What Is Considered Metastatic Breast Cancer

Breast Cancer Progression Tends To Be Consistent And Predictable

There are many ways that breast cancer can develop but most of the time it starts in the breast ducts.

While cancer is still confined to the breast ducts, specialists refer to it as ductal carcinoma in situ, or DCIS. The good news is that if breast screening detects cancer at this in-situ stage, the chance of survival is close to 100%.

As cancer moves into the breast duct wall and finally begins to affect the surrounding breast tissue, specialists call it infiltrative or invasive breast cancer.

If treatment does not occur, breast cancer will usually spread to other areas of the body . Very often the first area that cancer usually spreads to is the lymph nodes in the underarm area .

Once cancer enters the lymphatic system, it can and usually does spread to other areas of the body. Sometimes this is called distant metastasis.

Not all breast cancers spread first to the axillary lymph nodes and then to the rest of the body. If the breast tumor occurs near the nipple, cancer may spread first to the internal mammary nodes beneath the sternum. And in some cases, the breast cancer can spread via the bloodstream without involving the lymphatic system.

Most Common Places It Spreads

It’s still breast cancer, even if it’s in another organ. For example, if breast cancer spreads to your lungs, that doesn’t mean you have lung cancer. Although it can spread to any part of your body, there are certain places it’s most likely to go to, including the lymph nodes, bones, liver, lungs, and brain.

Our Advice To Other Women With Metastatic Breast Cancer: Be Nice To Yourself

Give yourself a break! is the advice that Sendelbach offers. Stop negative self-talk about what you should have done but didnt do, she says. If you have MBC, you need to be kind and loving to yourself.

The body has only so much energy to offer per day, and managing metastatic breast cancer requires a lot of it. So it doesnt make sense to try to compare what youre able to do with what your cancer-free friends are accomplishing.

Just getting through the day can be hard, Sendelbach says. Getting rid of those not good enough feelings can lift a huge weight off you.

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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 wound in the breast
• To treat a small number of metastases in a certain area, such as the brain
• To help prevent bone fractures
• When an area of cancer spread is pressing on the spinal cord
• To treat a blood vessel blockage in the liver
• To provide relief of pain or other symptoms

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 their goalwhether it is to try to cure the cancer or to prevent or treat symptoms.

Prognosis For Metastatic Breast Cancer

Metastatic breast cancer isnt the same for everyone who has it. According to the National Breast Cancer Foundation, your symptoms at stage 4 will depend on the degree to which the cancer has spread in your body.

Although metastatic breast cancer has no current cure, it can be treated. Getting the right treatment can increase both your quality of life and longevity.

Life expectancy for breast cancer is based on studies of many people with the condition. These statistics cant predict your personal outcome each persons outlook is different.

The following factors can affect your life expectancy with metastatic breast cancer:

• your age

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Central Nervous System Metastases

Clinically symptomatic CNS metastases are reported in 10â15% of patients with metastatic breast cancer in large autopsy studies, up to 40% of women who died of metastatic breast cancer were reported to have at least one brain metastasis. CNS metastases are often viewed by patients and doctors as a late complication of metastatic breast cancer for which few effective treatments exist. In most cases, CNS involvement occurs after metastatic dissemination to the bones, liver and/or lungs has already occurred for that reason, many patients already have refractory, terminal breast cancer by the time they are diagnosed with brain metastases. The diagnosis of brain metastases from breast cancer relies mainly on patient-reported symptoms and neuroimaging. The role of imaging in patients with suspected brain metastases is a very good modality to aid in diagnosis. According to Weil et al., 2005, neuroimaging such as Computed Tomography and Magnetic Resonance Imaging prove to be very effective in the diagnosis of brain and central nervous system metastases.

Symptoms of brain metastases from breast cancer are:

• new-onset headache
• cranial neuropathy, which may cause diplopia and Bell’s palsy
• vomiting and nausea
• deficits in sensation, motor function, and speech

Emotional And Spiritual Care

End-of-life care also includes emotional, mental, and spiritual therapy. A personâs healthcare team may include social workers, counselors, mental health professionals, and religious or spiritual advisors.

According to the Anxiety and Depression Association of America, up to 40 percent of people with cancer experience serious mental distress. This may include anxiety, depression, panic attacks, and post-traumatic stress disorder .

Medications, therapy, religious or spiritual rituals, and support groups can help a person cope with mental health issues and stress during this difficult time.

Caregivers may also need help with stress, anxiety, and depression. The palliative care team can usually also provide support and advice to caregivers for their emotional needs.

The Breast Cancer Healthline app provides people with access to an online breast cancer community, where users can connect with others and gain advice and support through group discussions.

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What Should A Person With Stage 3 Breast Cancer Expect From Treatment

Stage 3 treatment options vary widely and may consist of mastectomy and radiation for local treatment and hormone therapy or chemotherapy for systemic treatment. Nearly every person with a Stage 3 diagnosis will do best with a combination of two or more treatments.

Chemotherapy is always given first with the goal to shrink the breast cancer to be smaller within the breast and within the lymph nodes that are affected. This is known as neoadjuvant chemotherapy.

Other possible treatments include biologic targeted therapy and immunotherapy. There may be various clinical trial options for interested patients with Stage 3 breast cancer.

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.

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Looking For More Of An Introduction

If you would like more of an introduction, explore these related items. Please note that these links will take you to other sections on Cancer.Net:

• ASCO AnswersFact Sheet: Read a 1-page fact sheet that offers an introduction to metastatic breast cancer. This free fact sheet is available as a PDF, so it is easy to print.
• ASCO AnswersGuide:Get this free 52-page booklet that helps you better understand breast cancer. The booklet is available as a PDF, so it is easy to print.
• Cancer.Net Patient Education Video: View a short video led by an ASCO expert in metastatic breast cancer that provides basic information and areas of research.

Alpelisib And Hormone Therapy

Alpelisib is a PI3 kinase inhibitor.

PI3 kinase is an enzyme important in cell growth. The PIK3CA gene helps control PI3 kinase enzyme activity. Some breast cancers have a PIK3CA gene mutation. This gene mutation is in the genes of breast cancer, not the person.

PI3 kinase inhibitors are a class of drugs designed to interrupt PI3 kinase signals and stop the growth of breast cancer cells with PIK3CA gene mutations.

Alpelisib in combination with the hormone therapy fulvestrant is FDA-approved to treat hormone receptor-positive, HER2-negative metastatic breast cancers with a PIK3CA gene mutation that have been treated with hormone therapy in the past.

The combination of alpelisib and fulvestrant can give more time before the cancer spreads compared to fulvestrant alone .

If alpelisib is being considered for your treatment plan, your tumor will be checked to see if it has a PIK3CA gene mutation. This can be done by testing tumor tissue or testing for tumor DNA in your blood .

Alpelisib is a pill.

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Myth #: When Breast Cancer Travels To The Bone Brain Or Lungs It Then Becomes Bone Cancer Brain Cancer Or Lung Cancer

Not true. Breast cancer is still breast cancer, wherever it travels in the body. However, the characteristics of the cells can change over time. For example, a breast cancer that tested negative for hormone receptors or an abnormal HER2 gene might test positive when it moves to another part of the body, or vice versa . Keep in mind that the cancer cells are trying to survive in the body, so they can change, says Dr. Gupta. We always emphasize rechecking the biology.

How Is Electrochemotherapy Given

Many people need only a single treatment of electrochemotherapy, although it can be repeated in the same area or used to treat a different area.

Treatment is usually carried out as an outpatient or day case, though some people may need to stay in hospital overnight. This depends on how much treatment is needed and your general health.

It can be given under general anaesthetic or sometimes local anaesthetic, depending on the size of the area or how many areas need to be treated. You may be given pain relief beforehand.

The chemotherapy is usually given into a vein . It can also be given by injection directly into the area of cancer being treated .

Bleomycin is the chemotherapy drug most commonly used. Cisplatin, another chemotherapy drug, may also be used.

A short time after the chemotherapy drug is given, electrical impulses are given directly to the area using an electrode with the help of a specially designed needle probe. The electrode may be applied a number of times to make sure the whole area is treated. The procedure usually takes about 30 minutes depending on the size of the area.

Afterwards, the area will often be covered with a dressing that may need changing regularly. The treated areas will usually scab over. Often the areas look worse before any improvement is seen.

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Stage Ii Breast Cancer

There are basically four sub-categories of breast cancer within the category of stage II. Breast tumors in the Stage II classification are:

• A breast tumor that is 2cm in diameter or less. BUT the cancer cells have already spread to the lymph nodes.
• OR a breast tumor that is larger than 5 cm but has not yet spread to the lymph nodes.
• OR breast tumors in between 2 cm and 5 cm in diameter -whether there is evidence of spread to the lymph nodes or not.

There are actually quite a number of specific subcategories and letters and numbers to indicate a more precise description of the breast cancer at Stage II. .

In summary, stage II breast cancer is of intermediate size and threatening to spread. Without a doubt, staging for stage II breast cancers requires a thorough investigation of potential metastases.

Survival Rates for Stage II Breast Cancer

The average survival rate for stage II breast cancers is about 93% after five years and about 75% after 10 years. The rate of local recurrence is about 16% for stage II breast tumors. Furthermore, only about 16% of stage II breast cancers either have or will develop lymph node metastasis.

See also our new up-to-date survival rates by stage OR our general survival rates for breast cancer

A baseline bone scan is unlikely to detect bone metastasis with stage 2 tumors, but they are usually necessary just to be sure.

Treatment for Stage II Breast Cancer

Myth #: The Mental And Emotional Experience Of People With Mbc Is The Same As That Of Earlier

People with MBC report hearing comments such as, At least you have a good type of cancer, Arent you glad so much research on breast cancer has been done?, Fortunately you have so many options. These might comfort people with early-stage breast cancer, who can look forward to one day finishing treatment and moving on but people with MBC dont have that luxury. They know they will be in treatment for the rest of their lives. They also know that their life is likely to be shorter than theyd planned.

Mentally and emotionally, people with MBC have a completely different experience. For them, the whole ringing the bell idea does not work, says Dr. Gupta. I have patients who are coming in once a week and have to plan their lives around their treatment. The whole pink brigade idea is very upsetting to them.

Fortunately, more and more people with MBC are speaking up and calling attention to how their experience differs from that of people with earlier-stage breast cancer. People with MBC live with cancer always in the background of their lives, but with new and emerging therapies, many are living longer and maintaining their quality of life.

Clearly, the experience of metastatic breast cancer is quite different from early-stage breast cancer. But there are so many patients who understand just what youre going through. Read more about Living with Metastatic Breast Cancer and join our discussion forum for people with stage IV/metastatic disease.

References

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Where Breast Cancer Tends To Go

Breast cancer most often spreads to these organs:

Bones. Breast cancer travels to the bones through the bloodstream. The ribs, spine, pelvis, and long bones of the arms and legs are the most common bones that breast cancer reaches. Bone pain and tenderness are signs the cancer is in your bones. Breast cancer cells can also get into bone marrow — the spongy tissue inside bones where blood cells are made.

Liver. Cancer cells can get into the liver through the bloodstream because the liver filters the blood.

Lungs. The lungs are another common site for metastatic breast cancer to spread because your blood flows through them to pick up oxygen.

Brain. Any type of breast cancer can spread to the brain, but HER2-positive and triple-negative cancers are most likely to reach this organ. Signs of cancer in the brain include headaches, seizures, vision changes, and dizziness.

How Does Cancer Spread Or Metastasize

The spread of cancer usually happens through one or more of the following steps:

• Cancer cells invade nearby healthy cells. When the healthy cell is taken over, it too can replicate more abnormal cells.
• Cancer cells penetrate into the circulatory or lymph system. Cancer cells travel through the walls of nearby lymph vessels or blood vessels.
• Migration through circulation. Cancer cells are carried by the lymph system and the bloodstream to other parts of the body.
• Cancer cells lodge in capillaries. Cancer cells stop moving as they are lodged in capillaries at a distant location and divide and migrate into the surrounding tissue.
• New small tumors grow. Cancer cells form small tumors at the new location

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When Metastatic Cancer Can No Longer Be Controlled

If you have been told your cancer can no longer be controlled, you and your loved ones may want to discuss end-of-life care. Whether or not you choose to continue treatment to shrink the cancer or control its growth, you can always receive palliative care to control the symptoms of cancer and the side effects of treatment. Information on coping with and planning for end-of-life care is available in the Advanced Cancer section of this site.

A Disease No One Gets

Sadly, people donât âgetâ mets. In fact, a recent survey sponsored by Pfizer Oncology shows just how misunderstood it is. Sixty percent of the 2,000 people surveyed knew little to nothing about MBC while 72 percent believed advanced breast cancer was curable as long as it was diagnosed early. Even more disheartening, a full 50 percent thought breast cancer progressed because patients either didnât take the right treatment or the right preventive measures.

âTheyâve built an industry built on four words â early detection equals cure â and that doesnât even begin to define breast cancer,â said Schoger, who helped found Breast Cancer Social Media, a virtual community for breast cancer patients, caregivers, surgeons, oncologists and others. âWomen are blamed for the fate of bad biology.â

The MBC Alliance, a consortium of 29 cancer organizations including the biggest names in breast cancer , addressed this lack of understanding and support as well as what many patient advocates term the underfunding of MBC research in a recently published landmark report.

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