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.
Whats The Outlook For Metastatic Breast Cancer
The right treatment plan can improve survival for people with metastatic breast cancer. However, survival rates vary and are dependent on a number of factors including type/biology of the breast cancer, parts of the body involved and individual characteristics. About 1 in 3 women live at least five years after diagnosis. Some live 10 years or longer. Your care team will discuss your prognosis with you in more detail.
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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What Is Stage 4 Breast Cancer
What is stage 4 breast cancer? Also referred to as stage iv breast cancer, is considered stage 4 once it has spread beyond the breast tissue and nearby lymph nodes to other organs or parts of the body. In most cases, breast cancer will spread to the bones, lungs, or liver. Not as often, but in some cases, breast cancer can also spread to other organs such as the brain.
A stage 4 breast cancer diagnosis is confirmed by examining factors of the American Joint Committee on Cancer TNM system, which includes:
- Size of the tumor
Take the breast cancer quiz to learn more about stage 4 breast cancer.
How Is Metastatic Breast Cancer Treated
The main treatment for metastatic breast cancer is systemic therapy. These therapies treat the entire body. Systemic treatments may include a combination of:
Your care team will plan your treatment based on:
- Body parts cancer has reached.
- Past breast cancer treatments.
- Tumor biology, or how the cancer cells look and behave.
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What Is Breast Cancer Staging
Breast cancer staging is the determination of the extent and spread of the cancer. An individual’s health care team uses stages to summarize the extent of the cancer in a standardized way that is recognized by all health care providers. They use this staging to determine the treatment most appropriate for the type of cancer. Cancer staging helps to determine the prognosis, or outlook, of a cancer, including rates of recurrence and survival rates.
Hormone Receptor Status Can Influence Survival Rates
When a breast cancer tumor is sent for histological analysis, one of the characteristics of the report will be the hormone receptor status of the tumor.
Estrogen receptor and progesterone receptor positive tumors tend to respond better to chemotherapy. Chemotherapy tends to be the treatment of choice for stage III and IV breast cancers.
Breast cancers which are triple negative tend to have the least favourable survival rates, regardless of breast cancer stage.
One 2011 research study looked at 269 triple-negative breast cancer patients all treated at the same institution between 2000 and 2006.
This study found that the average age at diagnosis was 55.3 years. The 5 year disease-free survival rate for the whole group was 68.2%. However, the 5 year overall survival rate for the entire group was higher at 74.5%.
Risk of recurrence was higher in the first 3 years following the initial diagnosis. However, the recurrence rate declined significantly after this initial 3 year period.
Other factors that were found to be important factors on survival rates were:-
- Lymph node status
- Lymphovascular invasion
- Age: Ladies older than 65 years had a poorer prognosis
However, ER and PR status tends to have more of an influence on survival than HER2 status. Patients with ER+/PR+/HER2- subtype of breast cancer have an estimated 5-year survival rate of 87.8%.
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How To Prevent Breast Cancer
There is no guaranteed way to prevent breast cancer. Reviewing the risk factors and modifying the ones that can be altered can help in decreasing the risk.
Following the American Cancer Society’s guidelines for early detection can help early detection and treatment.
There are some subgroups of women that should consider additional preventive measures.
- Women with a strong family history of breast cancer need genetic testing such as HER2-Positive and BRCA Gene tests. Discuss this with a health care provider and meet with a genetic counselor who can explain what the testing can and cannot tell and then help interpret the results after testing.
- Chemoprevention is the use of medications to reduce the risk of cancer. The two currently approved drugs for chemoprevention of breast cancer are tamoxifen and raloxifene , which also blocks the effect of estrogen on breast tissues. Their side effects and whether these medications are right for an individual need to be discussed with a health care provider.
- Aromatase inhibitors are medications that block the production of small amounts of estrogen usually produced in postmenopausal women. They prevent reoccurrence of breast cancer but are not approved at this time for breast cancer chemoprevention.
- For a small group of patients who have a very high risk of breast cancer, surgery to remove the breasts may be an option. Although this reduces the risk significantly, a small chance of developing cancer remains.
Breast Cancer Survival Rate
Breast cancer or breast cancer survival rate is categorized in several stages, depending on the severity of the cancer cell growth.
- Stage 0, at this stage, the cancer cells have not attacked healthy cells, and the survival rate is 100%.
- Stage I, the survival rate at this stage is also high at 100%.
- Stage II, in this stage, the cancer cells have spread to 3 or 4 lymph nodes, and the survival rate is about 93%.
- Stage III, in this stage, the tumor is larger, and the cancer cells have spread to 9 or more lymph nodes, the chances for survival at this stage are 72%.
- Stage IV, in this stage the cancer is invasive and has spread to other parts of the body, the survival rate at this stage is lower at about 22%
Remember, these numbers are estimates, and individual responses to cancer are different.
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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. “The higher the stage, the more likely the cancer is to come back.”
What Exactly Is Stage 4 Breast Cancer
In the simplest terms, 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, according to the American Cancer Society .
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, tells Health. The more common sites of spread include the bone, lung, liver and brain. It’s important to note, however, that when breast cancer spreads to another area of the body, like the bones or lungs, it does not become bone or lung cancerit’s still breast cancer, according to the National Cancer Institute .
Stage 4 breast cancer is an uncommon initial diagnosistechnically called de novo metastatic breast cancer, it’s only found in 6 percent of all breast cancer diagnoses. 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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How Is Stage 4 Breast Cancer Treatedand What’s The Survival Rate
While every stage 4 breast cancer diagnosis is differentwhich means the methods used to treat it will also differthis stage of breast cancer is usually treated systemically , since the cancer has already spread to other areas of the body. Systemic treatments usually include options like hormone therapy, chemotherapy, targeted therapy, and immunotherapy, according to the NCI.
Still, those treatments vary depending on a variety of factors, including where the cancer is located, as well as the patient’s symptoms, overall health, and previous cancer treatmentsand patients are closely monitored throughout treatment for the best outcome. Patients are generally started on the treatment of best reflex or biology and followed closely using scans, with change in treatments as needed if the current treatment is not resulting and either shrinkage or stability of the breast cancer, Dr. Tripathy explains.
In addition to more standard systemic treatment options, Dr. Tripathy explains that there are newer technologies being increasingly usedlike ones that sequence the DNA of cancerous tumor cells for more specified treatmentsas well as various clinical trials designed to offer more options and possibly better outcomes to those dealing with the disease.
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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What Doesn’t Affect Survival
Just as there are factors associated with a better or worse prognosis, there are some factors that do not appear to make a big difference. These are generally less understood by the general public:
- Aggressiveness of treatment
- Having a positive attitude
The goal of treatment for metastatic breast cancer is often very different than that of early-stage disease, and this can raise anxiety among patients and loved ones of patients. With early-stage breast cancer, the goal is usually to be aggressive in order to reduce the risk that the cancer will come back.
In contrast, with stage 4 disease, the goal is usually to use the minimum amount of treatment possible to control the disease . Studies have found that more aggressive treatment does not improve survival rates but does reduce quality of life.
While having a good attitude may improve your sense of well-being, it has not been shown to affect survival rates. In fact, holding in negative emotions in order to appear positive may be detrimental to your health in general.
For Family And Friends
Caring for a loved one with stage 4 breast cancer has special challenges as well. Fortunately, organizations such as CancerCare now offer support groups design for loved ones who are caring for someone with cancer. In addition to caring for yourself , it’s helpful to learn about metastatic breast cancer.
Common things that people learn about cancer usually refer to an early-stage disease, and myths about metastatic breast cancer can be painful for those living with advanced disease. For example, one of the things not to say to someone with metastatic breast cancer is, “When will you be done with treatment?”
For the most part, people with metastatic breast cancer will require some type of treatment for the rest of their lives.
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Discussion On The Figures And Bar Graphs
As we can see outlook for breast cancer according to stage has improved immensely since these statistics first started appearing on the internet.
The estimated 5 year survival rates from Dr. Halls early data for Stage I was only 85%. By 2002 this figure has risen to 88% and for 2012 almost a 100% survival rate.
For Stage II the outlook is also much improved. From the 2002 data the survival rate was between 74% and 81%. Again by the latest data the relative percentage survival rate is 93%.
Furthermore Stage III in 2002 had a percentage survival rate of 41% to 49%. However, the 2012 data shows that this percentage has risen to 72%
Sadly, the survival percentage for stage IV breast cancer remains fairly low. 15% 5-year survival rate in 2002 to 22% 5-year relative survival rate in 2012.
NOTE: Just a word of caution on statistics. The first two graphs are percentage survival rates. So, if the figure is, for example, 93% for Stage II breast cancer, this means that 93 out of 100 patients with a Stage II diagnosis will be alive 5 years later.
On the other hand, relative survival rates in the lower table, compares breast cancer sufferers with the general population. So, if the relative survival rate for Stage II breast cancer is 93% this means that people with that diagnosis are 93% as likely to be alive 5 years later as the general population with similar life factors.
What Is A 5
A relative survival rate compares women with the same type and stage of breast cancer to women in the overall population.For example, if the 5-year relative survival rate for a specific stage of breast cancer is 90%, it means that women who have that cancer are, on average, about 90% as likely as women who dont have that cancer to live for at least 5 years after being diagnosed.
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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.
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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Stage I Breast Cancer
In Stage I, the cancer cells have spread to surrounding breast tissue, but they are still contained in a small area. Stage I is divided into stages IA and IB.
In stage IA:
- The tumor measures up to 20 millimeters .
- Cancer has not spread to the lymph nodes.
In stage IB:
- No tumor or a small tumor is in the breast.
- Small clusters of cancer cells are in the lymph nodes.
Many people with stage I cancer have no symptoms, but some women feel a mass, Henry says. “For most women, it’s found on mammogram,” she says.
The five-year survival rate is 98% to 100% for stage I. Because cancer caught at this stage has a high survival rate, this underscores the importance of getting mammograms, Bryce says. And a sizable number of women do not.
In 2018, an estimated 63% of US women 45 and older were up to date with breast cancer screening, according to a 2021 American Cancer Society report.