When Metastatic Cancer Can No Longer Be Controlled
If you have been told your cancer can no longer be controlled, you and your loved ones may want to discuss end-of-life care. Whether or not you choose to continue treatment to shrink the cancer or control its growth, you can always receive palliative care to control the symptoms of cancer and the side effects of treatment. Information on coping with and planning for end-of-life care is available in the Advanced Cancer section of this site.
What Is Cancer Staging
Staging is a way of describing how extensive the breast cancer is, including the size of the tumor, whether it has spread to lymph nodes, whether it has spread to distant parts of the body, and what its biomarkers are.
Staging can be done either before or after a patient undergoes surgery. Staging done before surgery is called the clinical stage, and staging done after surgery is called the pathologic stage. Doctors use diagnostic tests to find out the cancer’s stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor recommend the best kind of treatment and can help predict a patient’s prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.
This page provides detailed information about the system used to find the stage of breast cancer and the stage groups for breast cancer, such as stage IIA or stage IV.
Surviving Stage 4 Breast Cancer: Is It Possible
Understanding survival rates of stage 4 breast cancer
According to the National Cancer Institute , an estimated 27 percent of people in the United States live at least 5 years after being diagnosed with stage 4 breast cancer.
Many factors can affect your longevity and quality of life. Different subtypes of breast cancer behave differently. Some are more aggressive than others, and some have far fewer treatment options than others. For this reason, your subtype may affect your outlook.
Higher survival rates are also associated with the extent and location of metastasis. In other words, your long-term outlook may be better if your cancer has only spread to your bones than if its found in your bones and lungs.
Immediately seeking treatment, like chemotherapy, surgery, or hormone therapy, can help improve your outlook. Making healthy lifestyle choices might also improve your chances of survival.
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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.
Poor Appetite And Weight Loss
Sometimes people with secondary breast cancer cant eat as much as usual. This means they have difficulty maintaining their weight as well as providing the body with energy. Low energy levels can affect mobility and might make it harder to manage any symptoms such as breathlessness.
Poor appetite can be due to the effects of the cancer, treatment or anxiety. A small number of people may have difficulty swallowing.
You might find it easier to eat little and often instead of having set meals. If you still feel you arent eating enough, are losing weight or have no interest in food, talk to your doctor or specialist nurse about dietary supplements or ask to speak to a dietitian for specialist advice.
In some circumstances you may be prescribed medication to help stimulate your appetite.
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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.
Andrew And Traceys Story
All the statistics only talk about the number of women affected what they dont mention is the effect on the people that love them parents, children, siblings, extended family, friends. My wife, Tracey, was diagnosed with breast cancer in late 2010 and was told it had spread to her liver and lung in 2012. Firstly, theres the pain that you have to watch your partner go through the ongoing pain from metastasis the spread of the cancer from her breasts to her spine, ribs, liver and lung. Secondly theres the fear. Fear of losing her sooner rather than later and being alone. Andrew, Husband of Tracey, diagnosed 2010.
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How Is Lymph Node Staging Based On Breast Cancer
Lymph node staging for breast cancer is based on how the nodes look under the microscope, and has changed as technology has improved. Newer methods have made it possible to find smaller and smaller collections of cancer cells, but experts havent been sure how much these tiny deposits of cancer cells affect outlook.
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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N Categories For Breast Cancer
N followed by a number from 0 to 3 indicates whether the cancer has spread to lymph nodes near the breast and, if so, how many lymph nodes are involved.
Lymph node staging for breast cancer is based on how the nodes look under the microscope, and has changed as technology has gotten better. Newer methods have made it possible to find smaller and smaller groups of cancer cells, but experts havent been sure how much these tiny deposits of cancer cells influence outlook.
Its not yet clear how much cancer in the lymph node is needed to see a change in outlook or treatment. This is still being studied, but for now, a deposit of cancer cells must contain at least 200 cells or be at least 0.2 mm across for it to change the N stage. An area of cancer spread that is smaller than 0.2 mm doesnt change the stage, but is recorded with abbreviations that indicate the type of special test used to find the spread.
If the area of cancer spread is at least 0.2 mm , but still not larger than 2 mm, it is called a micrometastasis . Micrometastases are counted only if there arent any larger areas of cancer spread. Areas of cancer spread larger than 2 mm are known to influence outlook and do change the N stage. These larger areas are sometimes called macrometastases, but are more often just called metastases.
NX: Nearby lymph nodes cannot be assessed .
N0: Cancer has not spread to nearby lymph nodes.
N1c: Both N1a and N1b apply.
N3: Any of the following:
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.
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The Risk Of Metastatic Breast Cancer
The risk of metastasis after breast cancer treatment varies from person to person. It depends on:
- The biology of the tumor
- The stage at the time of the original diagnosis
- The treatments for the original cancer
Modern treatments continue to improve survival for people with metastatic breast cancer. However, survival varies greatly from person to person.
About one-third of women diagnosed with metastatic breast cancer in the U.S. live at least 5 years after diagnosis . Some women may live 10 or more years beyond diagnosis .
Your oncologist can give you some information about your prognosis, but they dont know exactly how long you will live.
What Is The Risk Of Breast Cancer Spreading To The Brain
Brain metastasis. The risk of breast cancer spreading to the brain is generally highest in those with HER2-positive or triple-negative breast cancer, which are more aggressive subtypes of this disease. About 1015 percent of women with stage 4 breast cancer will develop brain metastasis. Symptoms include: a headache.
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A Second Cancer Diagnosis
As a survivor, Chelle knew there is always a risk of breast cancer coming back. In 2017, she received the bad news. Despite years of remission and the removal of so many lymph nodes, there was a mass in the remaining axillary lymph nodes under her arm.
I said, Ive had enough chemo and enough radiation, Chelle said. I just didnt want anymore.
Instead, her oncologist prescribed a targeted therapy combined with a hormone therapy for treatment. One of the medications was delivered to Chelles home and one time it got lost.
RMCC told me to just come to the office and get it there until FedEx was able to sort out the issue, Chelle said. RMCC was and is ready and willing to help in any way that they can.
Chelle remained stable until 2021, when another scan showed she had lymphoma, and it was affecting her thyroid.
Chelle was taken off the targeted therapy and did two cycles of R-CHOP chemotherapy. Then in December she ended up in the hospital with a fractured sternum.
Her doctors said she was cancer free and discontinued the R-CHOP. But thats what they said in 2006, so when they say, you know, no more cancer, in the back of my mind, I say, yeah, okay, Chelle said.
Treatment For Metastatic Cancer
There are treatments for most types of metastatic cancer. Often, the goal of treating metastatic cancer is to control it by stopping or slowing its growth. Some people can live for years with metastatic cancer that is well controlled. Other treatments may improve the quality of life by relieving symptoms. This type of care is called palliative care. It can be given at any point during treatment for cancer.
The treatment that you may have depends on your type of primary cancer, where it has spread, treatments youve had in the past, and your general health. To learn about treatment options, including clinical trials, find your type of cancer among the PDQ® Cancer Information Summaries for Adult Treatment and Pediatric Treatment.
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Its Never Too Late To Exercise
Exercise is important for your overall mental and physical health. Since fatigue is often a symptom associated with stage 4 breast cancer, it can help to plan your exercise during your most energetic time of day.
Consistency is key. Its better to exercise in small amounts every day than to follow an extreme pattern of occasional intense activity between long periods of inactivity.
While there are potential benefits to exercise when you have stage 4 cancer, its important to talk to your healthcare provider before starting an exercise program.
If your blood counts are low or your electrolyte levels are imbalanced, most healthcare providers wont recommend exercising because you could put yourself at risk for further harm.
Also, your healthcare provider may recommend avoiding public places, like gyms, because of your risk for germ exposure.
Safety is always a concern when you have stage 4 breast cancer. Bleeding and risks of injury are important considerations.
Some women experience balance and foot numbness problems due to their treatments and fatigue. If this is the case, its best to do exercises that put you at less risk for falls. An example could be riding a stationary bicycle instead of running on a treadmill.
There might not be a direct link between exercise and stage 4 breast cancer survival rates, but you can reap other benefits from regular exercise.
For example, it may help you:
- lose excess body fat
- improve your quality of life
- reduce side effects from treatment
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.
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Additional Markers For Breast Cancer Staging
Additional markers specific to breast cancer will further define your stage, which may be helpful in choosing targeted treatments to fight the cancer.
- ER: The cancer has an estrogen receptor. Estrogen is a hormone, and some cancers have receptors that respond to estrogen.
- PR: The cancer has a progesterone receptor. Progesterone is also a hormone.
- HER2: The cancer makes the protein HER2 .
- G: Grade of cancer refers to how different the cells look from normal. Grade 1 indicates that the cells look fairly normal, while grade 2 cells are growing a little faster, and grade 3 cells look markedly different than normal breast tissue.
These markers, along with the TNM measurements, define your stage.
A cancer recurrence refers to cancer that returns in the same breast, and it requires new staging. This new stage is marked by an R at the end to indicate restaging. If it develops in the other breast, its considered a new cancer.
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:
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.
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Treatment For Advanced Breast Cancer
Treatment of metastatic breast cancer aims to control the growth and spread of the cancer, to relieve symptoms, reduce pain, and improve or maintain quality of life.
The treatment recommended by doctors will depend on which treatments are likely to control the breast cancer and what side effects the person can cope with. Treatment options may involve:
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