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.
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 Is Stage I
Stage I is the earliest point of invasive cancer when tumor cells have started to spread to surrounding, normal breast tissue, Cruz said. In this stage the spread is contained to a small area.
Stage I is divided into categories IA and IB based on the size of a tumor and where cancer cells are detected. In IA, the tumor is about the size of a grape, Cruz said. Stage IB indicates the tumor is smaller or nonexistent, but there are small clusters of cells in the lymph nodes.
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Examples Using The Full Staging System
Because there are so many factors that go into stage grouping for breast cancer, it’s not possible to describe here every combination that might be included in each stage. The many different possible combinations mean that two women who have the same stage of breast cancer might have different factors that make up their stage.
Here are 3 examples of how all of the factors listed above are used to determine the pathologic breast cancer stage:
The Signs Of Advanced Breast Cancer
The best way to beat the disease is to know the early warning signs so that it can be detected and treated sooner.
There are four general symptoms to look our for, according to Cancer Research UK.
- Feeling under the weather
- Having less appetite
Not all of these symptoms could be a sign of advanced breast cancer and they may be caused by other conditions.
Symptoms can also vary depending on which part of the body the cancer has spread to.
But if you’re worried about a symptom or if it continues for more than a few days, then it’s best to tell your doctor or specialist nurse.
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Signs & Symptoms Include:
- A new lump in the breast or under the arm
- A lump that has changed in size and/or shape
- A change in the shape or size of the breast
- A constant pain in any part of the breast. Pain in the nipple is a common sign of breast cancer.
- Red swollen or flaky areas of skin on the breast.
- Dimpling or irritation of the breast skin.
- A nipple which is tender to touch or has inverted
- Discharge from the nipple that is not milk.
- Symptoms observed from a mammogram include:
- Dense Mass – breast cancer cells collectively form a tumor a dense mass which is whiter than surrounding tissue. A dense mass may also be felt as a lump in the breast.
- Breast microcalcifications – small clusters or lines of calcium indicating an increase in breast tissue cell activity.
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.
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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.
T Categories For Breast Cancer
T followed by a number from 0 to 4 describes the main tumor’s size and if it has spread to the skin or to the chest wall under the breast. Higher T numbers mean a larger tumor and/or wider spread to tissues near the breast.
TX: Primary tumor cannot be assessed.
T0: No evidence of primary tumor.
Tis: Carcinoma in situ
T1 : Tumor is 2 cm or less across.
T2: Tumor is more than 2 cm but not more than 5 cm across.
T3: Tumor is more than 5 cm across.
T4 : Tumor of any size growing into the chest wall or skin. This includes inflammatory breast cancer.
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Stages Of Breast Cancer
Staging describes or classifies a cancer based on how much cancer there is in the body and where it is when first diagnosed. This is often called the extent of cancer. Information from tests is used to find out the size of the tumour, what part of the breast has cancer, whether the cancer has spread from where it first started and where the cancer has spread. Your healthcare team uses the stage to plan treatment and estimate the outcome .
The most common staging system for breast cancer is the TNM system. For breast cancer there are 5 stages stage 0 followed by stages 1 to 4. Often the stages 1 to 4 are written as the Roman numerals I, II, III and IV. Generally, the higher the stage number, the more the cancer has spread. Talk to your doctor if you have questions about staging.
When describing the stage of breast cancer, sometimes doctors group them as follows:
In situ breast cancer The cancer cells are only in the duct or lobule where they started and have not grown into nearby breast tissue . It is stage 0.
Early stage breast cancer The tumour is smaller than 5 cm and the cancer has not spread to more than 3 lymph nodes. It includes stages 1A, 1B and 2A.
Locally advanced breast cancer The tumour is larger than 5 cm. The cancer may have spread to the skin, the muscles of the chest wall or more than 3 lymph nodes. It includes stages 2B, 3A, 3B and 3C. Inflammatory breast cancer is also considered locally advanced breast cancer.
Find out more about .
Will I Need More Than One Treatment For Metastatic Breast Cancer
Medications are important for metastatic breast cancer to help control its spread. Resistance to therapies may develop, which can lead your care team to recommend a change in treatment.
When you start a treatment regimen, you and your care team will see how:
- The cancer responds to the therapy.
- The side effects impact you.
If the treatment isnt working or the side effects are unbearable, your care team can discuss switching the treatment method. They may recommend a different drug, dosage or schedule.
There are many treatments available. If one therapy isnt working for you for whatever reason, there is usually another one you can try.
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Checking The Lymph Nodes
Before your treatment you have an ultrasound scan to check the lymph nodes in the armpit close to the breast. This is to see if they contain cancer cells. If breast cancer spreads, it usually first spreads to the lymph nodes close to the breast.
Depending on the results of your scan you might have:
- a sentinel lymph node biopsy during your breast cancer operation
- surgery to remove your lymph nodes
Warning Signs And Words To Know
The most common symptom or warning sign of breast cancer is a lump in the breast. But both Cance and Cruz said not all lumps are cancerous. Women should also watch for nipple discharge and changes in breast shape or size.
Cance says vocabulary such as local, regional or distant may be used to describe a patient’s diagnosis. Local refers to the area where the cancer is confined within the breast. Regional may be used when the lymph nodes, primarily those in the armpit, are involved. The term distant is used when the cancer is found in other parts of the body as well, according to Cance.
Another term typically introduced after a breast cancer diagnosis is T-N-M. T represents the tumor size N relates to the involvement of nearby lymph nodes and M refers to whether the cancer has spread beyond the breast, according to Memorial Sloan Kettering Cancer Center.
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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
Recurrence Of Metastatic Breast Cancer
Metastatic breast cancer is considered a chronic disease, so it doesnt go away and recur.
But in recent years, people under age 50 have seen a particularly strong decline in death rates due to breast cancer, according to the Centers for Disease Control and Prevention .
These declines are due in part to improved screening and treatment for the disease.
There are a few general facts that are helpful to know about breast cancer outlook:
- Breast cancer is the most common cancer diagnosis in the United States, according to the
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Why Cancer Cells Tend To Spread To The Parts Of The Body They Do
Where a cancer starts is linked to where it will spread. Most cancer cells that break free from the primary tumor are carried in the blood or lymph system until they get trapped in the next downstream organ or set of lymph nodes. This explains why breast cancer often spreads to underarm lymph nodes, but rarely to lymph nodes in the belly. Likewise, there are many cancers that commonly spread to the lungs. This is because the heart pumps blood from the rest of the body through the lungs blood vessels before sending it elsewhere.
The Number Staging System
Breast cancer can also be divided into four number stages. We have put these into a table to make them easier to understand. You can .
This information is about stage 1 to 3 breast cancer.
Stage 1 breast cancer is when the cancer is 2cm or smaller. There may be no cancer cells in the lymph nodes in the armpit or tiny numbers of cancer cells are found. Sometimes the cancer cannot be found in the breast, but cancer cells have spread to lymph nodes in the armpit.
Stage 2 breast cancer is when the cancer is up to or bigger than 5cm. It may or may not have spread to the lymph nodes under the arm. Sometimes the cancer cannot be found in the breast. But cancer cells have spread to 1 to 3 lymph nodes in the armpit or near the breast bone.
Stage 3 breast cancer is sometimes called locally advanced breast cancer. The cancer has spread to the lymph nodes in the armpit and sometimes to other lymph nodes nearby. It may have spread to the skin of the breast or to the chest muscle. The skin may be red, swollen or have broken down. Sometimes the cancer cannot be found in the breast or is small but has spread to 4 to 9 lymph nodes in the armpit.
Stage 4 breast cancer is also called secondary or metastatic breast cancer. This is when the cancer has spread to other parts of the body, such as the bones, the liver or lungs. We have separate information about secondary breast cancer.
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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:
Stage 3 Breast Cancer
Stage 3 means that the cancer has spread from the breast to lymph nodes close to the breast or to the skin of the breast or to the chest wall.
It is also called locally advanced breast cancer.
The stage of a cancer tells you how big it is and how far it has spread. It helps your doctor decide which treatment you need.
Staging for breast cancer is very complex. Many different factors are considered before doctors can confirm your final stage. For example, they also use a sample of your cancer to test for:
- receptors for the female hormones
- HER2 status
- the grade of your cancer
You may also have a CT scan to check that the cancer has not spread to other parts of your body.
Do speak to your breast doctor or nurse if you have any questions about staging.
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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.