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.
Risk Stratification And Subgroup Analysis
According to the optimal cut-off value determined by X-tile software, patients were divided into three different risk groups: low-risk , intermediate-risk , and high-risk group . The median OS of the three prognostic groups were 44, 18, and 7 months, with a 3-year survival rate of 56, 23, and 7%, respectively . As was shown in Figure 3, intermediate-risk and high-risk groups demonstrated higher risk of death than low-risk group in both the training and validation sets .
To further assess whether the prognostic score was also effective for treatment guidance, subgroup analysis was performed to explore surgery of primary site and chemotherapy benefit in different risk groups . The results found that patients in low-risk and intermediate-risk groups could benefit from locoregional surgical treatment, but it seemed not to prolong the survival time of patients of high-risk group significantly . However, chemotherapy could produce a significant survival benefit in these three different risk groups .
Figure 5 Subgroup analysis of overall survival for patients who received locoregional treatment or not.
Figure 6 Subgroup analysis of overall survival for patients who received chemotherapy or not.
Systemic Treatments For Stage Iv Breast Cancer
Treatment often continues until the cancer starts growing again or until side effects become unacceptable. If this happens, other drugs might be tried. The types of drugs used for stage IV breast cancer depend on the hormone receptor status, the HER2 status of the cancer, and sometimes gene mutations that might be found.
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Progression During Hormone Therapy
For hormone receptor-positive cancers that were being treated with hormone therapy, switching to another type of hormone therapy sometimes helps. For example, if either letrozole or anastrozole were given, using exemestane, possibly with everolimus , may be an option. Another option might be using fulvestrant or a different aromatase inhibitor, along with a CDK inhibitor. If the cancer has a PIK3CA mutation and has grown while being treated with an aromatase inhibitor, fulvestrant with alpelisib might be considered. If the cancer is no longer responding to any hormone drugs, chemotherapy immunotherapy, or PARP inhibitors might be options depending on specific features of the cancer or any gene changes that might be present.
Treatments For Breast Cancer Metastasis To Liver
When you get the news that breast cancer metastasis to liver is incurable you may go through a range of emotions. When breast cancer is only in the breast tissue or the lymph nodes in your armpit a cure is highly possible. Once cancer spreads beyond those areas, it is no longer curable. However, you can still receive treatment to slow the progression of the cancer.
Doctors usually focus treatment on extending life and increasing the quality in which you live. When determining treatment, they look at the following:
- Your past treatments
- How the cancer cells look
- Extent of metastasis
- Hormone receptor sensitivity
If your cancer cells are positive for hormone receptor sensitivity, they can give you hormone therapy treatments to trick the cancer cells into dying.
They can also do more rounds of chemotherapy and radiation to shrink any tumors and slow their growth. These treatments may also help reduce your symptoms. New symptoms may develop from side-effects of the treatments.
The side-effects of treatments include nausea, vomiting, anemia, loss of appetite, weight loss, and lowered immune response. Side-effects are treatable in order to continue aggressive therapy.
Response to Treatment
To combat this from happening, doctors will monitor the response to treatments. If resistance occurs, they can switch drugs. They can also head this off by switching drugs in the very beginning of treatment for metastasis.
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Where In The Body Does Breast Cancer Spread
In theory, breast cancer can spread to any part of the body, but it most commonly spreads to the lymph nodes, lungs, liver, bones and sometimes the brain. Keep in mind though, that even if your breast cancer spreads to other areas of your body, its still considered breast cancer. For example, if breast cancer spreads to your lungs, it does not mean that you now have lung cancer too.
If your breast cancer has moved to other parts of your body, you might experience symptoms relating to the area it has spread to, but not always.
Here Dr. Roesch explains how metastatic breast cancer can affect different parts of the body:
Phesgo For Early Breast Cancer
If you are taking PHESGO for early breast cancer, you will take it every 3 weeks for a total of 1 year unless side effects become too difficult to manage or the cancer comes back sooner.
You will also get chemotherapy, but the dosing schedule and number of cycles will depend on which type of chemotherapy you are getting. Chemotherapy is typically stopped sooner than PHESGO. Your doctor will decide what chemotherapy regimen is right for you.
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Questions To Ask Your Care Team
- Is treatment with PHESGO right for me?
- How is PHESGO different from PERJETA® + Herceptin® ?
- How is PHESGO different from chemotherapy?
- How is PHESGO given?
- Can I switch from PERJETA + Herceptin to PHESGO?
Starting treatment with PHESGO
- Can we discuss goals for me and my cancer treatment?
- What can I expect during treatment with PHESGO?
- How will you know if my treatment is working?
- When will I start treatment with PHESGO?
- Do I take PHESGO with chemotherapy?
The treatment experience
- How long will I get chemotherapy?
- How often will I get my injections?
- How many injections will I get/how long will I get PHESGO?
- Where will I go to get my treatment?
- How long will I spend in the clinic on treatment days?
- How do I prepare for treatment?
- What should I wear on treatment days?
- What should I bring with me to my appointments?
- What potential side effects should I expect or know about?
- How might my side effects be different once I finish chemotherapy when Im only getting PHESGO?
- What should I do if I experience a side effect?
- Is there anything I can do to help with certain side effects?
- Are there any side effects that may require you to stop my treatment?
My care team
- Who is on my healthcare team?
- What can they help me with?
- How can I reach them?
Have other questions?
This is not meant to replace the advice of your healthcare team.
Looking for more support?
What Is The Prognosis For Stage Iv Breast Cancer
Whether a patients metastatic breast cancer is the oligometastatic type or the most challenging, widespread sort, the best possible care addresses the patient as a unique individual. And according to Habibi, there are more reasons for hope than ever before.
Advancements in treatment options have extended the survival of patients with metastatic breast cancer, which had a stigma of being untreatable just a generation ago.
Even within the last decade, all aspects of care have seen a good amount of progress. Better diagnostic tests such as improved PET and CT scans are helping us find cancers faster and initiate treatment. And targeted therapies such as radiation, surgery and systemic treatments have seen improvements as well.
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Palliative And Supportive Care
Palliative and supportive care focuses on symptom control and support. Its an extremely important part of the care and treatment for many people living with secondary breast cancer and can significantly improve quality of life for them and their families.
People often associate palliative care with end-of-life treatment. However, many people value having it at any stage of their illness, alongside their medical treatment, to help prevent and relieve symptoms such as pain or fatigue. It can also help with the emotional, social and spiritual effects of secondary breast cancer.
The palliative and support care teams are based in hospitals, hospices and the community. You can be referred by your treatment team, GP or breast care nurse depending on your situation.
Integrative Therapies For Metastatic Breast Cancer
You may find it beneficial to add integrative therapies to your treatment plan. There are many evidence-informed integrative modalities to boost the mind and body. Practices like gentle yoga, meditation, massage and music therapy may feel enjoyable and reduce stress and anxiety levels.
To help our patients maintain quality of life after a metastatic breast cancer diagnosis, our team of breast cancer experts may offer supportive care services to help manage side effects of the disease and its treatments. These may include:
Before starting any integrative therapies, however, ask your care team for advice on which ones are most suited to you and fit into your overall treatment plan, as well as how to do them safely.
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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
Risks/chances Of Breast Cancer Metastasis To Liver
There are a slight number of cases early in cancer diagnosis that already have breast cancer metastasis to the liver. The number totals around less than 5 percent of all breast cancer diagnoses. In cases of early breast cancer that is still only in breast tissue, risk increases depending on the person, health status, and time after cancer treatment.
If you have been diagnosed with breast cancer metastases, there will be some increased challenges in treating and slowing the progression. It depends on the stage of cancer, the treatment, and time since diagnosis.
Metastasis occurs when the cancer has spread to the lymph nodes and hitches a ride into other organs. At first, the cancer goes into the lymph nodes near the armpit “axillary lymph nodes.” At this stage, there is a possibility of curing the cancer. If the cancer moves beyond the axillary lymph nodes, there is no cure but it is treatable.
Path of Breast Cancer Spreading to the Liver
Breast cancer spreading into your liver takes a certain path in stages. These are:
- Invasion of Local Tissue
The cancer cells invade the local breast tissue and form tumors. The cells then grow into tissue around the breasts. It begins to take over all the healthy tissue in the area. The cancer moves outside of the breast tissue or “margins.”
- Lymph Node Invasion
After entering the lymph nodes, the cancer then invades the circulation and travels through the bloodstream to distant organs. This can include the lungs, liver, brain, and bones.
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Diagnosing Metastatic Breast Cancer
To diagnose metastatic breast cancer, your doctor may recommend one or more tests:
- A complete blood count to assess your bone marrow function
- Tests for minerals and enzymes that can provide evidence of spreading cancer or other health conditions
- Tests for proteins that signal the presence of cancer
Liver Resections Of Isolated Liver Metastasis In Breast Cancer: Results And Possible Prognostic Factors
1Department of General, Thoracic, Vascular and Transplantation Surgery, University Hospital Rostock, Schillingallee 35, 18057 Rostock, Germany
2Department of General, Visceral, Vascular and Paediatric Surgery, University Hospital of the Saarland, Kirrberger Straße, 66424 Homburg/Saar, Germany
3Department of Medical Statistics, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
Metastasis is the most common cause of death in cancer patients . Breast cancer might spread via blood stream and cause liver metastasis. This can arise simultaneously or decades after the primary tumour. Metastases are often the sole sign of recurrence of the breast cancer. References show that 212% of patients with breast cancer have liver metastasis , which, however, might be isolated in some cases. In patients with resectable colorectal liver metastasis, surgical resection is the only curative approach, if an additional nonresectable extrahepatic tumour is excluded. References report 5-year survival rates of 30 to 47% in these patients . Surgical management is therefore recommended in the German S3-guidelines for colorectal cancer . In contrast to this the data on isolated liver metastasis in breast cancer patients is not as explicit.
2. Patients and Methods
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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.
Can Breast Cancer Recur At The Same Site
Yes, it can recur locally or regionally. Symptoms of a local recurrence are a new lump, a firm area, pulling or swelling at the site, redness, change in the shape of the nipple, and thickening near the scar. Symptoms of regional recurrence, which includes the underarm lymph nodes and upper chest area on the same side as the initial cancer, are a lump, swelling, or numbness of the arm, pain, and problems swallowing. These symptoms warrant prompt reporting to your physician.
What Should I Ask My Healthcare Provider About Metastatic Breast Cancer
If youve been diagnosed with metastatic breast cancer, ask your provider:
- What are my treatment options?
- What is my prognosis?
- What side effects can I expect?
- Will complementary therapy help me feel better?
- What if I want to stop treatment?
- How can I feel my best during treatment?
A note from Cleveland Clinic
Metastatic breast cancer is advanced breast cancer. Providers classify it as stage 4 breast cancer. It happens when cancer cells, often left behind after previous breast cancer treatment, start to spread to other parts of the body. While there is no cure for metastatic breast cancer, treatment can prolong your life and help you feel better. There are many medications available, so if one treatment isnt working, your care team can try a different approach. If you notice any symptoms or dont feel your best, especially if youve undergone breast cancer treatment in the past, talk to your healthcare provider.
Last reviewed by a Cleveland Clinic medical professional on 04/14/2021.
Symptoms Of Metastatic Breast Cancer
Symptoms depend on where the cancer has metastasized. According to Habibi, common areas include the bones of the spine, the lungs and the liver. The symptoms can be back pain, shortness of breath, cough and fatigue.
Some types, including triple negative breast cancer, can also spread to the brain. The patient can experience headache, convulsions, changes in mood, and difficulty with speech or field of vision, Habibi says.
People who have been treated for breast cancer should be on the lookout for symptoms such as:
- Back or neck pain
Reporting these symptoms is important, says Habibi. Patients are usually the first and best people to notice something is not right, and can ask for guidance from their physicians.
After completion of the active phase of cancer care, and in the absence of specific symptoms, we usually do not recommend routine metastatic workup.
Doing a lot of unnecessary testing can harm the patient, he explains. Small abnormalities in one test can lead to additional test and biopsies, which can be very stressful to the patient, and repeated testing without symptoms has not been shown to improve outcomes.
However, patients should continue with their routine follow-ups as prescribed by their surgeon, medical oncologist and primary care doctor, the latter of whom plays a very important role in the survivorship phase.
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How Is Metastatic Breast Cancer Diagnosed
If you have symptoms of metastatic breast cancer, your provider may recommend tests including:
- Blood tests, including complete blood count and comprehensive metabolic panel.
- Imaging studies, including MRI, CT, bone scan and PET.
- Bronchoscopy, which uses a scope to look inside your lungs this can be done if there is a concerning spot in the lungs.
- Biopsy to remove tissue from a suspicious area and analyze it.
- A tap to remove fluid from an area with symptoms. For example, pleural tap removes fluid from the lung area. Spinal tap removes fluid from the spinal cord area.
Can Stage 4 Breast Cancer Go Into Remission
Stage 4 breast cancer can go into remission, meaning that it isnt detected in imaging or other tests. Pathological complete remission indicates a lack of cancer cells in tissues removed after surgery or biopsy.
But its rare to take tissue samples while treating stage 4 breast cancer. This could mean that although treatment has been effective, it hasnt completely destroyed the cancer.
Advances in stage 4 breast cancer treatments are helping to increase the length of remission.
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