Stage Iv Triple Positive Breast Cancer

Faith In The El Camino Health Cancer Care Team

Through it all, Carol drew strength from knowing she had an entire team in her corner fighting her cancer. In fact, she says she cant begin to describe how much she has grown to love everyone at the El Camino Health Cancer Center.

The whole team is amazing, she says. Dr. Dormady and nurse practitioner Katie are the best! They put up with my questions and quirks with the best humor and love. They understood my desire to be treated but not overtreated.

The nurses are like family. I have to give a shoutout to my nurse Hannah. We shared our lives together every week for a whole year. That was the biggest blessing ever. I still drop by with treats when Im in the area as an excuse to say hi.

Regional Recurrence Within Three Years Carries A Less Favorable Prognosis But Overall Survival Statistics Are Still Good

Generally speaking, if the breast cancer returns regionally lymph nodes) within the first five years following original treatment, the overall likelihood of survival is thought to be somewhat poorer.

Five-year overall survival after an isolated chest wall recurrence is 68% and after intra-breast recurrence it is 81%.

In one 2010 medical research study, the ten year overall survival rate was estimated at 84% for women without recurrence. However, this figure goes down to 49% for women with a locoregional recurrence and 72% for women with a second primary tumour.

A large 2015 study examined the impact of the time of the disease free interval on survival rates. For women with a locoregional recurrence that happened in the first 18 months, the ten year overall survival rate is around 30%. The overall 10 year survival rate for those whose recurrence happened within 3 years goes up to 50%. Furthermore, for those who suffered a recurrence after 3 years the ten year overall survival rate increases to 70%.

This recent study clearly demonstrates that the longer the time span since the primary prognosis and treatment to the recurrence, the better the long-term prognosis.

The rate of distance breast cancer metastasis and overall survival is most favorable for women in which the recurrence occurred locally and after five years.

However, women with a same-breast recurrence within five years have a distant metastasis rate of about 61%, which are slightly poorer odds.

Relative Survival Rates For Breast Cancer

The National Cancer Institute gives 5-year relative survival rates for breast cancer based on how far the disease had spread before a doctor found it.

• Localized : 99%
• Unknown stage: 55%
• All stages: 90%

While these numbers can give you a general idea, they are an average for women with any type of breast cancer. They arent specific to the HER2+ type. They also come from data that researchers collected from 2010 to 2016, so they dont reflect more recent treatment advances.

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Treatment Of Stage Iv Breast Cancer

Stage IV cancers have spread beyond the breast and nearby lymph nodes to other parts of the body. When breast cancer spreads, it most commonly goes to the bones, liver, and lungs. It may also spread to the brain or other organs.

For women with stage IV breast cancer, systemic drug therapies are the main treatments. These may include:

• Some combination of these

Surgery and/or radiation therapy may be useful in certain situations .

Treatment can often shrink tumors , improve symptoms, and help some women live longer. These cancers are considered incurable.

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.

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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.

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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Carol: My Year Of Treatment For Triple Positive Breast Cancer

In the third trimester of her first pregnancy, Carol was scratching at the pregnancy rash covering her body when she felt a lump in her breast. At her biweekly checkup, she brought it to the attention of her El Camino Health obstetrician Dr. Maureen Khoo, who immediately ordered an ultrasound. A biopsy confirmed triple-positive breast cancer.

“I was so stunned and shocked,” says Carol, who remembers the first part of her cancer journey as a crazy time. “They induced my baby at 39 weeks so we could start treatment. The day I checked out of the hospital after giving birth, I checked back in to finish my scans.”

Carol was grateful that the El Camino Health scheduling staff took charge of the details, shepherding her along to each of her appointments. When it was time to talk about treatment options, she met with top oncologist Dr. Shane Dormady.

What Does Triple Negative Mean In Terms Of Breast Cancer

Normal breast cells have receptors that respond to hormones such as estrogen and progesterone, which allows them to grow and regress in response to the hormone level. Hormone receptors may or may not be present in breast cancer. About two-thirds of breast cancers are positive and contain these receptors like normal breast cells do. These are less aggressive cancers that are less likely to need chemo and are often treated with hormone therapy and surgery. Radiation may or may not be needed.

HER2/neu , is a protein molecule that has a role in cell proliferation in normal cells. In some breast cancers, this protein is overly produced or positive. For HER2-positive tumors, there a specific medication that targets this protein.

Triple-negative breast cancers are not positive for estrogen receptors, progesterone receptors or HER2 protein. Since these targets are absent in triple-negative breast cancer, chemotherapy is needed, Sun says. Triple-negative breast cancer is often very sensitive to chemotherapy, which, despite the side effects, is an effective treatment that can save lives. Because this is an aggressive cancer, treatment is aggressive also. But there are several ways we can address it.

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The Biology Of The Tumor

Many tests will be done on a sample of the metastatic tumor . The results of these tests give information on the biology of the tumor that help guide treatment.

The NCCN has an animated video on these tumor tests.

Understanding Breast Cancer Metastasis

Metastasis is a complex process in which malignantcancer cells from the breast spread into other regions of the body. Once metastasis has occurred, it is much more difficult to effectively treat breast cancer.

If breast cancer has metastasized to other areas of the body, it is termed a Stage IV breast cancer. Sometimes metastasis has occurred at the time the original breast cancer is diagnosed.

However, in other cases, the metastasis of breast cancer is found months or even years after the initial treatment. This would be termed a recurrent breast cancer.

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Can Metastatic Breast Cancer Be Cured

There is no cure for metastatic breast cancer. Once the cancer cells have spread to another distant area of the body, its impossible to get rid of them all. However, the right treatment plan can help extend your life and improve its quality.

Metastatic breast cancer treatment aims to shrink tumors, slow their growth and improve your symptoms.

What Is The Survival Outlook For Breast Cancer

According to the National Cancer Institute , the percentage of patients surviving five years after diagnosis is:

• 99 percent for breast cancer that is still local to the breast
• 86 percent for breast cancer that has spread just outside the breast
• 29 percent for breast cancer that has spread to more distant parts of the body

The NCI also lists the five-year survival rate for breast cancer overall as 90.6 percent for women and 83 percent for men.

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Triple Negative Breast Cancer Facts

1. Hormone treatments is not possible with this type of breast cancer.2. This is a much rarer type of breast cancer that affects a higher rate of Hispanics, African Americans, younger people and people that have a BRACA 1 gene mutation.3. Approximately 80% of BRACA 1 gene mutation tumors are triple negative.4. There is a strong correlation between an autosomal inheritance pattern and TNBC but most studies fall short of calling it a causal relationship.5. This cancer is harder to treat, is more likely to recur in the first five years after treatment and can be more aggressive BUT all of the factors including successful treatment largely depend on the stage in which the cancer is identified and the grade of the tumor.6. TNBC has a higher recurrence rate in the first five years after remission while other cancers like estrogen receptor positive cancers have much lower rates of recurrence during the first five years of remission.7. While TNBC recurs at a higher rate in the first five years once the five year mark passes with each additional year of survival the odds of recurrence is drastically reduced.8. After 5 years the chance of recurrence of TNBC is reduced by 50%.9. With each year after the 5 year mark the chance of recurrence is reduced by an additional 10%-15%.10. Long term survivors have almost a 0% rate that the disease will recur. With other breast cancers the recurrence rate climbs after the first 5 years.

Tumour Reviewtriple Positive Breast Cancer: A Distinct Subtype

HER-2, ER and PgR have a key role in treatment decision making in breast cancer.

Triple positive tumours exhibit a unique clinical and biological behavior.

TP breast cancer behavior might be also driven by HR status.

TP tumors with low disease burden and high HR expression resemble luminal tumours.

The identification and characterization of this subset may avoid overtreatment.

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Examples Using The Full Staging System

Because there are so many factors that go into stage grouping for breast cancer, it’s not possible to describe here every combination that might be included in each stage. The many different possible combinations mean that two women who have the same stage of breast cancer might have different factors that make up their stage.

Here are 3 examples of how all of the factors listed above are used to determine the pathologic breast cancer stage:

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.

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Cancer Alters Your Life And It Never Really Leaves You

For those beginning their cancer journey, Carol has two bits of advice. Definitely dont put off getting anything suspicious checked. She doubts she would have found the cancer early if she werent seeing Dr. Khoo regularly. Lastly, know that cancer never leaves you. Post-cancer PTSD and anxiety is real, even after treatment ends, and thats OK.

Because El Camino Health knows that the emotional toll may continue long after cancer treatment ends, theyve developed the Survivorship Program to support patients like Carol who may have questions or fears about whats happening with their mind, body or emotions.

Now at age 33, Carols life is basically back to normal, although she still struggles with the possibility that she may not be able to have more children through natural means.

As much as cancer sucked, states Carol, I truly appreciate the many new perspectives it gave me: A glimpse of the lives of the doctors and nurses providing care. The depths of empathy of everyone on a cancer journey. And it forced me to jump off the never-ending achievement treadmill with no regrets. Life is such a gift!

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The Tnm Staging System

The breast cancer staging system, called the TNM system, is overseen by the American Joint Committee on Cancer . The AJCC is a group of cancer experts who oversee how cancer is classified and communicated. This is to ensure that all doctors and treatment facilities are describing cancer in a uniform way so that the treatment results of all people can be compared and understood.

In the past, stage number was calculated based on just three clinical characteristics, T, N, and M.

The T category describes the original tumor:

• HER2 status: are the cancer cells making too much of the HER2 protein?

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  Oncotype DX score, if the cancer is estrogen-receptor-positive, HER2-negative, and there is no cancer in the lymph nodes

Adding information about tumor grade, hormone-receptor status, HER2 status, and possibly Oncotype DX test results has made determining the stage of a breast cancer more complex, but also more accurate.

In general, according to experts, the new staging system classifies triple-negative breast cancer at a higher stage and classifies most hormone receptor-positive breast cancer at a lower stage.

You also may see or hear certain words used to describe the stage of the breast cancer:

• Distant: The cancer is found in other parts of the body as well.

The updated AJCC breast cancer staging guidelines have made determining the stage of a cancer a more complicated but accurate process. So, the characteristics of each stage below are somewhat generalized.

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