Diagnosing Metastatic Breast Cancer
Getting a clear picture of where breast cancer has spread is essential for creating a personalized treatment plan. Your care team will likely use a combination of the following tests and tools to diagnose both localized and advanced breast cancer:
Ultrasound exam: With this imaging technique, sound waves create a picture of internal areas of the body.
Magnetic resonance imaging : This procedure produces detailed images using magnetic fields and radio waves.
Blood chemistry studies: A blood sample is taken to measure the amounts of certain substances that are released by your organs and tissues. A higher or lower amount of a particular substance may be a sign of disease.
Breast biopsy: A biopsy is the removal of cells or tissues so a pathologist may view them through a microscope. Your original breast cancer diagnosis was likely confirmed with a biopsy.
What Is Stage Iv Breast Cancer
Stage IV is the most advanced stage of breast cancer. It has spread to nearby lymph nodes and to distant parts of the body beyond the breast. This means it possibly involves your organs such as the lungs, liver, or brain or your bones.
Breast cancer may be stage IV when it is first diagnosed, or it can be a recurrence of a previous breast cancer that has spread.
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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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 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 Stage Iii Breast Cancer
In stage III breast cancer, the cancer has spread further into the breast or the tumor is a larger size than earlier stages. It is divided into three subcategories.
Stage IIIA is based on one of the following:
- With or without a tumor in the breast, cancer is found in four to nine nearby lymph nodes.
- A breast tumor is larger than 50 millimeters, and the cancer has spread to between one and three nearby lymph nodes.
In stage IIIB, a tumor has spread to the chest wall behind the breast. In addition, these factors contribute to assigning this stage:
- Cancer may also have spread to the skin, causing swelling or inflammation.
- It may have broken through the skin, causing an ulcerated area or wound.
- It may have spread to as many as nine underarm lymph nodes or to nodes near the breastbone.
In stage IIIC, there may be a tumor of any size in the breast, or no tumor present at all. But either way, 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
The Positive Predictive Value Typically Increases For Palpable Breast Masses
If a breast lesion on a mammogram is also clinically palpable on physical examination the medical practitioner will want to know if the tumor has liquid or solid elements.
So, in other words, medics will want to distinguish between a possible breast cyst or a solid mass. Indeed, ultrasound can make this distinction, as can fine-needle aspiration biopsy.
However, the features of a solid mass on a mammogram are an irregular shape with spiculated margins.
Also, if the mass shows microcalcifications with a segmental distribution and a linear morphology the radiologist will be increasingly suspicious of malignancy.
These are just some of the mammographic indicators which come into play with a BI-RADS 4 category assessment and the decision whether or not a biopsy is necessary. The positive predictive value of breast cancer in BI RADS category 3 and 5 lesions remains about the same.
This is regardless of whether the lesion is palpable or not. But in suspicious breast masses, categorized as BI-RADS 4, the positive predictive value increases by up to 30% if the lesion is physically palpable.
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Birads : The Average Time Between Screening And Confirmed Diagnosis Is Usually 2 To 7 Days
Depending upon the radiologists interpretation of the mammogram, there may be more or less urgency in finding out a definitive diagnosis.
On average, for women with a BI RADS category of 3 or 4 on a mammogram, the time interval between initial breast cancer screening and a definitive diagnosis is about 2 days.
However, for women with a BI RADS category of 4 or 5, additional imaging and biopsy studies may be necessary. So the average time interval before a diagnosis is, or ought to be about7 days.
Breast Examination After Treatment For Breast Cancer
After surgery
The incision line may be thick, raised, red and possibly tender for several months after surgery. Remember to examine the entire incision line.
If there is redness in areas away from the scar, contact your physician. It is not unusual to experience brief discomforts and sensations in the breast or nipple area .
At first, you may not know how to interpret what you feel, but soon you will become familiar with what is now normal for you.
After breast reconstruction
Following breast reconstruction, breast examination for the reconstructed breast is done exactly the same way as for the natural breast. If an implant was used for the reconstruction, press firmly inward at the edges of the implant to feel the ribs beneath. If your own tissue was used for the reconstruction, understand that you may feel some numbness and tightness in your breast. In time, some feeling in your breasts may return.
After radiation therapy
After radiation therapy, you may notice some changes in the breast tissue. The breast may look red or sunburned and may become irritated or inflamed. Once therapy is stopped, the redness will disappear and the breast will become less inflamed or irritated. At times, the skin can become more inflamed for a few days after treatment and then gradually improve after a few weeks. The pores in the skin over the breast also may become larger than usual.
What to do
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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.
M Categories For Breast Cancer
M followed by a 0 or 1 indicates whether the cancer has spread to distant organs — for example, the lungs, liver, or bones.
M0: No distant spread is found on x-rays or by physical exam.
cM0: Small numbers of cancer cells are found in blood or bone marrow , or tiny areas of cancer spread are found in lymph nodes away from the underarm, collarbone, or internal mammary areas.
M1: Cancer has spread to distant organs as seen on imaging tests or by physical exam, and/or a biopsy of one of these areas proves cancer has spread and is larger than 0.2mm.
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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.
Symptoms Of Metastatic Breast Cancer
The symptoms of stage 4 breast cancer depend on the location of the cancer and where it has spread in your body.
- If breast cancer has spread to your bones, you may notice a sudden new bone pain. Breast cancer most commonly spreads to your ribs, spine, pelvis, or arm and leg bones.
- If it has spread to your brain, you may experience headaches, vision or speech changes, or memory problems.
- Breast cancer that has spread to your lungs or liver usually causes no symptoms.
The main treatments for stage 4 breast cancer are targeted drug therapies that destroy cancer cells wherever they are in your body.
These treatments may include:
- hormone therapy, which stops or slows the growth of tumors by preventing your body from producing hormones or interfering with the effect of hormones on breast cancer cells
- chemotherapy, where drugs given orally or through an IV travel through your bloodstream to fight cancer cells
- immunotherapy, which uses drugs that stimulate your immune system to destroy cancer cells
- a combination of these therapies
In some cases, surgery or radiation therapy may be used to treat stage 4 breast cancer.
The following are the common treatment options for different types of stage 4 breast cancer.
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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.
Treatment Options For Stage 4 Cancer
Stage 4 cancer is challenging to treat, but treatment options may help control the cancer and improve pain, other symptoms and quality of life. Systemic drug treatments, such as targeted therapy or chemotherapy, are common for stage 4 cancers.
Often, a clinical trial may be an option, offering new treatments to help you fight stage 4 cancer.
Below are the prevailing treatment options for the five most common cancers.
Treatment of stage 4 breast cancer: For cancer that has spread beyond the breast and nearby lymph nodes, systemic drug treatments are typically used. These include:
- Hormone therapy
- Chemotherapy
- Immunotherapy
They may be used alone or in combination, and they may also be determined by the hormone receptor and the HER2 status of the cancer.
Surgery and radiation may be treatment options in specific cases to help improve symptoms caused by a growing tumor, not to get rid of the cancer. The tumor may be removed with surgery or shrunk by radiation therapy if, for example, its:
- Blocking a blood vessel
- Causing a wound
- Affecting the spinal cord
Treatment of stage 4 lung cancer: In general, stage 4 lung cancer is also treated with systemic drug therapies.
Stage 4 lung cancer that has spread to one distant area tends to be treated differently than lung cancer that has spread more widely. For stage 4A cancers, treatment tends to focus on the one site where the cancer has spread.
There may also be clinical trials assessing new treatments for stage 4 melanoma.
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I Have To Prioritize And Try Not To Sweat The Small Stuff
For Sendelbach, each week begins with a list of her priorities. Obviously, getting to my doctors appointments is very important, she says. But if the clothes arent folded, is that a dire situation? Absolutely not!
Sendelbach has learned to make compromises: If her husband and son have to pick up their clean clothes from the couch, she can live with that.
I have learned, she says, to look at every situation and ask if this is going to truly make a difference in my day or my familys day for better or worse. If the answer is no, then that task might be left undone.
It wasnt always this way for Sendelbach, though. When she was first diagnosed with cancer, her son was just a year old and she had been married for only two and a half years. You know how it is when you first have a baby if everything isnt perfect, then the world is falling apart! she laughs. Now, to us we ate, were all still alive, the house is acceptable if were good, its all okay.
How Long Can You Live With Stage 4 Breast Cancer
Many patients and caregivers wonder, is stage 4 breast cancer curable, or is stage 4 breast cancer always terminal? This can depend on many factors such as the subtype of disease and the extent of metastasis. Despite stage 4 cancer being the least likely to be cured or go in remission, many patients live for several years after a diagnosis of metastatic cancer. In rare cases, some patients will end up beating metastatic breast cancer. However, once breast cancer is in stage 4, it has spread to other tissues and organs around the body, which can make it more difficult to treat.
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Stage 4 Breast Cancer Survivor Stories
Following are stories from two survivors of breast cancer, told in their own narrative.
“I am Kathy from Littleton, Colorado. I had been a successful hairstylist till the March of 2013. I was used to the occasional back ache as I did most of my work standing up, but one day the backache was so bad I had to go to the hospital to get some relief. After getting an MRI, I received the news that I had stage four breast cancer that had metastasized in my bones. My stage 4 breast cancer life expectancy was only two months. When looking for treatment, I found the University of Colorado Anchutz Cancer Center. For a year I went through chemotherapy once a week, three biopsies and three rounds of radiation. After two years, I am still battling my cancer while living a healthy life. My doctors call this a miracle as I go to the gym five days a week, work for various cancer awareness organizations and recently started a new business.”
When Do People Get A Metastatic Breast Cancer Diagnosis
Metastatic breast cancer can occur at different points:
- De novo metastatic breast cancer: About 6% of women and 9% of men have metastatic breast cancer when theyre first diagnosed with breast cancer.
- Distant recurrence: Most commonly, metastatic breast cancer is diagnosed after the original breast cancer treatment. A recurrence refers to the cancer coming back and spreading to a different part of the body, which can happen even years after the original diagnosis and treatment.
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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.