Symptoms Of Breast Cancer
Breast cancer can have several symptoms, but the first noticeable symptom is usually a lump or area of thickened breast tissue.
Most breast lumps are not cancerous, but it’s always best to have them checked by a doctor.
You should also see a GP if you notice any of these symptoms:
- a change in the size or shape of one or both breasts
- discharge from either of your nipples, which may be streaked with blood
- a lump or swelling in either of your armpits
- dimpling on the skin of your breasts
- a rash on or around your nipple
- a change in the appearance of your nipple, such as becoming sunken into your breast
Breast pain is not usually a symptom of breast cancer.
Find out more about the symptoms of breast cancer.
Testing For Breast Cancer Metastasis
If a patients symptoms, follow-up exam or screening test suggests a possible breast cancer recurrence or metastasis, a physician may suggest a:
- Whole-body bone scan
- X-ray or ultrasound of the belly or chest
- CT scan of the chest, belly, pelvis or brain
- MRI of the spine or brain
- Tap, which involves the removal of fluid from the area with symptoms to check for cancer cells
Metastatic Breast Cancer Treatment
Metastatic breast cancer cannot be cured. Instead, treatment is focused on preventing cancer from spreading and managing symptoms. Systemic therapy, a therapy used to treat the entire body, is the main treatment option.
Any of the following may be included in a systemic therapy treatment plan:
- Chemotherapy. Drugs are used to kill cancer cells.
- Hormone therapy. Stops the growth of cancer cells that rely on specific hormones by blocking hormone receptors.
- Targeted therapy. Targets changes in cancer cells that help them grow, divide and spread.
- Immunotherapy. Uses the body’s immune system to locate and kill cancer cells.
A systemic treatment plan is created by considering:
- Where cancer has spread
- Cancer cell biology
Local therapies, treatments for specific areas of the body, like surgery or radiation may not be as effective treatment options for metastatic breast cancer. However, some patients may still receive them.
In some cases, clinical trials may allow patients to try new treatment options that are not available to the public.
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How To Treat Metastatic Breast Cancer
If you have a metastatic breast cancer diagnosis, then the main goal of your health care provider is to improve your quality of life and help you to live longer. You cant cure the cancer at this stage as the cancerous cells have spread to different parts of the body. However, treatment could potentially ease your symptoms.
Metastatic breast cancer is incurable but treatable. Our goals are to treat the cancer, slow progression, and maintain/improve quality of life, Dr. Teplinsky says. Goals of treatment may change over time sometimes we focus on treating the cancer, and other times, we are more focused on symptom management.
What Is Metastatic Breast Cancer
Metastatic breast cancer occurs when cancer that started in the breast spreads to another part of the body. Its also known as stage 4 breast cancer.
There isnt a cure currently for metastatic breast cancer, but treatments can help relieve symptoms, improve quality of life, and prolong life.
The outlook for people with metastatic breast cancer and the length of time between a stage 4 diagnosis and the onset of end-of-life symptoms varies greatly.
Research suggests that about 27 percent of people who receive a metastatic breast cancer diagnosis live at least 5 years after their diagnosis.
Keep in mind that these statistics cant predict your personal outlook. Many individual factors play a role in survival rates.
Newer treatments are helping extend lives and improve the quality of life for people with metastatic breast cancer.
Regardless of what stage of cancer you have, its important to be informed.
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Early Warning Signs Of Breast Cancer
Common symptoms of breast cancer include:
- A lump in your breast or underarm that doesnât go away. This is often the first symptom of breast cancer. Your doctor can usually see a lump on a mammogram long before you can see or feel it.
- Swelling in your armpit or near your collarbone. This could mean breast cancer has spread to lymph nodes in that area. Swelling may start before you feel a lump, so let your doctor know if you notice it.
- Pain and tenderness, although lumps donât usually hurt. Some may cause a prickly feeling.
- A flat or indented area on your breast. This could happen because of a tumor that you canât see or feel.
- Breast changes such as a difference in the size, contour, texture, or temperature of your breast.
- Changes in your nipple, like one that:
Metastatic Breast Cancer Survival Rate
Although this form of cancer isnt curable, the good news is that it is very treatable. In fact, recent developments in treatment mean that people with a metastatic breast cancer diagnosis can have a better quality of life. The five-year survival rate after diagnosis for people with stage four breast cancer is 29%, according to the American Cancer Society .
Dr. Eleonora Teplinsky, head of breast medical oncology at Valley Health System, says: We have made remarkable strides in breast cancer in the last decade. New drugs keep getting approved. Were seeing improved survival. People are able to live their lives, work, travel, and be with their families.
If youve recently received a metastatic breast cancer diagnosis, then you may well feel frightened and overwhelmed. Those feelings are completely valid and normal. Your health care provider will be able to walk you through treatment options and provide information on emotional support for you and your loved ones.
Below, Dr. Teplinsky explains everything you need to know about metastatic breast cancer, including symptoms and how its diagnosed.
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Symptoms Of Metastatic Breast Cancer
The symptoms of metastatic breast cancer may be different than those of early-stage breast cancer, but not always. Sometimes, there are no symptoms at all.
You should always speak with your doctor if you experience any new signs or symptoms, but here are some of the most common signs that breast cancer has spread:
- Bone pain or bone fractures due to tumor cells spreading to the bones or spinal cord
- Headaches or dizziness when cancer has spread to the brain
- Shortness of breath or chest pain, caused by lung cancer
- Jaundice or stomach swelling
The symptoms of breast cancer metastasis may also vary depending on where in the body the cancer has spread. For example:
- If the breast or chest wall is affected, symptoms may include pain, nipple discharge, or a lump or thickening in the breast or underarm.
- If the cancer has spread to bones, symptoms may include pain, fractures or decreased alertness due to high calcium levels.
- If the cancer has spread to the lungs, symptoms may include shortness of breath, difficulty breathing, coughing, chest pain or fatigue.
- If the cancer has spread to the liver, symptoms may include nausea, fatigue, swelling of the feet and hands or yellowing skin.
- If cancer has spread to the central nervous system, which includes the brain or spinal cord, symptoms may include pain, memory loss, headache, blurred or double vision, difficulty with and/or movement or seizures.
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.
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Symptoms Of Metastasis May Vary Depending On Where The Cancer Has Spread To
Here are some symptoms that vary by locations commonly associated with breast cancer metastasis.
Metastasis in the bone may cause:
- Severe, progressive pain
- Bones that are more easily fractured or broken
Metastasis to the brain may cause:
- Persistent, progressively worsening headache or pressure to the head
- Vision disturbances
- Behavioral changes or personality changes
Metastasis to the liver may cause:
- Abnormally high enzymes in the liver
- Abdominal pain, appetite loss, nausea, and vomiting
Metastasis to the lungs may cause:
- Chronic cough or inability to get a full breath
- Abnormal chest X-ray
- Other nonspecific systemic symptoms of metastatic breast cancer can include fatigue, weight loss, and poor appetite, but its important to remember these can also be caused by medication or depression.
If you notice these symptoms, be sure you talk with your physician. They could be important for getting the treatment you need.
Interested in learning more? i3Health is hosting an upcoming webinar Metastatic Triple-Negative Breast Cancer: Applying Treatment Advances to Personalized Care. Learn more here.
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 five 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.
As KatyK of Idaho comments: that you are cured if you are cancer-free five 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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What Can I Expect While Living With Metastatic Breast Cancer
Your care team will monitor you every few months to check if the cancer is responding to treatment, and also to see if you are having any side effects. The process of restaging the cancer includes:
- History/physical exam.
- Imaging tests, including CTs and bone scan or PET scan.
Before your scans or tests, its normal to feel anxiety. It may help to bring a friend or family member to the appointment with you.
Symptoms Of Recurrent Prostate Cancer
Recurrent prostate cancer is the state where cancer returns after its treatment. It may occur around the prostate and refer to local recurrence. In case it is found in the other part of the body, it is also referred to as metastatic. Certain symptoms will let you get an idea about it. These are as follows:-
- There is blood in the urine
- Difficulty in urination
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Why Does My Provider Need To Test The Metastatic Tumor
Your care team will test the metastases to figure out the biology of the tumor, which can help guide your treatment plan. Providers may test tumors for:
- Hormone receptor status: If the cancer is hormone receptor-positive, hormonal therapy may be your first treatment.
- HER2 status: Human epidermal growth factor receptor 2 is a protein that is overexpressed on some breast cancer cells. HER2-positive cancer responds to specific HER2-targeted therapies.
- PIK3CA gene mutation: If a tumor is hormone receptor-positive and HER2-negative, your provider may test for this gene mutation. Specific targeted therapies can be used to treat tumors with this mutation.
- PD-L1 status: Tumors that are hormone receptive-negative and HER2-negative may be tested for PD-L1 status. If the PD-L1 test is positive, you may be recommended to receive a combination of immunotherapy and chemotherapy.
Survival Rates Of Stage 4 Breast Cancer
Unfortunately, cancer cells often become more difficult to treat and may develop drug resistance once they spread. According to the Australian Institute of Health and Welfare , the 5-year survival rate for women whose breast cancer is metastatic at first diagnosis is 32%, compared to the 91% on average for all breast cancer patients.
Factors affecting survival rate of metastatic breast cancer
Survival rates can provide an estimate of what percentage of patients with the same stage of breast cancer are still alive after a certain period of time . However, they cannot predict how long any specific individual with breast cancer will live. The length of survival time for people with metastatic breast cancer can vary significantly from person to person, but there are a number of factors which can influence this including:
- Response to treatment
- The extent and location of metastases
- The presence of other health issues not related to cancer
- The specific subtype of breast cancer . This is very important, as some types of cancer can be more aggressive than others and respond differently to treatment.
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How Does Cancer Spread Or Metastasize
The spread of cancer usually happens through one or more of the following steps:
- Cancer cells invade nearby healthy cells. When the healthy cell is taken over, it too can replicate more abnormal cells.
- Cancer cells penetrate into the circulatory or lymph system. Cancer cells travel through the walls of nearby lymph vessels or blood vessels.
- Migration through circulation. Cancer cells are carried by the lymph system and the bloodstream to other parts of the body.
- Cancer cells lodge in capillaries. Cancer cells stop moving as they are lodged in capillaries at a distant location and divide and migrate into the surrounding tissue.
- New small tumors grow. Cancer cells form small tumors at the new location
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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Living With Metastatic Breast Cancer
It can be upsetting for you, your family, and other loved ones to learn that breast cancer has spread to other areas of the body. But there are ways to manage your feelings, get support, figure out how to talk about the diagnosis with family and friends, and work after being diagnosed.
Its not always easy to balance your sexual needs with the physical and emotional challenges of a metastatic breast cancer diagnosis. You can manage the sexual issues that can often come up with a metastatic breast cancer diagnosis.
Testing For Metastatic Breast Cancer
Once youve explained to your health care provider that youre concerned about new symptoms, they will likely ask you for a detailed health history which could include a physical exam.
They may then conduct an X-ray, ultrasound scan, MRI, or CAT scan and order a blood test or tumor biopsy. If youre currently undergoing treatment, then a scan regimen may currently make up part of your health care. This can vary depending on your cancer and treatment plan.
Patients with metastatic breast cancer will routinely have scans every few months to check on their status of the cancer, Dr. Teplinksy says. These scans may be CT scans and bone scans or PET scans. Sometimes, other scans are done as well. These scans will help your health care provider to monitor your cancer and identify if it has spread.
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Myth #: If Youre Diagnosed With Metastatic Breast Cancer You Did Something Wrong Or Didnt Get The Right Treatment The First Time
When some people hear stage IV breast cancer, they assume something must have been missed along the way to let the cancer get that far. There is a misconception that breast cancer always develops in orderly steps from stages I to II, III, and then IV and that theres plenty of time to catch it early. People with MBC can face misguided assumptions that they must have skipped mammograms or self-exams, or they didnt control risk factors such as not exercising enough, watching their weight, or eating healthy. But a person can do everything right and still get MBC. Although regular screenings increase the odds of diagnosing breast cancer at an earlier stage, they cant guarantee it.
Another major misconception: If youre diagnosed with metastatic cancer after being treated for an early-stage breast cancer, you must have chosen the wrong treatment regimen or it wasnt aggressive enough. But between 20% and 30% of people with an earlier-stage breast cancer will eventually go on to develop MBC and theres often no good explanation as to why. And it can happen to anyone. Treatments can reduce the risk of recurrence, but they cant eliminate it.
As Illimae of Houston notes: that a stage IV diagnosis equals negligence on the part of the patient. In my case, it had spread before I ever felt a lump. I felt it Saturday and saw my doc on Monday, I ignored nothing, sometimes it just happens that fast.