Central Nervous System Metastases
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Clinically symptomatic CNS metastases are reported in 10â15% of patients with metastatic breast cancer in large autopsy studies, up to 40% of women who died of metastatic breast cancer were reported to have at least one brain metastasis. CNS metastases are often viewed by patients and doctors as a late complication of metastatic breast cancer for which few effective treatments exist. In most cases, CNS involvement occurs after metastatic dissemination to the bones, liver and/or lungs has already occurred for that reason, many patients already have refractory, terminal breast cancer by the time they are diagnosed with brain metastases. The diagnosis of brain metastases from breast cancer relies mainly on patient-reported symptoms and neuroimaging. The role of imaging in patients with suspected brain metastases is a very good modality to aid in diagnosis. According to Weil et al., 2005, neuroimaging such as Computed Tomography and Magnetic Resonance Imaging prove to be very effective in the diagnosis of brain and central nervous system metastases.
Symptoms of brain metastases from breast cancer are:
- new-onset headache
- cranial neuropathy, which may cause diplopia and Bell’s palsy
- vomiting and nausea
- deficits in sensation, motor function, and speech
What Should A Person With Stage 4 Breast Cancer Expect From Treatment
Treatment options vary widely depending on where you live, your access to specialists and sub-specialists, and your willingness to try therapies that are still in the experimental phase.
Seek out oncology specialists who specialize in Stage 4 breast cancer. Discuss with your treatment team what clinical trials may be available for your clinical situation.
During this time, be sure to surround yourself with a support system of friends and family.
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.
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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.
What Causes Death In Metastatic Breast Cancer
The most common cause of death was metastatic disease to various organs, accounting for 42% of all deaths. Infection was the second most common cause of death however, only 27% of the patients with infection had significant neutropenia. In patients dying of hemorrhage, only 9% were thrombocytopenic.
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Additional Markers For Breast Cancer Staging
Additional markers specific to breast cancer will further define your stage, which may be helpful in choosing targeted treatments to fight the cancer.
- ER: The cancer has an estrogen receptor. Estrogen is a hormone, and some cancers have receptors that respond to estrogen.
- PR: The cancer has a progesterone receptor. Progesterone is also a hormone.
- HER2: The cancer makes the protein HER2 .
- G: Grade of cancer refers to how different the cells look from normal. Grade 1 indicates that the cells look fairly normal, while grade 2 cells are growing a little faster, and grade 3 cells look markedly different than normal breast tissue.
These markers, along with the TNM measurements, define your stage.
A cancer recurrence refers to cancer that returns in the same breast, and it requires new staging. This new stage is marked by an R at the end to indicate restaging. If it develops in the other breast, its considered a new cancer.
Myth #: Metastatic Breast Cancer Requires More Aggressive Treatment Than Earlier
Related to myth #3 is the notion that because MBC is advanced cancer, doctors have to pull out all the stops to fight it. But thats actually not the case, says Breastcancer.org professional advisory board member Sameer Gupta, MD, a medical oncologist at Bryn Mawr Hospital in Bryn Mawr, Pa., and a clinical assistant professor of medicine at Jefferson Medical College in Philadelphia. The goal is control rather than cure. Think of it as a marathon vs. a 50-yard dash.
Doctors treat earlier-stage breast cancer more aggressively because the goal is to cure it: destroy all of the cancer cells and leave none behind, reducing the risk of recurrence as much as possible. With MBC, the goal is control so that patients can live well for as long as possible. And chemotherapy isnt necessarily the mainstay of treatment.
DivineMrsM of Ohio shares her experience: eople in general think we should be hooked up to a chemo IV and looking sickly. When I told one woman I took a daily anti-estrogen pill to combat MBC, she looked at me with pity and sadness like I had no clue what I was talking about. Or that I was making up that I had advanced breast cancer, perhaps as a sympathy ploy or for attention. She even asked, Arent you on chemo? And I worked with this woman for a number of years, she was not a stranger!
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Systemic & Common Drug Treatments
Chemotherapy is the process by which anti-cancer drugs are used as a method of cancer treatment. Because the process of chemotherapy is aimed at destroying cancer cells, it has been shown to effectively cure cancer in some people. While chemotherapy may not be completely effective in curing Stage 4 cancer, it does offer the benefit of easing and relieving some of the symptoms of itwhich is certainly a step in the right direction.
Additionally, immunotherapy refers to the process by which a patients own immune system is stimulated, in an effort to encourage the body to fight off the cancer. One common form of immunotherapy treatment utilizes various drugs, known as checkpoint inhibitors, to encourage the immune system to identify and attack cancer cells on its own. There are many forms of immunotherapy, so its best to consult with your doctor to learn more.
Mechanisms In Bone Metastases
The primary extracellular matrix components and cell-surface receptors which aid in metastasis are:
Metastatic breast-cancer cells excrete lysophosphatidic acid which binds to receptors on tumor cells, inducing cell proliferation and release of cytokines and stimulating bone resorption. After the breast-cancer cells have left the primary tumor, they interact with the bone microenvironment and secrete osteolytic factors capable of osteoclast formation and bone resorption. Apart from the breast tumor cells, the resident stromal cells also contribute to tumor survival. Growth factors such as epidermal growth factor , fibroblast growth factor and transforming growth factor beta are implicated in the development and progression of metastatic breast cancer.
- Matrix metalloproteinases
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Living With Stage 4 Breast Cancer
Metastatic breast cancer affects people in different ways. Some women who are diagnosed with metastatic breast cancer may experience a reduction in their overall health as a result of disease progression and/or the resulting side effects of their treatment. If you are experiencing any symptoms that concern you or if symptoms get worse, it is important that you discuss these with your doctor. In addition, while there is no strong evidence that a special diet will improve the prognosis of metastatic breast cancer, healthy lifestyle choices can help you to feel your best, manage symptoms and improve your overall wellbeing.
Many women also find the uncertainty of their situation difficult to manage. Some people cope best by living in the present and not thinking too much about the future. Other people prefer to plan ahead, which gives them a greater sense of control. The best approach is the one that works best for you.
What Is Stage 2 Breast Cancer
Also known as invasive breast cancer, the tumor in this stage measures between 2 cm to 5 cm, or the cancer has spread to the lymph nodes under the arm on the same side as the breast cancer. Stage 2 breast cancer indicates a slightly more advanced form of the disease. At this stage, the cancer cells have spread beyond the original location and into the surrounding breast tissue, and the tumor is larger than in stage 1 disease. However, stage 2 means the cancer has not spread to a distant part of the body.
At stage 2, a tumor may be detected during a breast self-exam as a hard lump within the breast. Breast self-exams and routine screening are always important and can often lead to early diagnosis, when the cancer is most treatable.
Stage 2 breast cancer is divided into two categories:
Stage 2A: One of the following is true:
- There is no tumor within the breast, but cancer has spread to the axillary lymph nodes, or
- The tumor in the breast is 2 cm or smaller and cancer has spread to the axillary lymph nodes, or
- The tumor in the breast measures 2 cm to 5 cm but cancer has not spread to the axillary lymph nodes.
Stage 2B: One of the following is true:
- The tumor measures 2 cm to 5 cm and cancer has spread to the axillary lymph nodes, or
- The tumor is larger than 5 cm but cancer has not spread to the axillary lymph nodes.
At stage 2, TNM designations help describe the extent of the disease. Most commonly, stage 2 breast cancer is described as:
Stage 2 breast cancer survival rate
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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.
How Is Stage 4 Breast Cancer Treated
The aim of treatment is to improve the quality and length of life of people with stage 4 breast cancer. Each person will be treated differently based on the disease characteristics and the intended goals of treatment.
Most treatments aim at decreasing the tumor burden and stabilizing the disease. In general, stage 4 cancer treatmentsalthough they may extend life in a significant number of peopleare considered palliative . This is because only a handful of people treated at this stage are cured of their disease.
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Cancer Care Team / Pain Clinics
If youre looking for support during this time, working with your oncologist and cancer care team can be helpful. Many teams include a patient navigator who is assigned to guide you through the different stages of your diagnosis and connect you to helpful resources that can assist you.
Pain clinics, or palliative care, is another option. Your palliative care team is there to support you by treating and preventing the painful and uncomfortable side effects that can result from certain forms of cancer treatment.
Stages Of Breast Cancer
Your breast cancer stage indicates the severity of the disease upon diagnosis. Your breast cancer stage indicates the severity of the disease upon diagnosis. Your cancer stage will always stay the same, even if the cancer shrinks or spreads during or after treatment. For instance, if youre diagnosed with stage 1 breast cancer, but the tumor later grows and spreads, its not considered stage 3 or 4 breast cancer. To determine whether the cancer has responded to treatment, a new stage may later be assigned an r in front of it to show that its different from the original stage.
Breast cancer staging is classified by:
- The size and location of the tumor
- Whether the cancer has spread to nearby lymph nodes or other parts of the body
- The grade of the tumoror how likely it is to grow and spread
- Whether certain biomarkershormone receptors or other proteinshave been found
All these attributes help your care team determine how to treat your cancer.
To assess the location, size and spread of cancer, your care team will use the TNM Staging System, developed and updated for breast cancer by the American Joint Committee on Cancer .
- TNM stands for Tumor-Node-Metastasis, which are important factors in determining the severity of your cancer.
- All cancers may be evaluated by TNM markers, but breast cancer staging also uses a few extra criteria for a more detailed description.
- Ultimately, your specific combination of TNM and these other markers will determine your cancers stage.
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Solid Tumors Vs Liquid
Cancer can occur in one of two different forms: solid tumors or liquid cancers.
When a cancer forms a solid mass, or tumorit is referred to as a solid tumor cancer. In this type of cancer, tumorous masses form in a specific bodily organ, such as the breasts, lungs, or ovariesfor example. Solid tumors can occur anywhere in the body.
On the other hand, liquid cancers, or liquid tumors, refer to those that specifically affect the blood, bone marrow, or lymph nodes of the body only. Leukemia, Lymphoma, and Myeloma are examples of liquid cancers.
Treatment Of Stage Iv Breast Cancer
Stage IV cancers have spread beyond the breast and nearby lymph nodes to other parts of the body. When breast cancer spreads, it most commonly goes to the bones, liver, and lungs. It may also spread to the brain or other organs.
For women with stage IV breast cancer, systemic drug 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 some women live longer. These cancers are considered incurable.
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Diagnosing Metastatic Breast Cancer
Getting a clear picture of where breast cancer has spread is essential for creating a personalized treatment plan. Your care team will likely use a combination of the following tests and tools to diagnose both localized and advanced breast cancer:
Ultrasound exam: With this imaging technique, sound waves create a picture of internal areas of the body.
Magnetic resonance imaging : This procedure produces detailed images using magnetic fields and radio waves.
Blood chemistry studies: A blood sample is taken to measure the amounts of certain substances that are released by your organs and tissues. A higher or lower amount of a particular substance may be a sign of disease.
Breast biopsy: A biopsy is the removal of cells or tissues so a pathologist may view them through a microscope. Your original breast cancer diagnosis was likely confirmed with a biopsy.
Is Metastatic Cancer A Terminal
Most cancers of metastatic cancers do not have a good prognosis and are often labeled terminal. Metastatic breast cancer cannot be cured but can be managed with treatment. According to the American Cancer Society, the 5-year survival rate after diagnosis for people with stage 4 breast cancer is 27%.
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Can Breast Cancer Stage 4 Be Cured
Theres currently no cure for stage 4 breast cancer, but with treatments it can be kept under control, often for years at a time. People with metastatic breast cancer need to receive treatments for the rest of their lives. If a certain treatment stops being effective, another treatment regimen may be tried.
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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