Relieving Symptoms Of Advanced Breast Cancer
Treatment to relieve symptoms depends on where the cancer has spread. For example, pain from bone metastases may be treated with radiation therapy, drugs called bisphosphonates such as pamidronate or zoledronic acid , or the drug denosumab . For more, see our information about the treatment of bone metastases.
Outlook For People With Stage 3 Breast Cancer
Its natural to want to know your outlook, but statistics dont tell the whole story. Your breast cancer type, overall health, and many more factors beyond your control may affect treatment outcomes.
Establishing open communication with your treatment team can help you best assess where you are in your cancer journey.
Support groups can be a great source of comfort as you navigate your diagnosis through your treatment and beyond. Your doctors office or hospital can offer some suggestions and resources in your area.
What Is Metastatic Cancer
Metastatic cancer is cancer that has spread from where it started to another part of the body. The original cancer is called the primary tumour. The cancer in another part of the body is called metastatic cancer. Metastatic cancer has the same type of cancer cells as the primary cancer. For example, when colon cancer spreads to the liver, the cancer cells in the liver are colon cancer cells. It is metastatic colon cancer, not liver cancer.
Metastatic cancer is also called:
- metastatic tumour, tumours or disease
- advanced cancer
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How Do Doctors Diagnose Metastasis
If you already had cancer treatment for non-metastatic cancer, you probably have a follow-up care plan. You will see your doctor for regular checkups. Specific tests may be done to look for metastases.
Alternatively, some people already have metastases when they are first diagnosed with cancer. In this situation, the metastases are usually found during the initial tests to stage the cancer.
Cancer may cause symptoms such as pain or shortness of breath. Sometimes these symptoms will lead your doctor to do necessary tests to find the metastases.
How Common Is It
About 155,000 women in the United States live with metastatic breast cancer. Men can have metastatic breast cancer too, but it’s rare.
Only 6% to 10% of women with breast cancer are diagnosed at stage IV. About 20% to 30% of women are diagnosed with an early-stage breast cancer, and then the cancer spreads.
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What Are The Survival Rates For Stage 3 Breast Cancer By Stage
Survival rates can be confusing. Remember that they dont reflect your individual circumstances.
The relative 5-year survival rate for stage 3 breast cancer is 86 percent, according to the American Cancer Society. This means that out of 100 people with stage 3 breast cancer, 86 will survive for 5 years.
But this figure doesnt consider breast cancer characteristics, like grade or subtype. It also doesnt distinguish between people with stage 3A, 3B, and 3C.
In comparison, the relative 5-year relative survival rate for stage 0 breast cancer is 100 percent. For stages 1 and 2, its 99 percent. For stage 4, the survival rate drops to 27 percent.
Tucatinib Neratinib And Lapatinib
The tyrosine-kinase inhibitors FDA-approved for metastatic breast cancer treatment are:
Tyrosine-kinase inhibitors are a class of drugs that target enzymes important for cell functions . These drugs can block tyrosine-kinase enzymes at many points along the cancer growth pathway.
A tyrosine-kinase inhibitor in combination with trastuzumab and chemotherapy can be used to treat HER2-positive metastatic breast cancer. This combination may give women with HER2-positive metastatic breast cancer more time before the cancer spreads compared to treatment with trastuzumab and chemotherapy alone .
Adding the tyrosine-kinase inhibitor tucatinib to treatment with trastuzumab and chemotherapy may also increase overall survival in women with HER2-positive metastatic breast cancer who were treated with trastuzumab in the past .
Neratinib is also used to treat HER2-positive early breast cancer.
Tucatinib, neratinib and lapatinib are pills.
Learn about neratinib and treatment of early breast cancer.
Tucatinib, neratinib and lapatinib and brain metastases
Many drug therapies cannot pass through the blood to the brain . So, they cant treat breast cancer that has spread to the brain.
However, tucatinib, neratinib and lapatinib can pass through the blood-brain barrier and may be used to treat some metastatic breast cancers that have spread to the brain.
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You May Not Know Im Sick By Looking At Me
I may look perfectly healthy, but Im sick, says Silberman. Treatment is hard. I sleep a lot. I still travel, but its difficult. I just visited a friend in Utah for four days, and it wore me out for two weeks.
Just because someone doesnt look like she has advanced-stage cancer, she can be very sick. It can be an invisible illness, says Silberman. You tell somebody you have cancer, but if you have hair, sometimes they dont believe you.
Survival Rates For Metastatic Breast Cancer
According to the American Cancer Society , the 5-year survival rate after diagnosis for people with stage 4 breast cancer is 28 percent. This percentage is considerably lower than earlier stages. For all stages, the overall 5-year survival rate is 90 percent.
Because survival rates are higher in the early stages of breast cancer, early diagnosis and treatment is crucial. But remember: The right treatment for stage 4 breast cancer can improve quality of life and longevity.
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What Makes Metastatic Breast Cancer Different
You may have heard doctors or the media talk about breast cancer as a disease that can be treated and then ends. At the end of treatment for your first diagnosis, maybe you felt your experience was over. Perhaps your doctors mentioned the chance of recurrence, but it sounded unlikely.
There are many people who undergo treatment and never have to deal with cancer again. A metastatic breast cancer diagnosis is different because it means you will actively deal with breast cancer for the rest of your life.
With metastatic breast cancer, the goal of treatment is to shrink or weaken the cancer, manage your symptoms and side effects and prevent the cancer from spreading further. Changes in treatment are made as the cancer grows or spreads to new places in your body. You and your doctors will talk regularly about progression, the growth of tumors or spread of cancer, and regression, decreases in tumor size or the cancers reach. When one treatment stops working, you and your doctors will look at new options.
When talking with your doctor, ask about treatment side effects. Maintaining your usual daily activities and being able to participate in the things you enjoy are essential to your overall well-being. It may be helpful to talk openly with your medical team about how symptoms and side effects impact you every day.
Treatment for metastatic breast cancer has two main goals: to control the cancer for as long as possible, with the highest quality of life possible.
About Metastatic Breast Cancer
Cancer begins when healthy cells change and grow out of control, forming a mass or sheet of cells called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread.When breast cancer is limited to the breast and/or nearby lymph node regions, it is called early stage or locally advanced. Read about these stages in a different guide on Cancer.Net. When breast cancer spreads to an area farther from where it started to another part of the body, doctors say that the cancer has metastasized. They call the area of spread a metastasis, or use the plural of metastases if the cancer has spread to more than 1 area. The disease is called metastatic breast cancer. Another name for metastatic breast cancer is “stage IV breast cancer if it has already spread beyond the breast and nearby lymph nodes at the time of diagnosis of the original cancer.
Doctors may also call metastatic breast cancer advanced breast cancer. However, this term should not be confused with locally advanced breast cancer, which is breast cancer that has spread to nearby tissues or lymph nodes but not to other parts of the body.
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What Are The Symptoms Of Bone Metastasis In Breast Cancer
All three doctors say that new, progressive pain in your bones or joints is the most common symptom of metastatic breast cancer in bones. “I always tell patients to inform me if there’s pain that’s not getting better,” says Dr. Tsarwhas. This can sometimes be confused with arthritis or other pre-existing chronic pain issues, he says, which is why it’s important for breast cancer patients to be proactive about any new pain they encounter.
New fractures or unexplained fractures can also be a sign of bone metastasis, Dr. Tsarwhas adds. Cancer can weaken bones and make them break more easily. “New lumps or bumps in the lymph node area…could be a sign of recurrent breast cancer as well,” he says.
A person with metastatic breast cancer in their bones may also experience more general cancer symptoms, such as fatigue, lack of appetite, and extreme, unexplained weight loss.;
What Does Stage 3 Mean
Because stage 3 breast cancer has spread outside the breast, it can be harder to treat than earlier stage breast cancer, though that depends on a few factors.
With aggressive treatment, stage 3 breast cancer is curable; however, the risk that the cancer will grow back after treatment is high.
Doctors further divide stage 3 cancer into the following stages:
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How Does Staging Relate To Types Of Breast Cancer
In addition to cancer stage, doctors will determine the tumor grade and subtype.
Tumors are graded on a scale of 1 to 3, based on how abnormal the cells appear compared to normal cells. The higher the grade, the more aggressive the cancer, meaning that it tends to be growing quickly.
The subtype is important because treatment and outlook will vary depending on which subtype of breast cancer that you have. Subtypes include:
Myth #: If Youre Diagnosed With Metastatic Breast Cancer You Did Something Wrong Or Didnt Get The Right Treatment The First Time
When some people hear stage IV breast cancer, they assume something must have been missed along the way to let the cancer get that far. There is a misconception that breast cancer always develops in orderly steps from stages I to II, III, and then IV and that theres plenty of time to catch it early. People with MBC can face misguided assumptions that they must have skipped mammograms or self-exams, or they didnt control risk factors such as not exercising enough, watching their weight, or eating healthy. But a person can do everything right and still get MBC. Although regular screenings increase the odds of diagnosing breast cancer at an earlier stage, they cant guarantee it.
Another major misconception: If youre diagnosed with metastatic cancer after being treated for an early-stage breast cancer, you must have chosen the wrong treatment regimen or it wasnt aggressive enough. But between 20% and 30% of people with an earlier-stage breast cancer will eventually go on to develop MBC and theres often no good explanation as to why. And it can happen to anyone. Treatments can reduce the risk of recurrence, but they cant eliminate it.
As Illimae of Houston notes: that a stage IV diagnosis equals negligence on the part of the patient. In my case, it had spread before I ever felt a lump. I felt it Saturday and saw my doc on Monday, I ignored nothing, sometimes it just happens that fast.
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:
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.
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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 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.
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.
Central Nervous System Metastases
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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
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What Is Stage 4 Breast Cancer
Metastatic breast cancer and stage 4 metastatic breast cancer are the same;thing.;Cancer;stage refers to how advanced or widespread cancer is in the body. Oncologists, or cancer specialists,;use cancer stage to guide important treatment decisions. Your doctor will determine the cancer stage at the time of;your initial;breast cancer diagnosis. However, breast cancer metastasis can occur years after an original diagnosis.;
Why Does My Provider Need To Test The Metastatic Tumor
Your care team will test the metastases to figure out the biology of the tumor, which can help guide your treatment plan. Providers may test tumors for:
- Hormone receptor status: If the cancer is hormone receptor-positive, hormonal therapy may be your first treatment.
- HER2 status: Human epidermal growth factor receptor 2 is a protein that is overexpressed on some breast cancer cells. HER2-positive cancer responds to specific HER2-targeted therapies.
- PIK3CA gene mutation: If a tumor is hormone receptor-positive and HER2-negative, your provider may test for this gene mutation. Specific targeted therapies can be used to treat tumors with this mutation.
- PD-L1 status: Tumors that are hormone receptive-negative and HER2-negative may be tested for PD-L1 status. If the PD-L1 test is positive, you may be recommended to receive a combination of immunotherapy and chemotherapy.
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Will I Ever Be Cured
Oncologists dont talk about curing stage 4 breast cancer as much as managing it as you would other chronic diseases, according to Brufsky. Were not likely going to get rid of every single bit of cancer, but were learning that people can live with this disease and be asymptomatic for years and years, he explains. While the mean survival of patients with HR-positive/HER-2-negative;metastatic breast cancer is now over five years, its hard to say what the future holds for a woman diagnosed with the disease today. The field is changing so quickly and dramatically that in two or three years, this will be a different conversation.