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What Does Stage 4 Metastatic Breast Cancer Mean

What Is Stage 0 Breast Cancer

Metastatic breast cancer patients share medical records, tumors with researchers

Also called carcinoma in situ, stage 0 is the earliest breast cancer stage. At stage 0, the breast mass is noninvasive, and there is no indication that the tumor cells have spread to other parts of the breast or other parts of the body. Often, stage 0 is considered a precancerous condition that typically requires close observation, but not treatment.

Stage 0 breast cancer is difficult to detect. There may not be a lump that can be felt during a self-examination, and there may be no other symptoms. However, breast self-exams and routine screening are always important and can often lead to early diagnosis of breast cancer, when the cancer is most treatable. Stage 0 disease is most often found by accident during a breast biopsy for another reason, such as to investigate an unrelated breast lump.

There are two types of stage 0 breast cancer:

Ductal carcinoma in situ occurs when breast cancer cells develop in the breast ducts. Today, stage 0 DCIS is being diagnosed more often because more women are having routine mammogram screenings. DCIS can become invasive, so early treatment can be important.

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.

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.

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A Note From Dr Halls Regarding The Statistics For Metastatic Recurrence In Breast Cancer

The statistic of 20% to 30% for metastatic breast cancer that recurs remain controversial amongst medical experts. The figure of 30% metastatic breast cancer recurrence rate first appears in a 2005medical study, but no statistical data or sources are cited.

The MBCN take the 18-year relative survival rate from the SEERS data between the years of 1990 to 1994 as 71%. The argument is, that this takes us close to the 30% recurrence rate statistic. However, there are many other factors at play and treatment has advanced so much that recurrence rates may have even halved since then.

It is safe to say that much more data and research into metastatic recurrence rates would be of huge value towards a long-term cancer cure.

Indeed, it has also been suggested that research into the rare group of women who survive many years with metastasis may be of equal importance to understanding recurrence and patterns of breast cancer.

What Is Stage 4 Breast Cancer

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Also known as metastatic breast cancer, the cancer in this stage has spread beyond the breast, underarm and internal mammary lymph nodes to other parts of the body near to or distant from the breast. The cancer has spread elsewhere in the body. The affected areas may include the bones, brain, lungs or liver and more than one part of the body may be involved.

At stage 4, TNM designations help describe the extent of the disease. Higher numbers indicate more extensive disease. Most commonly, stage 4 breast cancer is described as:,

  • T: T1, T2, T3 or T4 depends on the size and/or extent of the primary tumor.
  • N1: Cancer has spread to the lymph nodes.
  • M1: The disease has spread to other sites in the body.

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Is It Possible To Survive Stage 4 Breast Cancer

While there is no cure for metastatic breast cancer, it is possible to control it with treatment for a number of years. The cancer can also go into remission. There are different types of remission:

  • Complete remission : when there are no cancer signs and symptoms that can be detected by tests or scans.
  • Partial remission : when the cancer has partly responded to treatment. It is still present but it has gotten smaller.

It is currently not possible to predict how long remission will last. However, the repeated cycle of growing, shrinking and stabilising can mean survival for many years. New treatments also continue to be developed. Treatment can help to control the cancer, help relieve symptoms and help you live longer.

It is not always easy, but many people find that with time, they are able to adjust to their diagnosis. Despite the many challenges that metastatic breast cancer brings, people can continue to live full, meaningful lives.

What Does Stage 3 Breast Cancer Mean

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What Is Stage 2 Breast Cancer

Also known as invasive breast cancer, the tumor in this stage measures between 2 cm to 5 cm, or the cancer has spread to the lymph nodes under the arm on the same side as the breast cancer. Stage 2 breast cancer indicates a slightly more advanced form of the disease. At this stage, the cancer cells have spread beyond the original location and into the surrounding breast tissue, and the tumor is larger than in stage 1 disease. However, stage 2 means the cancer has not spread to a distant part of the body.

At stage 2, a tumor may be detected during a breast self-exam as a hard lump within the breast. Breast self-exams and routine screening are always important and can often lead to early diagnosis, when the cancer is most treatable.

Stage 2 breast cancer is divided into two categories:

Stage 2A: One of the following is true:

  • There is no tumor within the breast, but cancer has spread to the axillary lymph nodes, or
  • The tumor in the breast is 2 cm or smaller and cancer has spread to the axillary lymph nodes, or
  • The tumor in the breast measures 2 cm to 5 cm but cancer has not spread to the axillary lymph nodes.

Stage 2B: One of the following is true:

  • The tumor measures 2 cm to 5 cm and cancer has spread to the axillary lymph nodes, or
  • The tumor is larger than 5 cm but cancer has not spread to the axillary lymph nodes.

At stage 2, TNM designations help describe the extent of the disease. Most commonly, stage 2 breast cancer is described as:

Stage 2 breast cancer survival rate

How Is Metastatic Breast Cancer Diagnosed

What Is Metastatic Breast Cancer?

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.

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Symptoms Of Metastasis May Vary Depending On Where The Cancer Has Spread To

Here are some symptoms that vary by locations commonly associated with breast cancer metastasis.

Metastasis in the bone may cause:

  • Severe, progressive pain
  • Bones that are more easily fractured or broken

Metastasis to the brain may cause:

  • Persistent, progressively worsening headache or pressure to the head
  • Vision disturbances
  • Behavioral changes or personality changes

Metastasis to the liver may cause:

  • Jaundice
  • Abnormally high enzymes in the liver
  • Abdominal pain, appetite loss, nausea, and vomiting

Metastasis to the lungs may cause:

  • Chronic cough or inability to get a full breath
  • Abnormal chest X-ray
  • Chest pain
  • Other nonspecific systemic symptoms of metastatic breast cancer can include fatigue, weight loss, and poor appetite, but its important to remember these can also be caused by medication or depression.

If you notice these symptoms, be sure you talk with your physician. They could be important for getting the treatment you need.

Interested in learning more? i3Health is hosting an upcoming webinar Metastatic Triple-Negative Breast Cancer: Applying Treatment Advances to Personalized Care. Learn more here.

Mechanisms Of Breast Cancer Metastasis

No one really knows what factors will make a certain patient more or less susceptible to breast cancer metastasis.

There is growing awareness that part of that susceptibility is due to host factors. The host factors are the characteristics of the non-malignant cells and the general biological environment surrounding the malignant breast tumor.

Sometimes the host factors are referred to as the pre-metastatic niche and it is thought that bone-marrow-derived progenitor cells may directly influence the dissemination of malignant cells to distant areas.

Non-neoplastichost cells within the tumor may also play a key role in the regulation of breast cancer metastasis.

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I May Not Feel Like A Fighter Theres No Final Victory

The language used to describe cancer and its treatment is often the language of war: fighting cancer, battling cancer, being a warrior. But those words may not resonate with women who have metastatic breast cancer.

Sendelbach recalls using fighting words when she was first diagnosed with stage 1 breast cancer. I was 30 years old, and I was in fight mode, she says. I was like, Hell yeah, I can kick cancers ass and so on. When she was diagnosed with stage 4, though, she realized there would be no end in sight, no final victory for her.

Theres not a finish line, she says, so to be in fight mode doesnt really work. There has to be an end in sight to stay in that place.

For her, metastatic breast cancer is something she deals with day to day. She describes her journey as a marathon, not a sprint. If you have to stop sometimes to walk and take water breaks, she says, you should. If you try to run as fast as you can all the time, its inevitable that youre going to fail.

What Are The Chances Of Breast Cancer Recurring

Stage 4 breast cancer symptoms and prognosis

Despite huge advancements in breast cancer screening, early detection and treatment, a percentage of breast cancers will recur and spread to distant sites.

Although at the moment, it is almost impossible to say which cancers will recur and at what time period from diagnosis, there are a few factors that are known to increase the risk for recurrence.

These risk factors include:-

  • Lymph node involvement and number of lymph nodes affected at the time of diagnosis
  • Tumor Size at the time of diagnosis
  • A subtype of Breast Cancer and hormonal receptor Status
  • The time span from the initial diagnosis to recurrence of breast cancer

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Plans Have To Be Flexible

My energy is unpredictable, says Sendelbach. I literally never know how Im going to feel from one day to the next. Its so hard to make plans because if I say yes to something thats two weeks away, the day of, I could wake up and feel absolutely horrible.

When someone with metastatic breast cancer declines an invitation or cancels at the last minute, its most likely not because they dont want to be there. Says Sendelbach, We physically cant do it.

Silberman agrees. Ive been going through for a long time, she says, and Ive had friends drop away. Because of MBC and my treatments, its hard for me to be reliable.

What Is Advanced Stage Iv Breast Cancer

Stage IV is the most invasive of all stages of breast cancer. At this stage, the cancer has spread beyond the breast and nearby lymph nodes to other organs of the body such as the lungs, distant lymph nodes, skin, bones, liver or brain.

Stage IV is often called advanced or metastatic breast cancer, its definitely scary for most patients. Its widespread but varies per person, Cruz said. But Ive had patients come up to me crying, thinking theyre going to die tomorrow but they live dozens of more years.

Cance and Cruz said stage IV can appear after a different stage of breast cancer was treated. In most stage IV cases, doctors take an aggressive form of treatment involving surgery, chemotherapy and more.

How can you treat breast cancer?

Treatment for breast cancer can vary depending on the stage, Cruz said, though most treatments involve some form of radiation or hormone therapy to shrink the cancer cells.

Cruz said some women opt to take a drastic preventative measure via a mastectomy. A mastectomy is surgery to remove the breast tissue, often where cancer cells are found or could later be found.

At first, the cancer will be biopsied and depending on the tumor characteristics, the treatment plan will involve surgery and possible chemotherapy or hormonal therapy and radiation, Cance said.

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Living With Stage : The Breast Cancer No One Understands

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Editor’s note: We’re bringing back this piece from October 2014 for Metastatic Breast Cancer Awareness Day and to honor Jody Schoger, featured in the story. Schoger died of metastatic breast cancer in May. Want to learn more about MBC? Look for our tweets at the Northwest Metastatic Breast Cancer Conference this Saturday at Fred Hutch.

A no-nonsense Texan of 60 years, Jody Schoger* has a very no-nonsense way of educating people about her metastatic breast cancer.

âSomeone will say, âWhen are you done with treatment?â and Iâll tell them, âWhen Iâm dead,ââ said Schoger, a writer and cancer advocate who lives near Houston. âSo many people interpret survivorship as going across the board. That everybody survives cancer now. But everybody does not survive cancer.â

An estimated 155,000-plus women in the U.S. currently live with âmets,â or metastatic breast cancer. This type of cancer, also called stage 4 breast cancer, means the cancer has metastasized, or traveled, through the bloodstream to create tumors in the liver, lungs, brain, bones and/or other parts of the body. Between 20 and 30 percent of women with early stage breast cancer go on to develop metastatic disease. While treatable, metastatic breast cancer cannot be cured. The five-year survival rate for stage 4 breast cancer is 22 percent median survival is three years. Annually, the disease takes 40,000 lives.

Being Your Own Advocate

Treatment Options for Metastatic or Stage IV (4) Breast Cancer

While there aren’t currently any studies looking at self-advocacy and survival, being your own advocate can’t hurt in maximizing your survival. Oncology is changing rapidly and it’s difficult for any oncologisteven those who specialize in breast cancerto stay aware of all of the latest research and clinical trials taking place.

It can be helpful to research your cancer yourself. Becoming involved via social media such as Twitter is also an excellent way to learn about the latest research, using the hashtag #bcsm, which stands for breast cancer social media.

Getting a second opinion can be helpful as well, especially from one of the larger cancer centers such as a National Cancer Institute-designated cancer center.

There are ways to learn about opportunities, however, that don’t require traveling for opinions. There are now clinical trial matching services in which a nurse navigator can help to match your particular tumor and characteristics with clinical trials in progress all over the world.

Several of the larger cancer centers are now also offering remote second opinions, in which an oncology team can review your medical information and talk to you on the phone about whether there are any opportunities for treatment for you that may not be available elsewhere.

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Advanced Cancer That Progresses During Treatment

Treatment for advanced breast cancer can often shrink the cancer or slow its growth , but after a time, it tends to stop working. Further treatment options at this point depend on several factors, including previous treatments, where the cancer is located, a woman’s menopause status, general health, desire to continue getting treatment, and whether the hormone receptor status and HER2 status have changed on the cancer cells.

Metastatic Breast Cancer Treatment And Planning

After a diagnosis of metastatic breast cancer, its helpful to take all the time you need to gather information and make decisions about your treatment. Learn about the medical specialists that may be involved in your care, treatment options, genetic testing, taking a break from treatment, and more.

SurgeryDoctors sometimes recommend surgery for metastatic breast cancer in order, for example, to prevent broken bones or cancer cell blockages in the liver. Learn more.

ChemotherapyChemotherapy is used in the treatment of metastatic breast cancer to damage or destroy the cancer cells as much as possible. Learn more.

Radiation TherapyYour doctor may suggest radiation therapy if youre having symptoms for reasons such as easing pain and controlling the cancer in a specific area. Learn more.

Hormonal TherapyHormonal therapy medicines are used to help shrink or slow the growth of hormone-receptor-positive metastatic breast cancer. Learn more.

Targeted TherapyTargeted therapies target specific characteristics of cancer cells, such as a protein that allows the cancer cells to grow in a rapid or abnormal way. Learn more.

Local Treatments for Distant Areas of MetastasisLocal treatments are directed specifically to the new locations of the breast cancer such as the bones or liver. These treatments may be recommended if, for example, the metastatic breast cancer is causing pain. Learn more.

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