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What Does Metastatic Breast Cancer Mean

The Biology Of The Tumor

What Does Metastatic Breast Cancer Mean To You?

Many tests will be done on a sample of the metastatic tumor . The main tests are:

Which tumors are tested?

What does the tumor test determine?

How do the test results guide treatment?

All tumors

Hormone receptor status

If the cancer is hormone receptor-positive, the first treatment is usually hormone therapy, often with a CDK4/6 inhibitor.

All tumors

HER2 status

If the cancer is HER2-positive, HER2-targeted therapies, such as trastuzumab , are included in the treatment plan.

Tumors that are both hormone receptor-positive and HER2-negative

Whether the tumor has a PIK3CA gene mutation

If the tumor has a PIK3CA gene mutation, the cancer may be treated with the PI3 kinase inhibitor alpelisib and the hormone therapy fulvestrant.

PD-L1 status

If the cancer is PD-L1-positive, the first treatment may be the immunotherapy drug pembrolizumab in combination with chemotherapy.

Adapted from NCCN, 2021

Research Into Advanced And Metastatic Breast Cancer

As metastatic breast cancer remains the leading cause of death from breast cancer, NBCF is committed to funding a broad spectrum of research that helps to further understand breast cancer metastasis, develop improved treatment options and enhance patient quality of life for those with metastatic breast cancer.

Survival Rates Of Stage 4 Breast Cancer

Unfortunately, cancer cells often become more difficult to treat and may develop drug resistance once they spread. According to the Australian Institute of Health and Welfare , the 5-year survival rate for women whose breast cancer is metastatic at first diagnosis is 32%, compared to the 91% on average for all breast cancer patients.

Factors affecting survival rate of metastatic breast cancer

Survival rates can provide an estimate of what percentage of patients with the same stage of breast cancer are still alive after a certain period of time . However, they cannot predict how long any specific individual with breast cancer will live. The length of survival time for people with metastatic breast cancer can vary significantly from person to person, but there are a number of factors which can influence this including:

  • Response to treatment
  • The extent and location of metastases
  • The presence of other health issues not related to cancer
  • The specific subtype of breast cancer . This is very important, as some types of cancer can be more aggressive than others and respond differently to treatment.

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Dealing With Emotions And Lifestyle Changes

Coping with emotions and lifestyle challenges is an important part of living with metastatic cancer. Ways of coping include:

  • Learning about the metastasis. You might want to know everything possible, or just basic information.

  • Talking with another health care professional such as a psychologist, psychiatrist, counselor, or oncology social worker about your situation.

  • Managing stress. From planning ahead to trying meditation and yoga, there are many options to help lower your stress level.

  • Finding meaning. Talking with a hospital chaplain, a counselor, or your religious leader can help.

Whats The Outlook For Metastatic Breast Cancer

metastatic breast cancer  Get Up Swinging

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.

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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.

How Does Breast Cancer Spread

Breast cancer can invade and grow into the tissue surrounding the breast or it can travel to other parts of the body and form a new tumor there. Nearly all types of cancer have the ability to spread , but whether or not it will spread is often linked to what type of breast cancer you have.

Breast cancer can spread in three ways:

  • It can spread from your breast into surrounding areas .
  • Cancer cells can travel through the bloodstream to other areas of the body.
  • Cancer cells can also move through the lymph node system to other parts of your body.
  • Every cancer is different, but the type of breast cancer you have typically plays a role in how aggressive or slow moving it is and where its most likely to spread, says Dr. Roesch.

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    How Having Metastatic From The Start Might Influence Treatment

    There are some advantages for women diagnosed with de novo metastatic breast cancer compared to women who have progressed following an early breast cancer. The main advantage is that their cancer is treatment naïve, meaning it has not previously been exposed to any anti-cancer treatments and is therefore likely to be more responsive to treatment. There have been some reports of small numbers of women who may even be cured from metastatic breast cancer in this circumstance. In addition, there are more treatment options available than for those who have received previous treatment for early breast cancer who may have already used up some of their options.

    The one positive was that my oncologist said that he more or less had an open book of treatments that he could offer me.

    Another positive that women sometimes describe is that they can feel the cancer in their breast getting smaller once treatments starts. Mammograms and breast ultrasounds may be used as a way of checking that the cancer in the breast is responding to treatment. Many women find this reassuring, knowing that the treatment they are having is working for them.

    How Is Metastatic Breast Cancer Treated

    What Does the Word Survivor Really Mean for the Metastatic Breast Cancer Patient?

    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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    Mechanism In Brain Metastasis

    The brain is a unique organ for metastasis, since the breast-tumor cells have to pass the bloodâbrain barrier to form micrometastases.

    CD44

    CD44 is a receptor for hyaluronic acid, involved in cell adhesion by binding to specific extracellular matrix components. A proposed mechanism for the function of CD44 is to regulate the adhesion of circulating cancer cells in the brain to the endothelium at the secondary site with the help of a hyaluronate matrix ligand or by its cytoplasmic attachments to actin-associated proteins of the merlin/ezrin/radixin/moesin family.

    Sialyl transferase

    Cell-surface sialylation has been implicated in cellâto-cell interactions, and over-expression of a brain sialyltransferase in breast-cancer cells is a mechanism highlighting the role of cell-surface glycosylation in organ-specific metastatic interactions. Breast-cancer metastasis to the brain involves mediators of extravasation through non-fenestrated capillaries, complemented by specific enhancers of BBB-crossing and brain colonization.

    What Does That Mean Glossary

    The ABCs of breast cancer A glossary of the breast cancer terms you have questions about. Were always updating this list with more decoded terms, so be sure to check back!

    If theres something you want to see on here, reach out to

    Adjuvant-therapy

    Adjuvant therapy is a secondary method of treatment that is performed after the primary treatment method to lower the risk of the cancer returning. Examples include: chemotherapy and radiation therapy.

    Advanced Breast Cancer

    Advanced breast cancer is another term used to describe metastatic breast cancer . It is not a different type of breast cancer. Rather, it is the most advanced stage of breast cancer.

    Advanced Care Planning

    Advanced care planning is the process of deciding ahead of time the kind of health and personal care you want in the future if you were to reach the point where you can no longer speak for yourself.

    Adverse Events

    Adverse events are also known as side effects, an adverse event is an unexpected or dangerous reaction to a treatment or medication. They are captured in the clinical trial and should be reported as part of the safety profile of the treatment.

    Axillary Lymph Node Dissection

    Lymph nodes are small glands located in the underarm area. When someones lymph nodes are removed its called an axillary lymph node dissection. This surgery is usually combined with a mastectomy .

    Benign

    Benign is an adjective used to describe a tumour that is non-cancerous.

    Biomarker

    Biopsy

    Blinded Study

    BRCA Genes

    DCIS

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    Are New Treatments For Metastatic Cancer Being Developed

    Yes. Researchers are now studying new ways to kill or stop the growth of primary cancer cells and metastatic cancer cells. One new area of research includes ways to boost the strength of the immune response against tumors.

    Regulatory T-cells and RANKL proteins may play a role in breast cancer metastasisRecent breast cancer research suggests that the bodys regulatory T cells, which are an integral part of the immune response system, may play a key role in metastasis.

    It is speculated that the T cells produce a protein which seems to accelerate the spread of breast cancer cells to other areas of the body. The inflammatory protein RANKL seems to influence the T-cells ability to spread cancer cells to distant areas of the body.

    It is believed that by interfering with RANKLs ability to interact with the T-cells, the early metastasis of breast cancer cells can be significantly inhibited

    What Does It Mean To Have Stage 1 Breast Cancer

    Stage 4 Breast Cancer in the Lungs

    In Stage 1 breast cancer, cancer is evident, but it is contained to only the area where the first abnormal cells began to develop. The breast cancer has been detected in the early stages and can be very effectively treated.

    Stage 1 can be divided into Stage 1A and Stage 1B. The difference is determined by the size of the tumor and the lymph nodes with evidence of cancer.

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    From Cured To Stage 4

    Others, like Teri Pollastro, a 54-year-old stage 4 patient from Seattle, respond surprisingly well.

    Diagnosed with early stage ductal carcinoma in situ in 1999, Pollastro underwent a mastectomy but did not receive chemotherapy, radiation or tamoxifen, since her cancer was ER negative.

    âThey used the C-word with me, they told me I was cured,â she said. âEvery time I went back to my oncologist, he would roll his eyes at me when I had questions.â

    In 2003, Pollastro switched to Seattle Cancer Care Alliance where she saw Dr. Julie Gralow, a breast cancer oncologist and clinical researcher at Fred Hutchinson Cancer Research Center. Gralow discovered Pollastroâs cancer had metastasized to her liver.

    âMy husband and I were in shock,â said Pollastro of her mets diagnosis. âYou donât go from being cured to stage 4.â

    Pollastro went on Herceptin, a type of immunotherapy for women with HER2-positive metastatic breast cancer, and did six months of chemotherapy.

    âI felt better right away with the treatment,â she said. âBut the problem is, it stopped . Thatâs what you can expect with mets. And thereâs always some residual cancer. And that starts percolating.â

    And along with mets, she also had to deal with many misconceptions regarding her disease.

    The Mercer Island, Washington, mother of two, who often counsels newly diagnosed patients, sometimes even found it difficult to relate to early stage breast cancer survivors.

    How Does Metastatic Breast Cancer Develop

    In some women with breast cancer, cancer cells break away from the cancer in the breast. The cancer cells spread to other parts of the body in blood vessels or lymphatic vessels and form a new cancer deposit. This can happen before or after treatment for breast cancer.The original cancer in the breast is called the primary cancer. If breast cancer develops in another part of the body it is called a metastatic breast cancer or a metastasis.

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    Metastatic Breast Cancer Is Terminal

    Metastatic breast cancer cant be cured and it is terminal. One thing I didnt know when I was first diagnosed is that breast cancer can only kill you if you have metastatic breast cancer, says Rosen, who explains that if your cancer remains in the breast, the tumor can be removed, but metastatic means it has spread outside the breast.

    MBC is almost like a different disease than early-stage breast cancer, adds Ann Silberman, 60, from Sacramento, California, who was diagnosed in 2009. We are going to die. Our concerns are much different from those of a person who has a treatment that will be over . Someone in an earlier stage may worry about losing their hair which is understandable but they will return to their normal life at some point.

    People with metastatic breast cancer expect to be on treatment for the rest of their lives. I dont think everyone understands that, Silberman says. I still get, When will your treatment be over? Well, its never going to be over.

    When Your First Diagnosis Is Metastatic Breast Cancer

    Metastatic Breast Cancer — An Introduction

    My first diagnosis was of metastatic breast cancer and I was completely ignorant about the whole thing. I thought from all the ads on TV that it was fine and it was curable. I needed to be told by somebody that it was more serious than an early breast cancer diagnosis. Penny

    For a small number of women, their diagnosis with metastatic breast cancer is their first diagnosis of breast cancer. Most women in this situation feel panic and uncertainty. After the initial shock, you will gradually start to think a little more clearly and realise there are things you can do to cope with the situation. Below is a list of things that you might find helpful:

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    What To Expect During A Tumor Marker Test

    Blood will be drawn from a vein in your arm. The entire process only takes a few minutes. Heres what you can expect:

  • The person doing the blood draw will sanitize the area where the needle will be placed.
  • A rubber band will be tied around your upper arm and youll be asked to make a fist. This helps to make the veins in your arm stick out, making it easier for the needle to be inserted.
  • A needle will be inserted into a vein in your arm. This will be attached to a test tube that will collect the blood sample.
  • Once the blood sample has been collected, the needle will be withdrawn from the vein.
  • A small amount of bleeding can happen when the needle is removed. Youll be asked to use a piece of gauze to apply pressure to the area.
  • A bandage will then be placed over the gauze. Plan to leave the bandage on for a few hours.
  • Metastatic Breast Cancer: What You Should Know

    What does it mean to have metastatic, or stage 4, breast cancer? A Rogel Cancer Center oncologist explains the diagnosis and how its treated.

    After hearing a diagnosis of metastatic breast cancer, a rush of questions emerges. But often, its not until long after leaving the doctors office.

    Metastatic means the cancer has spread beyond the breast and immediate lymph nodes to other organs or tissues in the body, most often the bones, brain, lungs or liver. Its considered stage 4 breast cancer, which means the cancer has progressed to its most advanced stage.

    But even though its moved to other organs, it still behaves like breast cancer and is treated with breast cancer therapies.

    More than 154,000 U.S. women are estimated to have metastatic breast cancer, according to the Susan G. Komen organization. Men can have metastatic breast cancer too, but its rare.

    To help patients fill in information gaps, N. Lynn Henry, M.D., Ph.D., the breast oncology disease lead for the University of Michigan Rogel Cancer Center, explains the nuances of stage 4 metastatic breast cancer.

    What are the differences between metastatic breast cancer, stage 4 breast cancer and advanced cancer?

    If any doctor uses the term advanced, ask for clarification, Henry adds.

    When does metastatic breast cancer appear?

    What are the symptoms?

    Symptoms of bone metastases:

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    Tests To Diagnose Metastatic Breast Cancer

    If you have any of the symptoms of metastatic breast cancer, your doctor may recommend one or more of the following tests:

    • blood tests
    • whole-body bone scan, with or without X-rays of specific bones
    • MRI of the spine or brain
    • CT scan of the chest, abdomen, pelvis, and/or brain
    • PET scan
    • X-ray or ultrasound of the abdomen or chest
    • bronchoscopy if you have a constant cough or trouble breathing
    • biopsy of any suspicious area
    • a “tap,” removal of fluid from the area with symptoms to check for cancer cells a pleural tap removes fluid between the lung and chest wall and a spinal tap removes fluid from around the spinal cord

    You can read the following pages for information on symptoms of breast cancer metastasis and diagnosis:

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