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.
Johns Hopkins Researchers Discover How Breast Cancer Spreads To Lung
The spread of breast cancer is responsible for more than 90 percent of breast cancer deaths. Now, the process by which it spreads — or metastasizes — has been unraveled by researchers at Johns Hopkins.
Reporting in two papers, the researchers have discovered the switch that enables breast cancer cells to travel to and be received in the lungs.
The results appear in two separate papers, one in the September 12 issue of the Proceedings of the National Academy of Science Early Edition and the other in the August 22 issue of Oncogene.
“Metastasis transforms breast cancer from a local, curable disease, to one that is systemic and lethal,” says Gregg L. Semenza, M.D., Ph.D., the C. Michael Armstrong Professor of Medicine, director of the Vascular Program in the Institute for Cell Engineering and a member of the McKusick-Nathans Institute of Genetic Medicine at Johns Hopkins. “Metastasis was long thought a late event in cancer progression, but we have now shown metastasis to be an early event that is dependent on HIF-1”
Discovered by Semenza’s team nearly 20 years ago, the HIF-1 protein controls genes that enable cells to survive in low oxygen, like cells in solid tumors. More recently, others have found that in patients with breast cancer, an increase in HIF-1 activity correlates with increase in metastasis and decreased survival.
Semenza’s team used breast cancer cells grown in low oxygen to examine the activity of 88 genes known to play a role in metastasis.
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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.
References
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Treatment For Physical Symptoms
The American Cancer Society urge that a person should not have to endure pain in the final months and days of life.
Many people find relief with opioid medications, but these can cause side effects such as fatigue and constipation. A person may use opioids in combination with other pain relief medications, such as acetaminophen or ibuprofen.
Other drugs, such as antidepressants and antiseizure medications, can also treat certain types of pain.
Doctors can also prescribe medications for nausea and vomiting. Some drugs for treating nausea can make a person drowsy. However, these drugs may help people eat and drink more or simply make it easier for them to function and interact with other people.
Surgical Therapy For Pulmonary Metastasis Of Breast Cancer
1 Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama , Division of Breast and Endocrine Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama , , Japan
Contributions: Conception and design: J Soh Administrative support: J Soh Provision of study materials or patients: J Soh Collection and assembly of data: J Soh Data analysis and interpretation: J Soh Manuscript writing: All authors Final approval of manuscript: All authors.
Correspondence to:
Keywords: Pulmonary metastasectomy oligometastasis differential diagnosis
Submitted Feb 15, 2020. Accepted for publication Mar 09, 2020.
doi: 10.21037/tcr.2020.03.63
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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
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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How To Reduce The Risk Of Metastasis
After someone has received initial treatment, breast cancer can lay dormant in the body before spreading to other areas. People who have received treatment in the past should monitor themselves for any signs or symptoms that could indicate cancer recurrence.
While there is no single way to avoid developing metastatic breast cancer entirely, there are some lifestyle changes that can help reduce a persons risk.
People may reduce the risk of metastases with the following factors:
- having regular health screenings
Is Metastatic Breast Cancer Curable
Currently there is no cure for metastatic breast cancer. However new and better treatment options mean that the cancer can remain under control for longer, sometimes for years at time.
Those diagnosed with metastatic breast cancer will need to undergo treatment for the rest of their lives. If one treatment ceases to be effective in keeping the cancer under control, another treatment regime may be suggested. These treatments are generally given for as long as they are providing a benefit to the patient. The goal is to maintain the best quality of life achievable, and to prolong life if possible.
Every diagnosis of metastatic breast cancer is different, and therefore each treatment regime and prognosis will be different. Your doctor and/or treatment team are best to advise on your personal medical situation.
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Treatment For Metastatic Breast Cancer
There are a number of different approaches to treating metastatic breast cancer. Every cancer is unique and treatment can be tailored to your specific circumstances.
Doctors usually treat metastatic breast cancer in any part of the body with systemic medications, which treat cancer throughout the entire body. Chemotherapy, hormonal therapy, targeted therapies, and immunotherapy are all systemic medications. Local treatments that target a specific part of the body, such as surgery or radiation, are sometimes recommended.
Most treatment decisions depend on where in the body the cancer has spread, the cancers characteristics , and any cancer treatments youve had in the past.
If youre being treated for metastatic breast cancer, you may want to talk to your doctor about whether participating in a clinical trial makes sense for you. Its important to know that researchers conducting clinical trials carefully consider your specific situation before approving you as a study participant. By participating in a clinical trial, you can help researchers find better breast cancer treatments that may help extend lives in the future. But you also may benefit from the treatment the researchers are studying.
Bone Metastases And Bone Problems
People with bone metastases are at risk of serious bone complications such as bone fractures , spinal cord compression and bone pain.
Bone complications are a concern for people with bone metastases as they can cause pain and may lead to loss of mobility, impacting quality of life. Bone complications can also decrease survival . With the use of bone-strengthening drugs, bone complications are not common .
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Symptoms Of Metastatic Breast Cancer
The symptoms of stage 4 breast cancer depend on the location of the cancer and where it has spread in your body.
- If breast cancer has spread to your bones, you may notice a sudden new bone pain. Breast cancer most commonly spreads to your ribs, spine, pelvis, or arm and leg bones.
- If it has spread to your brain, you may experience headaches, vision or speech changes, or memory problems.
- Breast cancer that has spread to your lungs or liver usually causes no symptoms.
The main treatments for stage 4 breast cancer are targeted drug therapies that destroy cancer cells wherever they are in your body.
These treatments may include:
- hormone therapy, which stops or slows the growth of tumors by preventing your body from producing hormones or interfering with the effect of hormones on breast cancer cells
- chemotherapy, where drugs given orally or through an IV travel through your bloodstream to fight cancer cells
- immunotherapy, which uses drugs that stimulate your immune system to destroy cancer cells
- a combination of these therapies
In some cases, surgery or radiation therapy may be used to treat stage 4 breast cancer.
The following are the common treatment options for different types of stage 4 breast cancer.
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 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 supportive 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.
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Treatment Of Lung Metastases
Treatment for lung metastases is usually based on the main type of cancer the person has. Treatment may include chemotherapy, immunotherapy or radiation therapy, or a combination of these.
Surgery may be an option if there are a small number of lung metastases and there are no metastases in other parts of the body. Also, surgery would only be used if the main cancer is under control.
Controlling symptoms is important, especially if treatment for the main cancer is not effective or may take a while to help. Shortness of breath can be one of the hardest feelings to deal with. Morphine-like medicines can be used to help decrease the feeling of shortness of breath. Anti-anxiety medicines may be helpful if the morphine-like medicines dont work.
Having trouble breathing can make you feel anxious, worried, and even like you are in a panic. Some patients find the steps below helpful.
- A fan blowing cool air on you
Pain can also be hard to deal with, especially if you have other symptoms. Talk to your healthcare team about how you can use medicines and supportive methods to treat your pain.
Most Common Places It Spreads
It’s still breast cancer, even if it’s in another organ. For example, if breast cancer spreads to your lungs, that doesn’t mean you have lung cancer. Although it can spread to any part of your body, there are certain places it’s most likely to go to, including the lymph nodes, bones, liver, lungs, and brain.
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Treatments For Lung Metastasis
Metastatic breast cancer in any part of the body is usually treated with systemic medicines, which treat cancer throughout the entire body. For lung metastasis, local treatments that specifically target the lungs, such as surgery or radiation, are sometimes recommended. But most lung metastases dont require local treatments because they dont cause major symptoms.
Chemotherapy destroys or damages cancer cells as much as possible and, therefore, doctors recommend it as a treatment for metastatic breast cancer. Because chemotherapy medicines are systemic treatments meaning they affect the entire body doctors generally recommend chemotherapy if:
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the cancer is growing quickly
Doctors often combine chemotherapy with targeted therapies, which are medicines that target specific characteristics of cancer cells.
Each persons chemotherapy treatment plan is different. But there are some general guidelines that doctors follow when using chemotherapy to treat metastatic breast cancer:
If breast cancer comes back after chemotherapy or doesnt respond to chemotherapy medicines, you can try a different combination of medicines. There are many chemotherapy medicines, and if one medicine or combination of medicines doesnt work, there is almost always something else you can try.
Cancer immunotherapy medicines work by helping your immune system work harder or more efficiently to fight cancer cells.
Is Stage 4 Breast Cancer Curable
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.
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Triple Negative Breast Cancer
With this type of breast cancer, the breast cancer cells dont have ER+ or PR+ receptors. They dont overproduce the HER2 protein, so hormone therapy isnt very effective.
Instead, triple negative stage 4 breast cancer is usually treated with chemotherapy. Radiation therapy may also be an option, depending on the site of metastasis.
From Cured To Stage 4
Others, like Teri Pollastro, a 54-year-old stage 4 patient from Seattle, respond surprisingly well.
Diagnosed with early stage ductal carcinoma in situ in 1999, Pollastro underwent a mastectomy but did not receive chemotherapy, radiation or tamoxifen, since her cancer was ER negative.
âThey used the C-word with me, they told me I was cured,â she said. âEvery time I went back to my oncologist, he would roll his eyes at me when I had questions.â
In 2003, Pollastro switched to Seattle Cancer Care Alliance where she saw Dr. Julie Gralow, a breast cancer oncologist and clinical researcher at Fred Hutchinson Cancer Research Center. Gralow discovered Pollastroâs cancer had metastasized to her liver.
âMy husband and I were in shock,â said Pollastro of her mets diagnosis. âYou donât go from being cured to stage 4.â
Pollastro went on Herceptin, a type of immunotherapy for women with HER2-positive metastatic breast cancer, and did six months of chemotherapy.
âI felt better right away with the treatment,â she said. âBut the problem is, it stopped . Thatâs what you can expect with mets. And thereâs always some residual cancer. And that starts percolating.â
And along with mets, she also had to deal with many misconceptions regarding her disease.
The Mercer Island, Washington, mother of two, who often counsels newly diagnosed patients, sometimes even found it difficult to relate to early stage breast cancer survivors.
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About Metastatic Breast Cancer
Cancer begins when healthy cells change and grow out of control, forming a mass or sheet of cells called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread. When breast cancer is limited to the breast and/or nearby lymph node regions, it is called early stage or locally advanced. Read about these stages in a different guide on Cancer.Net. When breast cancer spreads to an area farther from where it started to another part of the body, doctors say that the cancer has metastasized. They call the area of spread a metastasis, or use the plural of metastases if the cancer has spread to more than 1 area. The disease is called metastatic breast cancer. Another name for metastatic breast cancer is “stage IV breast cancer if it has already spread beyond the breast and nearby lymph nodes at the time of diagnosis of the original cancer.
Doctors may also call metastatic breast cancer advanced breast cancer. However, this term should not be confused with locally advanced breast cancer, which is breast cancer that has spread to nearby tissues or lymph nodes but not to other parts of the body.
Looking For More Of An Introduction
If you would like more of an introduction, explore these related items. Please note that these links will take you to other sections on Cancer.Net:
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ASCO AnswersFact Sheet: Read a 1-page fact sheet that offers an introduction to metastatic breast cancer. This free fact sheet is available as a PDF, so it is easy to print.
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ASCO AnswersGuide:Get this free 52-page booklet that helps you better understand breast cancer and its treatment options. The booklet is available as a PDF, so it is easy to print.
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What To Know About Metastatic Breast Cancer Or Breast Cancer Thats Spread Elsewhere In Your Body
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Breast cancer thats metastasized has spread to the bones, brain, lungs, or other parts of the body.
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Symptoms can depend on where the cancer is in your body, but pain, weakness, and fatigue are common.
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Treatments include hormone and radiation therapy, chemotherapy, and palliative, or supportive, care.
Metastatic, or stage IV, breast cancer is an advanced stage of breast cancer.
It involves cancer that has spread away from the initial site of the breast to other parts of the body. About 30% of people with breast cancer develop metastatic breast cancer.
While metastatic breast cancer is a serious form of advanced cancer, treatment can still help improve survival odds.