. Cancer has spread to axillary lymph nodes that may be attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone.
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How Is Prognosis Estimated
Prognosis is estimated by looking at what has happened over many years to large groups of people diagnosed with a similar cancer. However, everyones situation is different so no one can say for certain what will happen to you. Also, treatments and survival rates are constantly improving, which affects the accuracy of estimates for people being treated today.
Prognosis is described in different ways. It may be put into words or numbers. Its often expressed as a five- or ten-year survival rate. This is an estimate of how many people are likely to be alive five or ten years following their diagnosis.
A 90% five-year survival rate means that 90 out of 100 people diagnosed with breast cancer are likely to be alive five years after their diagnosis. It doesnt mean these people will only live for five years it just states how many people are likely to be alive at that point.
Cancer Research UK has general statistics on five- and ten-year breast cancer survival rates on their website. Remember, these statistics are based on large groups of patients and cannot predict what will happen in your individual case.
How Long Can You Live With Stage 3 Cancer
The five-year relative survival rate for these three types of tumors is 44 percent, according to the American Cancer Society. Early detection generally results in a better outlook. When diagnosed and treated in stage 1, the five-year relative survival rate is 92 percent.Outlook by stage.StageSurvival Rate365%435%2 more rows
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Playing An Active Role
You play an active role in making treatment decisions by understanding your breast cancer diagnosis, your treatment options and possible side effects.
Together, you and your health care provider can choose treatments that fit your values and lifestyle.
The National Academy of Sciences released the report, Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis in 2013. Susan G. Komen® was one of 13 organizations that sponsored this study.
The report identified key ways to improve quality of care:
Figure 2 Why Understaging May Occur
When the prostate is removed, a pathologist examines slices of the gland for evidence of cancer. A. Under a microscope, the pathologist can distinguish tiny tumors, consisting of clumps of visibly abnormal cells. B. With current imaging technology, it is not yet possible for a pathologist to identify micrometastases individual cancer cells shed from the primary tumor that have gone on to seed adjacent tissue. In this image, for example, cancer cells have already penetrated the capsule and migrated to adjacent tissue, even beyond the margin of tissue removed during surgery.
Individual prostate cancer cells can spread to more remote areas of the body in three ways . Whats more, they can do so without being detected with our current technology, essentially escaping under the radar. So its always possible even if you are diagnosed with early-stage prostate cancer that the cancer has already spread and will manifest in the coming years. How likely is it that an early-stage prostate cancer will become active without treatment? A small study provides some clues .
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Myth #: The Mental And Emotional Experience Of People With Mbc Is The Same As That Of Earlier
People with MBC report hearing comments such as, At least you have a good type of cancer, Arent you glad so much research on breast cancer has been done?, Fortunately you have so many options. These might comfort people with early-stage breast cancer, who can look forward to one day finishing treatment and moving on but people with MBC dont have that luxury. They know they will be in treatment for the rest of their lives. They also know that their life is likely to be shorter than theyd planned.
Mentally and emotionally, people with MBC have a completely different experience. For them, the whole ringing the bell idea does not work, says Dr. Gupta. I have patients who are coming in once a week and have to plan their lives around their treatment. The whole pink brigade idea is very upsetting to them.
Fortunately, more and more people with MBC are speaking up and calling attention to how their experience differs from that of people with earlier-stage breast cancer. People with MBC live with cancer always in the background of their lives, but with new and emerging therapies, many are living longer and maintaining their quality of life.
Clearly, the experience of metastatic breast cancer is quite different from early-stage breast cancer. But there are so many patients who understand just what youre going through. Read more about Living with Metastatic Breast Cancer and join our discussion forum for people with stage IV/metastatic disease.