Advanced Cancer That Progresses During Treatment
Treatment for advanced breast cancer can often shrink the cancer or slow its growth , but after a time, it tends to stop working. Further treatment options at this point depend on several factors, including previous treatments, where the cancer is located, a woman’s menopause status, general health, desire to continue getting treatment, and whether the hormone receptor status and HER2 status have changed on the cancer cells.
What Is Breast Cancer
Breast cancer originates in your breast tissue. It occurs when breast cells mutate and grow out of control, creating a mass of tissue . Like other cancers, breast cancer can invade and grow into the tissue surrounding your breast. It can also travel to other parts of your body and form new tumors. When this happens, its called metastasis.
Additional Tools For Diagnosing Advanced Breast Cancer
The additional tools below are often used specifically for diagnosing advanced cancer:
Sentinel lymph node biopsy: This procedure removes sentinel lymph node cells during surgery for examination. When breast cancer spreads, it often heads first to the lymph nodes.
Chest X-ray: This detailed image of the chest may help doctors see whether cancer has spread to the bones.
Computed tomography scan: Also known as a CAT scan, this procedure takes detailed pictures of internal areas of the body using a computer linked to an X-ray machine. A dye may be used to help the organs show up more clearly in the images.
Bone scan: This procedure looks for bone metastasis, or cancer cells that have spread to the bone. A small amount of radioactive material is injected into the blood, then detected with a scanner.
Positron emission tomography scan: A PET scan is a detailed imaging tool that uses a radioactive drug, known as a tracer, to search for cancer cells within your body.
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How Do You Treat Stage 4 Breast Cancer
- an oral chemo drug called capecitabine for 18 to 24 weeks. This might help some women live longer.
- more pembrolizumab after surgery to reduce the chances of the cancer coming back.
- the targeted drug olaparib for one year for women who have a BRCA mutation to help lower the chance of the cancer recurring.
Metastatic Or Stage 4 Breast Cancer Survival Rate
The five-year survival rate for metastatic breast cancer patients depend on how far the cancer has spread:
- Regional metastatic breast cancer: The five-year relative survival rate is 86 percent .
- Distant metastatic breast cancer: The five-year relative survival rate is 29 percent.
Breast cancer treatment: The care you need is one call away
Your multidisciplinary team will work with you to develop a personalized plan to treat your breast cancer in a way that fits your individual needs and goals.
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Can Metastatic Breast Cancer Go Into Remission
Metastatic breast cancer may never go away completely. But treatment can control its spread. Cancer may even go into remission at some points. This means you have fewer signs and symptoms of cancer.
A treatment break may be considered in certain situations, including if remission occurs or if someone is experiencing intolerable side effects. A pause in treatment can help you feel your best and improve your quality of life.
Does Breast Cancer Stop Working
Treatment for advanced breast cancer can often shrink the cancer or slow its growth , but after a time, it tends to stop working. Further treatment options at this point depend on several factors, including previous treatments, where the cancer is located, and a womans age, general health, and desire to continue getting treatment.
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How Can I Be Sure That My Cancer Will Be Detected Before It Has Spread
While you cant prevent breast cancer altogether, there are certain things you can do to reduce your risk of discovering it at an advanced stage. For example:
- Get routine mammograms. The American Cancer Society recommends having a baseline mammogram at age 35, and a screening mammogram every year after age 40.
- Examine your breasts every month after age 20. Youll become familiar with the contours and feel of your breasts and will be more alert to changes.
- Have your breasts examined by a healthcare provider at least once every three years after age 20, and every year after age 40. Clinical breast exams can detect lumps that mammograms may not find.
Treatment Options For Metastatic Breast Cancer
Treatment for metastatic breast cancer often is based on systemic therapies, which use drugs rather than surgery or radiation. Metastases treatments are designed to shrink tumors and slow their growth, help ease symptoms and improve quality of life. Treatment may change, such as when one therapy stops working, or the side effects become too uncomfortable. Rather than having only one treatment, most patients undergo several treatments combined to help fight the cancer.
The four broad categories of drug-based treatments are:
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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 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.
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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
What Is A Normal Breast
No breast is typical. What is normal for you may not be normal for another woman. Most women say their breasts feel lumpy or uneven. The way your breasts look and feel can be affected by getting your period, having children, losing or gaining weight, and taking certain medications. Breasts also tend to change as you age. For more information, see the National Cancer Institutes Breast Changes and Conditions.external icon
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What Hormones Are Used For Cancer
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 an aromatase inhibitor , along with a CDK inhibitor. If the cancer has a PIK3CA mutation and has grown while on an aromatase inhibitor, fulvestrant with alpelisib might be considered. If the cancer is no longer responding to any hormone drugs, chemotherapy is usually the next step.
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.
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Treatments For Stage 4 Breast Cancer
The following are treatment options for ductal carcinoma and lobular carcinoma. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.
Stage 4 means that the breast cancer has spread to other parts of the body. It is also called advanced breast cancer, or metastatic breast cancer. Treatments cannot completely cure metastatic breast cancer, but they can control it very well, sometimes for many years. Doctors may offer one treatment until it stops working and then give another one.
The treatments offered for stage 4 breast cancer depend on the hormone-receptor status and the HER2 status of the cancer cells. They will also depend on where the cancer has spread, if it is causing any symptoms and your overall health.
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.
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What Are The Risk Factors
Several factors can increase a mans chance of getting breast cancer. Having risk factors does not mean you will get breast cancer.
- Getting older. The risk for breast cancer increases with age. Most breast cancers are found after age 50.
- Genetic mutations. Inherited changes in certain genes, such as BRCA1 and BRCA2, increase breast cancer risk.
- Family history of breast cancer. A mans risk for breast cancer is higher if a close family member has had breast cancer.
- Radiation therapy treatment. Men who had radiation therapy to the chest have a higher risk of getting breast cancer.
- Hormone therapy treatment. Drugs containing estrogen , which were used to treat prostate cancer in the past, increase mens breast cancer risk.
- Klinefelter syndrome.Klinefelter syndrome is a rare genetic condition in which a male has an extra X chromosome. This can lead to the body making higher levels of estrogen and lower levels of androgens .
- Certain conditions that affect the testicles. Injury to, swelling in, or surgery to remove the testicles can increase breast cancer risk.
- Liver disease. Cirrhosis of the liver can lower androgen levels and raise estrogen levels in men, increasing the risk of breast cancer.
- Overweight and obesity. Older men who are overweight or have obesity have a higher risk of getting breast cancer than men at a normal weight.
The Role Of Caregivers
Caregivers also play a vital role in helping a person with cancer be as comfortable as possible. To help, a caregiver can:
According to the American Society for Clinical Oncology, in 2018, doctors will diagnose invasive breast cancer in an estimated 268,670 people in the United States.
The ACS state that the 5-year relative survival rate for people with metastatic breast cancer is around 22 percent. This means that people with metastatic breast cancer are 22 percent as likely as people without the condition to live at least 5 years following diagnosis.
However, many factors can affect how long a person with metastatic breast cancer lives for, including:
- the type of breast cancer
- the stage of breast cancer
- where the cancer has spread to
- how well the cancer responds to treatment
- any other health issues that the person has
Everyoneâs outlook is different. It is also important to note that survivals rates are just estimates, and that doctors base these figures on data from at least 5 years ago. Continuing advancements in cancer treatments means that survival rates are improving.
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Stomach Upset Loss Of Appetite And Weight Loss
Cancer can cause nausea, vomiting, diarrhea, and constipation. Anxiety and lack of sleep can also upset the digestive system.
It can be more difficult to eat a healthy diet as these symptoms occur, setting up a vicious cycle. As women avoid certain foods because of stomach upset, the digestive system may lack the fiber and nutrients it needs to function optimally.
Over time, women may lose their appetite and have difficulty taking in the calories they need. Not eating regularly may cause significant weight loss and nutritional imbalances.
What Does Stage 4 Mean
If a person has stage 4 breast cancer, this means that the cancer cells have spread to other organs in their body, such as the lungs, lymph nodes, bones, skin, liver, or brain. Cancer stages range from 1 to 4 and indicate the extent of the disease. A doctor may also refer to stage 4 as advanced or metastatic breast cancer.
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How Is The Stage Determined
The staging system most often used for breast cancer is the American Joint Committee on Cancer TNM system. The most recent AJCC system, effective January 2018, has both clinical and pathologic staging systems for breast cancer:
- The pathologic stage is determined by examining tissue removed during an operation.
- Sometimes, if surgery is not possible right away or at all, the cancer will be given a clinical stage instead. This is based on the results of a physical exam, biopsy, and imaging tests. The clinical stage is used to help plan treatment. Sometimes, though, the cancer has spread further than the clinical stage estimates, and may not predict the patients outlook as accurately as a pathologic stage.
In both staging systems, 7 key pieces of information are used:
- The extent of the tumor : How large is the cancer? Has it grown into nearby areas?
- The spread to nearby lymph nodes : Has the cancer spread to nearby lymph nodes? If so, how many?
- The spread to distant sites : Has the cancer spread to distant organs such as the lungs or liver?
- Estrogen Receptor status: Does the cancer have the protein called an estrogen receptor?
- Progesterone Receptor status: Does the cancer have the protein called a progesterone receptor?
- HER2 status: Does the cancer make too much of a protein called HER2?
- Grade of the cancer : How much do the cancer cells look like normal cells?
In addition, Oncotype Dx® Recurrence Score results may also be considered in the stage in certain situations.
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.
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How Long Do You Live With Stage 4 Breast Cancer
The 5-year relative survival rate for stage 4 breast cancer is 22 percent, which means that 22 percent of people will live for at least 5 years after diagnosis. However, many factors influence survival rates, including: the subtype of breast cancer. how fast the tumor is growing. how likely the cancer is to come back.
What Is Metastatic Breast Cancer
Metastatic breast cancer is the most advanced stage of breast cancer. Breast cancer develops when abnormal cells in the breast start to divide uncontrollably. A tumor is a mass or collection of these abnormal cells.
Metastasis refers to cancer cells that have spread to a new area of the body. In metastatic breast cancer, cells may spread to the:
Healthcare providers name cancer based on its primary origin. That means breast cancer that spreads to other body parts is still considered breast cancer. The cancer cells are still breast cancer cells. Your care team will use breast cancer therapies, even if the cancer cells are in other areas.
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