What Is Secondary Breast Cancer

What Doesn’t Affect Survival

Just as there are factors associated with a better or worse prognosis, there are some factors that do not appear to make a big difference. These are generally less understood by the general public:

• Aggressiveness of treatment
• Having a positive attitude

The goal of treatment for metastatic breast cancer is often very different than that of early-stage disease, and this can raise anxiety among patients and loved ones of patients. With early-stage breast cancer, the goal is usually to be aggressive in order to reduce the risk that the cancer will come back.

In contrast, with stage 4 disease, the goal is usually to use the minimum amount of treatment possible to control the disease . Studies have found that more aggressive treatment does not improve survival rates but does reduce quality of life.

While having a good attitude may improve your sense of well-being, it has not been shown to affect survival rates. In fact, holding in negative emotions in order to appear positive may be detrimental to your health in general.

Breast Cancer Treatment Miami

Breast cancer is an area where women really need to find out what their options are because CyberKnife is an amazing option, which has not really been fully exploited, says Dr. Pomper.

CyberKnife has been used to treat early-stage breast cancers for 10 plus years with very high success rates, according to Dr. Pomper.

It is especially useful in ladies who have left-sided cancers, which is close to the heart or with small breasts where you really want to be super precise, he says.

However, CyberKnife is also an important tool in breast cancer that has metastasized to other parts of the body and especially to the lymph nodes.

The CyberKnife advantage is that even if an area has been treated with radiation before, we can treat the same area because the technology is so precise. We treat a lot of lymph node lesions at CyberKnife Miami and we treat them very successfully, Dr. Pomper says. Some doctors mistakenly tell patients the area cant be treated if its been treated before with other types of radiation. Thats not always true. Those patients should get a second opinion at The CyberKnife Center of Miami.

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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How To Handle Emotions

Coping with the many symptoms that can occur with stage 4 breast cancer can be frustrating and discouraging, and people sometimes wonder if they will have to feel poorly the rest of their lives. Anxiety and depression are also severe for some people with advanced disease.

Fortunately, palliative care team consults are now offered at many cancer centers. While hospice is a form of palliative care, palliative care can be helpful even with early, curable tumors. Working with a palliative care team to address physical and emotional issues frees you up to work with your oncologist on issues that treat your cancer specifically.

While the research is also young, it appears that those people who receive palliative care consults not only have a better quality of life with advanced cancer, but they may actually live longer, too.

Locally Advanced Breast Cancer

Locally advanced cancer means that the cancer has spread into nearby;tissue;and lymph nodes around the breast. This includes lymph nodes around the collar bone and breast bone. It hasnt spread to other organs.

This is different to secondary breast cancer. And it is;different to early breast cancer which may be affecting just the breast, or the breast and your;lymph nodes under your arm.

• brain
• bones

Your doctor will arrange some scans and tests if you have symptoms. They will also examine you and find out how you how are feeling.

• Find out about symptoms of secondary breast cancer

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How Long Do People Live With Secondary Breast Cancer

One of the first things many people with secondary breast cancer want to know is how long theyve got to live.

Life expectancy is difficult to predict as each persons case is different and no two cancers progress in the same way. However, as treatments have improved, more and more people are living longer after a diagnosis of secondary breast cancer.

Your specialist will have an understanding of the likely progression of your secondary breast cancer and can talk to you about what you might expect. You may worry if their answers are vague but it isnt possible to accurately predict how each persons cancer will respond to treatment.

Newly Diagnosed Or Worried About A Symptom

In the days or weeks after a diagnosis of secondary breast cancer, you may feel distressed and find it hard to think clearly.

You can read our;information for people newly diagnosed with secondary breast cancer, including where to find support.

If you havent been diagnosed but are worried about a symptom, find out more about the;signs and symptoms of secondary breast cancer.

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Cancers Linked To Treatment With Tamoxifen

Taking tamoxifen lowers the chance of hormone receptor-positive breast cancer coming back. It also lowers the risk of a second breast cancer. Tamoxifen does, however, increase the risk for uterine cancer . Still, the overall risk of uterine cancer in most women taking tamoxifen is low, and studies have shown that the benefits of this drug in treating breast cancer are greater than the risk of a second cancer.

Treatment For Secondary Breast Cancer

A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team .

Your doctor and nurse will talk to you about the best treatment for you. They will also ask you about your preferences. They will talk to you about things to consider when making treatment decisions. You may have some treatments as part of a clinical trial.

Secondary breast cancer can be controlled, often for many years, but it cannot be cured. Because of new and improved treatments, women with secondary breast cancer are living for longer. The aim of treatment is to control the cancer, improve the symptoms and help you to live well for longer.

The treatment you have will depend on:

• where the cancer is in your body
• if it is ER positive or HER2 positive
• previous breast cancer treatment you have had.

You may have a combination of treatments.

Treatments for secondary breast cancer include:

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If Cancer Has Spread To The Lungs

The first symptoms of this may be a cough that doesn’t get better or breathlessness. If cancer cells settle on the outside of the lungs, they can irritate the membranes which cover the lungs . This causes fluid to build up and press on the lungs which can make you breathless. This is called apleural effusion. The fluid can be drained away to make your breathing easier.

Breathlessness can be frightening, but there are effective ways of managing it. When treatment – usually chemotherapy – starts to work, your breathing will improve.

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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Stages Of Breast Cancer: Stage Iiib

A stage IIIb breast cancer is one in which the tumor may be of any size but it has grown into the chest wall or the skin of the breast.; A stage IIIb designation also applies if there is evidence of either

• axillary lymph node metastasis
• internal mammary node metastasis

presenting in such a way as to suggest that total surgical removal is not possible.

There is a unique type of breast cancer,; inflammatory breast cancer, that causes the breast to appear red and swollen. This is because the cancer cells block some of the lymphatic vessels. Inflammatory breast cancers tend to have a poorer prognosis and are generally stage;IIIb at least.

Symptoms Of Metastatic Breast Cancer

The symptoms of metastatic breast cancer may be different than those of early-stage breast cancer, but not always. Sometimes, there are no symptoms at all.

You should always speak with your doctor if you experience any new signs or symptoms, but here are some of the most common signs that breast cancer;has spread:

• Bone pain or bone fractures due to tumor cells spreading to the bones or spinal cord
• Headaches or dizziness when cancer has spread to the brain
• Shortness of breath or chest pain, caused by lung cancer
• Jaundice or stomach swelling

The symptoms of breast;cancer metastasis may also vary depending on where in the body the cancer has spread. For example:

• If the breast or chest wall is affected, symptoms may include pain, nipple discharge, or a lump;or thickening in the breast or underarm.
• If the cancer has spread to bones, symptoms may include pain, fractures or decreased alertness due to high calcium levels.
• If the cancer has spread to the lungs, symptoms may include shortness of breath, difficulty breathing, coughing, chest pain or fatigue.
• If the cancer has spread to the liver, symptoms may include nausea, fatigue, swelling of the feet and hands or yellowing skin.
• If cancer has spread to the central nervous system, which includes the brain or spinal cord, symptoms may include pain, memory loss, headache, blurred or double vision, difficulty with and/or movement or seizures.

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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.

What Investigations Are Necessary For Staging Breast Cancer

Breast cancer staging almost always involves a bone scan, as breast cancer is highly prone to metastasize to the bones.

During this test, medics inject a small amount of a radioactive substance into the bloodstream, where it eventually collects in the bones. A radiation scanner is then able to detect accumulations of tracer substance in the bones.

If breast cancer spreads beyond the breast, 25% of the time it goes into bones first.

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Symptoms If Cancer Has Spread To The Bones

You may have any of these symptoms if your cancer has spread to the bones:

• an ache or pain in the affected bone
• breaks in the bones because they are weaker
• breathlessness, looking pale, bruising and bleeding due to low levels of blood cells – blood cells are made in the bone marrow and can be crowded out by the cancer cells

Sometimes when bones are damaged by advanced cancer, the bones release calcium into the blood. This is called hypercalcaemia and can cause various symptoms such as:

• tiredness

• Find out more about cancer that has spread to the bones

Systemic Treatments For Stage Iv Breast Cancer

Treatment often continues until the cancer starts growing again or until side effects become unacceptable. If this happens, other drugs might be tried. The types of drugs used for stage IV breast cancer depend on the hormone receptor status and the HER2 status of the cancer:

Hormone receptor-positive cancers

Women with hormone receptor-positive cancers are often treated first with hormone therapy . This may be combined with a targeted drug such as a CDK4/6 inhibitor, everolimus or a PI3K inhibitor.

Women who havent yet gone through menopause are often treated with tamoxifen or with medicines that keep the ovaries from making hormones along with other drugs. Because hormone therapy can take months to work, chemo is often the first treatment for patients with serious problems from their cancer spread, such as breathing problems.

Hormone receptor-negative cancers

Chemo is the main treatment for women with hormone receptor-negative cancers, because hormone therapy isnt helpful for these cancers.

HER2-positive cancers

Trastuzumab may help women with HER2-positive cancers live longer if its given along with chemo or with other medications such as hormonal therapy or other anti-HER2 drugs. Pertuzumab , another targeted drug, might be added as well. Other options might include targeted drugs such as;lapatinib or ado-trastuzumab emtansine .

HER2-negative cancers in women with a BRCA gene mutation

HER2-negative breast cancers in women with a PIK3CA mutation

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Local And Regional Recurrence

Breast cancer that comes back in the skin of the breast where the cancer was first removed, or in the operation scar, is known as a local recurrence.

Breast cancer may also come back in the lymph nodes in the armpit, behind the breast bone, or in the lower part of the neck. This is called regional recurrence. If cancer cells are blocking the lymph nodes in the armpit, fluid can build up in the arm causing swelling known as lymphoedema.

Local and regional recurrences are not secondary breast cancer, as the cancer has not spread to another organ in the body.

These recurrences are usually less serious than secondary breast cancer. But you will usually have tests to find out if the cancer has spread to other parts of the body.

A local or regional recurrence that hasn’t spread anywhere else in the body may be treated with surgery, if possible, or with radiotherapy. Your treatment will depend on the treatments you received to remove and treat the primary breast cancer.

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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How Can I Take Care Of Myself While Living With Metastatic Breast Cancer

Living with metastatic breast cancer can be challenging. Your care team can help provide physical and emotional support. Talk to them about how you can:

• Eat the most nutritious diet for your needs.
• Exercise regularly.
• Get emotional support, including finding support groups.
• Reach out for help from friends, family and loved ones.
• Find mental health services.
• Find complementary therapies.

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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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.