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.
Stage Iv Breast Cancer
Stage IV, also called metastatic, is the most advanced stage of breast cancer. In this stage, the cancer has spread to nearby lymph nodes and to other parts of the body, such as the lungs, liver, brain, or bones.
If the cancer has spread to the bone, patients may have bone pain or back pain, and if it has spread to the liver, patients may have pain on the right side of their abdomen, Bryce says. Some of the changes in the skin and nipple listed earlier under stage II may also occur in stage IV.
When the cancer has spread to other, distant parts of the body, the five-year survival rate is 28%. With the treatments that we have available to us today, most patients, unfortunately, are not cured of their cancer if it is stage IV, Henry says. But, she adds, We can still treat, we can still manage, we can still help people feel good for as long as possible.
Also, many new treatments are emerging. People are living longer even with stage IV disease, Bryce says. A 2018 study found that the effectiveness of breast cancer treatment on survival increased substantially from 1975 to 2015.
You May Not Know Im Sick By Looking At Me
I may look perfectly healthy, but Im sick, says Silberman. Treatment is hard. I sleep a lot. I still travel, but its difficult. I just visited a friend in Utah for four days, and it wore me out for two weeks.
Just because someone doesnt look like she has advanced-stage cancer, she can be very sick. It can be an invisible illness, says Silberman. You tell somebody you have cancer, but if you have hair, sometimes they dont believe you.
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.
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.
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Other Information About Staging
Along with the numerical stages, breast cancer is classified using the American Joint Committee on Cancer TNM system, which takes into account:
- The size of the tumor ,
- Spread to nearby lymph nodes ,
- Spread or metastasis to distant sites ,
- Estrogen receptor status,
- Status called Her2 protein ,
- The grade of the cancer , or how much the cells look like normal cells
The grade for breast cancer is how aggressive it looks under the microscope, Henry says. The grade is also assigned a number, with one being the least aggressive and three being the most. Since both the stage and grade are numbered systems, patients sometimes confuse the two, she says.
When meeting with a breast cancer patient, Henry says she talks about the stage, the grade, and other factors to advise the best form of 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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Stage Iii Breast Cancer
In stage III, the cancer has spread farther in the breast, or the tumor is larger. This stage includes three subcategories:
Stage IIIA involves one of the following:
- Cancer is found in four to nine nearby lymph nodes, with or without a tumor in the breast.
- A breast tumor is larger than 50 mm, and the cancer has spread to between one and three nearby lymph nodes.
In stage IIIB, the tumor has spread to the chest wall behind the breast, and:
- Cancer may have spread to the skin, causing swelling or inflammation.
- Cancer may have broken through the skin, causing a wound.
- Cancer may have spread to as many as nine lymph nodes under the arm or nodes near the breastbone.
In stage IIIC, with or without a tumor in the breast, the cancer has spread to one of the following places:
- Ten or more underarm lymph nodes
- Lymph nodes near the collarbone
- Some underarm lymph nodes and lymph nodes near the breastbone
- The skin of the breast
In stage III, the patient may experience similar symptoms as stage II, listed earlier. The five-year survival rate for stage III breast cancer is 66% to 98%.
Note: For stages 0 to III, the goal is to cure the cancer and to keep it from coming back, Henry says. âThe higher the stage, the more likely the cancer is to come back.â
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.
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Treatment For Stage Iv Breast Cancer
Systemic treatments, such as chemotherapy, hormonal therapy, and targeted therapies are commonly used to treat stage IV breast cancer. The cancers characteristics determine which of these treatments makes the most sense.
Nearly all stage IV breast cancer is treated with some type of chemotherapy. If the cancer is hormone-receptor-positive, it almost always is treated with hormonal therapy. As the name implies, targeted therapies target specific characteristics of cancer cells, such as the HER2 protein that tells cancer cells to grow in a rapid or an abnormal way. So cancer that is HER2-positive is almost always treated with an anti-HER2 targeted therapy.
Previous studies have looked at whether adding surgery to the treatment plan for stage IV disease can improve outcomes. Still, the results have been mixed.
The researchers who did this study wanted to see if adding surgery to systemic treatments would improve survival for women diagnosed with specific types of stage IV breast cancer.
Diagnosis Of Stage 4 Breast Cancer
If you are diagnosed with breast cancer, you may have further tests to determine the extent that the cancer has spread throughout the body. This is called staging. It helps you and your doctors decide on the best treatment options for you.
In addition the numbered staging system, the TNM staging system is also commonly used for breast cancer staging.
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Coping With Advanced Breast Cancer
Being told that you have advanced or metastatic breast cancer may be very confronting or overwhelming. Some women also find the news that their cancer has spread or come back is more devastating than their original diagnosis.
There are many resources available online to help you further understand the meaning of your diagnosis and how to manage the emotional, physical and practical issues arising from metastatic breast cancer. Below are some links where these resources can be accessed:
Connecting and speaking with others who have gone through a similar experience can also be helpful. Cancer Council runs support groups all across Australia which can provide support and information for people with cancer and their families. Groups in each state can be accessed here:
Although support groups can provide a safe place for people to express their feelings amongst others who share a similar experience, some people are more comfortable talking one-on-one, such as with a counsellor, therapist or trained volunteer . Your GP can also refer you to a psychologist, social worker or other trained therapist. Every person is different and it is important to find a healthy support system that works for you.
Stage 4 Breast Cancer Explained
According to the American Cancer Society , a stage 4 breast cancer diagnosiswhich is often referred to as metastatic breast cancer or terminal breast canceris the disease in its most serious and life-threatening form.
“Stage 4 breast cancer refers to the spread of breast cancer beyond the area of the breast and surrounding lymph nodes,” Debu Tripathy, MD, professor, and chairman of the Department of Breast Medical Oncology, at the University of Texas MD Anderson Cancer Center, told Health. “The more common sites of spread include the bone, lung, liver, and brain.” It’s important to note, however, that according to the NCI, when breast cancer spreads to bones or another area of the body, like the lungs, it does not become bone or lung cancerit’s still breast cancer.
Stage 4 breast cancer is an uncommon initial diagnosistechnically called de . According to a study published in BMC Cancer in October 2020, only 5-10% of patients receive metastatic breast cancer as their initial diagnosis. Instead, metastatic breast cancer often emerges months or years after someone has already completed treatment for an initial breast cancer diagnosis in an earlier stage.
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What Is The Survival Rate Of Stage 4 Breast Cancer
The stage 4 breast cancer survival rate for 5 years is 28 percent. This rate is low comparing to the survival rate of all stages, which is nearly 90 percent. Because the survival rate is considerably higher in early stages of breast cancer, early detection is extremely important. Mammograms help detect breast cancer early before the disease has spread. Breast cancer is the second most common cancer type in women, so promoting awareness for early detection can make an impact.
The median survival rate of stage 4 breast cancer is three years. This means that after 3 years, 50 percent of patients are still alive. While this rate is for all stage 4 patients, the survival rate depends on several factors. For example, those with known biomarkers have access to new targeted drugs being developed in clinical trials for breast cancer patients of all stages. These new therapies are improving the outcomes of cancer patients, including those in stage 4.
Local Or Regional Treatments For Stage Iv Breast Cancer
Although systemic drugs are the main treatment for stage IV breast cancer, local and regional treatments such as surgery, radiation therapy, or regional chemotherapy are sometimes used as well. These can help treat breast cancer in a specific part of the body, but they are very unlikely to get rid of all of the cancer. These treatments are more likely to be used to help prevent or treat symptoms or complications from the cancer.
Radiation therapy and/or surgery may also be used in certain situations, such as:
- When the breast tumor is causing an open or painful wound in the breast
- To treat a small number of metastases in a certain area, such as the brain
- To help prevent or treat bone fractures
- When a cancer is pressing on the spinal cord
- To treat a blood vessel blockage in the liver
- To provide relief of pain or other symptoms anywhere in the body
In some cases, regional chemo may be useful as well.
If your doctor recommends such local or regional treatments, it is important that you understand the goalwhether it is to try to cure the cancer or to prevent or treat symptoms.
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Clinical Trials Are A Promising Treatment Option
For people with advanced stages of cancer, clinical trials can be considered the gold standard of treatment. I recommend clinical trials highly, says Rosen. You get access to medication and treatment that you normally wouldnt have.
A clinical trial could even have positive results on your cancer. We are living in an exciting time for cancer treatment, says Kimmick. There are myriad new drugs coming out that will improve the lives of all women with breast cancer, both metastatic and early stage.
However, its important to be realistic about the potential outcome of your trial. Rosen was recently enrolled in a clinical trial in which the medication proved toxic for her. But she has no regrets about participating. It feels like Im helping researchers who are working on cures for cancer, she says. When I had a bad reaction to the drug, they were able to put my side effects in their study. I feel like I did help, and that makes me happy.
People interested in joining a clinical trial for treatment should talk to their doctor about options that might be good for them.
What Does It Mean To Have Stage 4 Breast Cancer
Stage 4 breast cancer means that the cancer has spread to other areas of the body, such as the brain, bones, lung and liver.
Although Stage 4 breast cancer is not curable, it is usually treatable and current advances in research and medical technology mean that more and more women are living longer by managing the disease as a chronic illness with a focus on quality of life as a primary goal. With excellent care and support, as well as personal motivation, Stage 4 breast cancer may respond to a number of treatment options that can extend your life for several years.
How To Handle Emotions
Coping with the many symptoms that can occur with stage 4 breast cancer can be frustrating and discouraging, and people sometimes wonder if they will have to feel poorly the rest of their lives. Anxiety and depression are also severe for some people with advanced disease.
Fortunately, palliative care team consults are now offered at many cancer centers. While hospice is a form of palliative care, palliative care can be helpful even with early, curable tumors. Working with a palliative care team to address physical and emotional issues frees you up to work with your oncologist on issues that treat your cancer specifically.
While the research is also young, it appears that those people who receive palliative care consults not only have a better quality of life with advanced cancer, but they may actually live longer, too.