Stage 4 Breast Cancer: Prognoses And Solutions
Breast cancer cases have doubled in the last 20 years. Women die more often from this disease than all other cancers. Cancers develop inside our bodies, from our own cells that have mutated for some reason. Scientists all over the world have been fighting over the cause of cancer for decades and have come to the conclusion that the diseases destructive mechanisms are triggered by not one but many factors.
When Your First Diagnosis Is Metastatic Breast Cancer
My first diagnosis was of metastatic breast cancer and I was completely ignorant about the whole thing. I thought from all the ads on TV that it was fine and it was curable. I needed to be told by somebody that it was more serious than an early breast cancer diagnosis. Penny
For a small number of women, their diagnosis with metastatic breast cancer is their first diagnosis of breast cancer. Most women in this situation feel panic and uncertainty. After the initial shock, you will gradually start to think a little more clearly and realise there are things you can do to cope with the situation. Below is a list of things that you might find helpful:
Treatments For Stage 4 Breast Cancer
The following are treatment options for ductal carcinoma and lobular carcinoma. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.
Stage 4 means that the breast cancer has spread to other parts of the body. It is also called advanced breast cancer, or metastatic breast cancer. Treatments cannot completely cure metastatic breast cancer, but they can control it very well, sometimes for many years. Doctors may offer one treatment until it stops working and then give another one.
The treatments offered for stage 4 breast cancer depend on the hormone-receptor status and the HER2 status of the cancer cells. They will also depend on where the cancer has spread, if it is causing any symptoms and your overall health.
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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.
Clinical Manifestations Of Stage 4
The main classification signs of breast cancer stage 4 are its spread to remote organs or lymph nodes. The size of the tumor at this stage is no longer important moreover, it may no longer be detected at the primary site.
It is the metastases that most often develop in the liver, lungs, and bones that give information about the development of the oncological process. They are painful and cause vivid symptoms. Metastases in the liver give jaundice and increase abdominal size. Metastases in the lungs give shortness of breath, and in the bones severe pain and frequent fractures.
- severe intoxication
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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.
Triple Negative Breast Cancer
With this type of breast cancer, the breast cancer cells dont have ER+ or PR+ receptors. They dont overproduce the HER2 protein, so hormone therapy isnt very effective.
Instead, triple negative stage 4 breast cancer is usually treated with chemotherapy. Radiation therapy may also be an option, depending on the site of metastasis.
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The Biology Of The Tumor
Many tests will be done on a sample of the metastatic tumor . The main tests are:
Which tumors are tested?
What does the tumor test determine?
How do the test results guide treatment?
Hormone receptor status
If the cancer is HER2-positive, HER2-targeted therapies, such as trastuzumab , are included in the treatment plan.
Tumors that are both hormone receptor-positive and HER2-negative
Whether the tumor has a PIK3CA gene mutation
If the tumor has a PIK3CA gene mutation, the cancer may be treated with the PI3 kinase inhibitor alpelisib and the hormone therapy fulvestrant.
Adapted from NCCN, 2021
Literature Search And Study Selection
We searched for clinical trials published in electronic databases through December 2018. The key words were âbreast neoplasmsâ, âmastectomyâ and âthe equivalent of stage-IV breast cancerâ. In total, 465 potentially relevant reports were identified.
Our meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses .
The following inclusive selection criteria were applied:
- Study population: MBC patients with no prior history of breast cancer diagnosis and who had not undergone primary surgery.
- Study design: studies examining the effect of local surgery in MBC patients were collected from available databases. Studies published as reviews, editorials, letters and comments were excluded.
- Outcome measures: OS reported for groups with versus without local surgery.
In the event of the same clinical case appearing in several publications, to avoid duplication of information, we included only the most informative article or that with the longest follow-up period.
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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.
What Can I Expect While Living With Metastatic Breast Cancer
Your care team will monitor you every few months to check if the cancer is responding to treatment, and also to see if you are having any side effects. The process of restaging the cancer includes:
- History/physical exam.
- Blood tests.
- Imaging tests, including CTs and bone scan or PET scan.
Before your scans or tests, its normal to feel anxiety. It may help to bring a friend or family member to the appointment with you.
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Whats The Outlook For Metastatic Breast Cancer
The right treatment plan can improve survival for people with metastatic breast cancer. However, survival rates vary and are dependent on a number of factors including type/biology of the breast cancer, parts of the body involved and individual characteristics. About 1 in 3 women live at least five years after diagnosis. Some live 10 years or longer. Your care team will discuss your prognosis with you in more detail.
Treatment For Advanced Breast Cancer
Treatment of metastatic breast cancer aims to control the growth and spread of the cancer, to relieve symptoms, reduce pain, and improve or maintain quality of life.
The treatment recommended by doctors will depend on which treatments are likely to control the breast cancer and what side effects the person can cope with. Treatment options may involve:
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How Long Can Someone Live With Stage 4 Cancer
Doctors usually describe a persons outlook using the 5-year survival rate. These are calculated based on data from thousands of other people with a similar cancer at a similar stage.
The original location of the cancer determines its type. Survival rates vary, depending on the type of cancer and how far it has spread within the body.
Below, we describe the survival rates for some of the most common forms of cancer in stage 4:
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
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What Is Stage 1 Breast Cancer
This breast cancer is the earliest stage of invasive breast cancer. In stage 1, the tumor measures up to 2 cm and no lymph nodes are involved. At this stage, the cancer cells have spread beyond the original location and into the surrounding breast tissue.
Because a stage 1 tumor is small, it may be difficult to detect. However, breast self-exams and routine screening are always important and can often lead to early diagnosis, when the cancer is most treatable.Stage 1 breast cancer is divided into two categories:
Stage 1A: The tumor measures 2 cm or smaller and has not spread outside the breast.
Stage 1B: Small clusters of cancer cells measuring no more than 2 mm, are found in the lymph nodes, and either there is no tumor inside the breast, or the tumor is small, measuring 2 cm or less.
At stage 1, TNM designations help describe the extent of the disease. For example, there may or may not be cancer cells in the lymph nodes, and the size of the tumor may range from 1 cm to 2 cm. Most commonly, stage 1 breast cancer is described as:
- T: T1, T2, T3 or T4, depending on the size and/or extent of the primary tumor
- N0: Usually, cancer has not spread to the lymph nodes.
- M0: The disease has not spread to other sites in the body.
Stage 1 breast cancer survival rate
The survival rate for stage 1A breast cancer may be slightly higher than for stage 1B. However, all women with stage 1 breast cancer are considered to have a good prognosis.
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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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.
Life Expectancy Of Stage 4 Breast Cancer
According to the American Cancer Society, 22% of the patients live five years after being diagnosed of stage 4 breast cancer. Compared to earlier stages of the cancer, this rate is considerably lower. At stage two, the five year survival rate is at 90% and at stage three, it is 72%. This shows that an early diagnosis is important for better chances of survival.
Predicting survival rates for patients are never really accurate. Your age, general health, hormone receptors on cells with cancer, the type of tissue the cancer has affected and your general outlook on life all affect your stage 4 breast cancer life expectancy.
About 50% percent of women who are diagnosed with stage four breast cancer are still alive 18 months after their diagnosis. Over the years, life expectancy for stage four cancer has been steadily and slowly improving. This has been mainly due to combination treatment of surgery, radiation, multiple medications, and a much more positive support network.
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What To Do If You Have Breast Cancer
When you learn about such an unpleasant diagnosis, the first thing to do is to avoid panic in any way. Try to pull yourself together. After that, be sure to look for an experienced doctor who will tell you what to do and how to proceed. Only an experienced doctor will be able to give you the right diagnosis, assess your overall condition, and be able to provide assistance that will lead to a positive result.
The main thing, in this case, is to see a professional doctor. Unfortunately, many countries have adopted a radical fight against this disease. Therefore, the question, whether it is possible to cure without surgery, the answer is a resounding no. But in the USA, such treatment can be carried out much more gently. Clinics here offer to conduct surgery for breast cancer, but try to keep as much healthy tissue as possible. In addition, after surgery in such centers, you will certainly be offered plastic surgery to restore the breast.
So, if you or your loved one was diagnosed with breast cancer, even if it is stage 4, do not panic. Find a great oncologist, select the best treatment option, and start it immediately. With this approach, the probability of a positive outcome increases many times. Remember even the worst and most difficult diagnosis can be a thing of the past if you start the right treatment on time and believe in the best outcome.
I Wish I Had Treated My Feelings As Valid
I remember being so frustrated, sad, and angry after my surgery. My mom brought up the possibility of a revision surgery, and at the time, I told her no, I didnt want more surgeries. I hadnt even begun chemotherapy, and I was sick of cancer. I felt like I was supposed to feel lucky that the surgery was deemed successful, and that the cancer didnt seem to have spread to my lymph nodes.
I told myself now was not the time for vanity. What I couldnt quite understand was that mixed emotions were normal and okay. I could feel both happy and dissatisfied at the same time. Similar dichotomous emotions came up when I froze my eggs. I felt lucky to be given the opportunity to freeze them, but also so mad that I was forced to make a decision about the chance of future children.
The truth is, there is no right way to feel, and I wish I had stopped fighting how I felt. Everyone has different experiences, desires, and feelings. Each experience is unique, and each experience is valid.
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