Why Prepare These Documents
There are two very important reasons to prepare these documents. One reason is for yourself so that your wishes are honored. They give you a chance to dictate what will happen if you are unable to speak for yourself.
Another reason is for your family. Decisions near the end of life are difficult to begin with, but are even more challenging if family members second guess themselves wondering if they are truly abiding by your wishes. This can become even more of an issue if family members disagree, and can lead to hurt feelings and family friction. Taking the time to spell out your wishes may prevent painful disagreements as your family members argue over what they believe you would have wanted.
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.
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.
Also Check: Will My Breast Cancer Come Back
What I Wish People Knew About Metastatic Breast Cancer
Women with metastatic breast cancer think about fighting cancer very differently than women who don’t have a stage 4 diagnosis. If you have advanced cancer, these women understand what youre going through.
The term metastatic breast cancer describes breast cancer that has spread beyond the breast to the bones, liver, brain, or another organ. Even if the cancer is found in another organ, its still referred to as breast cancer and is treated as such.
While metastatic breast cancer is terminal and cannot be cured, because of improved treatments more women are living longer than ever with it. Even so, a lack of information and many misconceptions about this diagnosis persist.
Here are several things you should know about metastatic breast cancer and the women who are living with it.
Survival Rate With Metastatic Breast Cancer
Many people wonder about the life expectancy for stage 4 breast cancer . It’s important to note that everyone is different and survival rates vary widely. There are some people who survive many years and even decades with stage 4 disease. At the same time, it’s important to understand that stage 4 breast cancer isn’t curable.
It can be helpful to look at current statistics and consider the many variables that affect life expectancy. While it’s important not to raise false hope, it may help to know the reality that there are some long-term survivors.
Some people want to know the statistics, but many don’t. If you’re living with stage 4 breast cancer, there is absolutely no requirement that you know the prognosis. The information provided here is only for those who truly wish to know what the current research iseven this research has many limitations.
Recommended Reading: What Does Pt1c Mean In Breast Cancer
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.
Stage Ia & Ib Treatment Options
Stage I describes invasive breast cancer . Stage I is divided into subcategories known as IA and IB.
In general, stage IA describes invasive breast cancer in which:
- the tumor measures up to 2 centimeters and
- the cancer has not spread outside the breast; no lymph nodes are involved
In general, stage IB describes invasive breast cancer in which:
- there is no tumor in the breast; instead, small groups of cancer cells larger than 0.2 millimeter but not larger than 2 mm are found in the lymph nodes or
- there is a tumor in the breast that is no larger than 2 cm, and there are small groups of cancer cells larger than 0.2 mm but not larger than 2 mm in the lymph nodes
Still, if the cancer is estrogen-receptor-positive or progesterone-receptor-positive, it is likely to be classified as stage IA.
Recommended Reading: What Kind Of Doctor Do You See For Breast Cancer
How Is Metastatic Breast Cancer Treated
The drugs and treatments used to treat metastatic breast cancer are typically the same as what’s used to treat earlier stages of breast cancer. Think: chemotherapy, radiation, immunotherapy, and targeted hormone therapies.;
As with earlier stages of the disease, metastatic breast cancer treatment also depends on the subtype of cancer, says Dr. Tsarwhas. An estrogen-positive cancer typically gets some kind of hormonal therapy, while an HER2-positive cancer will often get an antibody treatment targeting the HER2 proteins. Meanwhile, triple-negative breast cancer doesn’t respond to hormonal therapies or HER2 antibody treatments, so it requires chemotherapy, immunotherapy, or other types of drugs.;;
Once you’ve figured out the specific type of metastatic breast cancer, the treatment approach is slightly different. “Because we can’t cure metastatic breast cancer, quality of life and quantity of life are important goals,” says Dr. Montero. “We try to utilize treatments that will control cancer but at the least amount of toxicity.” For example, in the case of estrogen-positive cancer, he says doctors will try to maximize anti-estrogen therapies to control the cancer before moving onto chemotherapy, because the estrogen drugs have fewer side effects. This allows patients to make the most out of their lives.;
Quick Guide On Skin And Nail Changes For Metastatic Breast Cancer Survivors
This video covers the side effects of nail changes, skin rashes, and sensitivities;and hand foot mouth syndrome that patients living with Metastatic Breast Cancer may experience. It explains nail changes, skin rashes, and sensitivities, as well as hand foot mouth syndrome, and includes;tips for coping with each symptom.
Recommended Reading: How Do You Know If You Have Breast Cancer
What Is Advanced Stage Iv Breast Cancer
Stage IV is the most invasive of all stages of breast cancer. At this point, the cancer has spread beyond the breast and nearby lymph nodes to other organs in the body such as the lungs, distant lymph nodes, skin, bones, liver, or brain.
Stage IV is often called advanced or metastatic breast cancer, its really scary for most patients. Its common but varies from person to person, said Cruz. But I have had patients who come to me crying, thinking they were going to die tomorrow but they are living decades longer.
Survival key:Breast cancer survivor says fitness was key to her recovery
Cance and Cruz said that stage IV can appear after treatment for a different stage of breast cancer. In most cases with stage IV, doctors adopt an aggressive form of treatment involving surgery, chemotherapy, and more.
How to treat breast cancer?
Treatment for breast cancer can vary depending on the stage, Cruz said, although most treatments involve some form of radiation or hormone therapy to shrink cancer cells.
Cruz said some women choose to take a drastic preventive measure through a mastectomy. A mastectomy is surgery to remove breast tissue, often where cancer cells are found or might be found later.
First, the cancer will be biopsied and, depending on the characteristics of the tumor, the treatment plan will involve surgery and possible chemotherapy or hormone therapy and radiation therapy, Cance said.
Also Check: What Are The Side Effects Of Radiation After Breast Cancer
What Is The Treatment For Metastatic Breast Cancer
Treatments include many of the same treatments as other stages of breast cancer:
- Radiation therapy
- Hormone therapy;; For patients diagnosed with Stage IV breast cancer that is hormone receptor positive, hormonal therapy may be the first line of defense against the disease. As long as the drugs are keeping the cancer from progressing, the patient may be kept on the medication for some time. If scans show the progression of the cancer, the medical oncologist may switch to another form of hormonal therapy or possibly stop this therapy and pursue a different line of systemic treatment, such as chemotherapy or biologic targeted therapy.
- Biologic targeted therapy
- Breast surgery It is controversial whether surgery should be done on the breast in the presence of known metastatic disease. In most cases, however, the knowledge of metastasis is discovered after the breast cancer surgery and other treatment has been performed. The cancer returns as a distant recurrence.
Don’t Miss: What To Eat During Breast Cancer Treatment
Research Into Advanced And Metastatic Breast Cancer
As metastatic breast cancer remains the leading cause of death from breast cancer, NBCF is committed to funding a broad spectrum of research that helps to further understand breast cancer metastasis, develop improved treatment options and enhance patient quality of life for those with metastatic breast cancer.
What Are The Symptoms Of Metastatic Cancer
Metastatic disease symptoms are tricky because they vary depending on where the cancer cells have spread, Henry says. Some symptoms might be caused by side effects of medication or they might be an indication of depression. Its important to explore the cause.
“I always encourage a patient with a history of breast cancer to call us if she has a new symptom, especially if it sticks around longer than expected,” she says.
These are some common symptoms of metastatic breast cancer by site:
Symptoms of bone metastases:
- Back, bone or joint pain
- Worsening headache or pressure to the head
- Vision problems
- Behavioral changes, confusion or personality changes
Symptoms of liver metastases:
- Abdominal pain, appetite loss, nausea and vomiting
Symptoms of lung metastases:
- Inability to draw a full breath
- Chest pain
Read Also: Who Is At High Risk For Breast Cancer
How Do Clinical Trials Fit Into The Equation
“I think clinical trials in general are very important, because almost every drug we have in practice right now, we learned about through a clinical trial,” Henry says.
The Rogel Cancer Center always tries to have clinical trials available for all patients, no matter the stage.
“Ask your oncologist about the opportunity to participate in clinical trials, even if it hasn’t been mentioned to you,” Henry says. “It’s one way to get access to new exciting drugs, which may be beneficial.”
Diagnosis Of Stage 4 Breast Cancer
If you are diagnosed with breast cancer, you may have further tests to determine the extent that the cancer has spread throughout the body. This is called staging. It helps you and your doctors decide on the best treatment options for you.
In addition the numbered staging system, the TNM staging system is also commonly used for breast cancer staging.
Read Also: How Many People Die From Breast Cancer
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
Surgery For Metastatic Breast Cancer At First Diagnosis
Nearly 10% of women are found to have metastatic disease when they are first diagnosed. Some research suggests that some women with metastatic breast cancer at first diagnosis may have better survival rates if the primary tumor in the breast is removed. If your first diagnosis of breast cancer was metastatic disease, you may want to ask your doctor if surgery to remove the breast tumor would be a good option for your specific situation.
Read Also: What Is Stage 3a Breast Cancer
Quick Guide On Nerve Problems For Metastatic Breast Cancer Survivors
This video covers the side effect of pain and neuropathy that patients living with Metastatic Breast Cancer may experience. It includes what is described as pain, types of treatment medication, how to cope with pain, what neuropathy is, and how one can cope with neuropathy. Additionally, there are tips for talking to your health care team about pain and neuropathy.
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.
Also Check: Is Bilateral Breast Cancer Metastatic
When Should You Ask For Hospice Care
Very often we hear people say they wish they had opted for hospice care earlier on, so how can you know when it is time?
In order to receive hospice care, you usually need a physicians note saying that you are expected to live six months or less. If you live longer, that’s not a problem and there’s no penalty. Your care can either be renewed for another six months or discontinued. You can also change your mind at any time if you decide you would rather pursue treatments designed to treat your cancer.
How Is Metastatic Breast Cancer Diagnosed
Currently, there’s no one test that can diagnose metastatic breast cancer. How the cancer is diagnosed depends on where it has spread in the body, Alberto Montero, MD, director of the breast cancer program at University Hospitals Seidman Cancer Center in Cleveland, Ohio, tells Health.
In most cases, a diagnosis begins with someone with a history of breast cancer reporting a new, unusual symptom to their doctor, Dr. Montero says. This would prompt tests and imaging that would lead to a diagnosis of metastatic cancer. If a former breast cancer patient says they have worsening leg or knee pain, for example, their doctor might order an X-ray and bone scan to check for cancer lesions in those areas.;
“We really pay attention to people’s symptoms,” says Dr. Lin. “If somebody with a known prior history of early breast cancer calls with any suggestive symptoms, then we go on to do scans or tests focused on the areas that are having symptoms.” This is not to say that everyone with a history of breast cancer who reports headaches or abdominal pain has metastatic cancer. But doctors know to investigate further if they have a breast cancer patient with unusual symptoms, because they could indicate a cancer recurrence.;
This is different from how earlier-stage breast cancer is diagnosed, says Dr. Lin. In those cases, breast cancer is usually detected through a mammogram, and then confirmed with an ultrasound and then a biopsy to confirm the diagnosis.;
You May Like: When Can Breast Cancer Occur