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.
Abemaciclib Palbociclib And Ribociclib And Hormone Therapy
The CDK4/6 inhibitors FDA-approved for metastatic breast cancer treatment are:
- Abemaciclib
- Palbociclib
- Ribociclib
CDK4 and CDK6 are enzymes important in cell division. CDK4/6 inhibitors are a class of drugs designed to interrupt the growth of cancer cells.
Although the CDK4/6 inhibitors abemaciclib, palbociclib and ribociclib have not been compared directly to one another, studies show similar results with each drug .
A CDK4/6 inhibitor in combination with hormone therapy can be used to treat hormone receptor-positive, HER2-negative metastatic breast cancers. Compared to treatment with hormone therapy alone, this combination can give people more time before the cancer spreads and increase overall survival .
The CDK4/6 inhibitor abemaciclib may also be used alone to treat hormone receptor-positive, HER2-negative cancers that have progressed during past hormone therapy and chemotherapy .
Abemaciclib, palbociclib and ribociclib are pills.
The table below lists some possible side effects for CDK4/6 inhibitors.
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For a summary of research studies on the use of CDK4/6 inhibitors in treating metastatic breast cancer, visit the Breast Cancer Research Studies section. |
What Symptoms Should You Have Checked Out
It is very important for you to be familiar with your body and your breasts. This way you will be more likely to notice when something does not seem normal.
You may just be glancing at your body in the mirror and notice an irregularity in your breast. Or you may be showering and feel something like a lump or area of thicker tissue. Regular breast self-exams can also help you spot a change. When you notice something that looks or feels abnormal, dont be afraid or embarrassed to get it checked by a healthcare provider.;
While breast cancer does not always have noticeable symptoms, some of the early signs that a tumor is developing are:;
- A dimpling or puckering in the skin of the breast
- A pitting in the skin or a change in texture, resembling an orange peel
- A color change in the skin, like a red- or purple-colored rash
- An area of warmth or swelling
- An abnormal nipple discharge
- A crusting, scaling, itching, or redness around the nipple
- A nipple that appear to be turning inwards;
- A change in the size or shape of the breast
In addition, what you might feel includes:
- A thickening, knot, lump, or nodule in your breast or under your arms
- Enlarged or swollen glands in your armpits or around your collarbone
- A swelling or heaviness in the breast;
- Pain in the breast or in a nipple
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What Causes Metastatic Breast Cancer
Breast cancer treatments are intended to eliminate any cancer cells that may remain after surgery. Potential treatments include radiation, hormone therapy, chemotherapy, and targeted therapy.
In some cases, some cancer cells survive these treatments. These cancer cells may break away from the original tumor. These cells then make their way to other parts of the body via the circulatory or lymphatic systems.
Once the cells settle somewhere in the body, they have the potential to form a new tumor. This can happen quickly or develop years after initial treatment.
Several tests are used to confirm a diagnosis of metastatic breast cancer. These include:
- MRI
How Fast Breast Cancer Grows
People may wonder about growth or doubling time when considering how long to wait to begin treatment. This growth is also very important to understand if you have a lump and have been advised to simply observe it over time.
Unless your healthcare provider is extremely confident that a lump is benign, it should be evaluated right away rather than waiting.
In general, the growth of breast cancer can be quite variable, but several studies provide at least an estimate of what may be happening.
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How Breast Cancer Metastasizes
When breast cancer metastasizes, the cancer cells enter the lymphatic channels or the bloodstream and spread to lymph nodes or other organs of the body.
Breast cancer cells can travel away from the breast and get into the blood stream fairly easily, but only a select few can survive and grow in other organs. Typically, your body will reject or attack things it doesnt recognize , but in the case of metastasis, cancer cells seem familiar enough that different areas of the body allow them to grow. The most common locations of breast cancer metastases are the liver, bones, lungs and brain.
If you had breast cancer before, this new diagnosis may be referred to as recurrent disease. In this case, some of the primary cancer cells survived the treatments you may have had after your early-stage diagnosis. Systemic therapies like hormonal therapy and chemotherapy aim to eliminate cancer cells in the breast as well as those that may have already started traveling to other parts of the body. But in some cases, those cells escape the treatment and begin to grow later.
Many doctors have researched the process of metastasis, but to date no one can predict how long cancer cells will be inactive before they begin to grow and can be detected.
Your doctors should run tests to make sure that the cancer cells from the metastatic site are the same as your primary diagnosis . They will adjust your treatments if necessary, for the best results possible.
Living With Metastatic Breast Cancer
When cancer comes back or is found in other parts of the body, it can be very upsetting for you, your family, and other loved ones. In this section, you can read about ways to live with metastatic breast cancer, manage feelings, get support, and talk to family and friends.
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How Effective Are Treatments For Bone Metastases
Although current treatments for bone metastases are unable to completely remove all cancer cells, many women with bone metastases can live for many years with extremely good quality of life.
The effect of bone metastasis on your prognosis is individual and depends on what type of cancer you have, where it has spread to and how you respond to various treatments. The main aim of any treatment is to control pain and other symptoms so you can enjoy your day-to- day activities as much as possible.
Symptoms Of Metastatic Cancer
Metastatic cancer does not always cause symptoms. When symptoms do occur, what they are like and how often you have them will depend on the size and location of the metastatic tumors. Some common signs of metastatic cancer include:
- pain and fractures, when cancer has spread to the bone
- headache, seizures, or dizziness, when cancer has spread to the brain
- shortness of breath, when cancer has spread to the lung
- jaundice or swelling in the belly, when cancer has spread to the liver
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Myth #: Metastatic Breast Cancer Is A Single Type Of Cancer That Will Be Treated The Same Way For Every Person
The label metastatic contributes to the myth that it is one kind of breast cancer. But like earlier-stage breast cancers, stage IV cancers can have different characteristics that will guide treatment choices. They can test positive or negative for hormone receptors and/or an abnormal HER2 gene the gene that causes the cells to make too many copies of HER2 proteins that can fuel cancer growth. These test results guide treatment choices.
For triple-negative stage IV cancers meaning they test negative for hormone receptors and an abnormal HER2 gene testing for PD-L1 is becoming more common. PD-L1 is a checkpoint protein found on the surface of healthy cells that prevents the bodys immune system T-cells from attacking them. Some breast cancer cells also have large amounts of PD-L1 on their surfaces, which helps shield them from the bodys immune response. Newer immunotherapies are being used to treat PD-L1-positive MBC.
Furthermore, treatment choices can depend on a persons age, overall health, and whether there are other medical conditions present.
The bottom line? Treatments vary. DivineMrsM of Ohio says it well: There is the misconception that there is one standardized treatment for every case of MBC, like a one size fits all. But there are different approaches and it cant always be said that one approach is better than another. Most people dont realize different subcategories of this disease.
Myth #: Metastatic Breast Cancer Is Curable
Whether metastatic breast cancer is someones first diagnosis or a recurrence after treatment for earlier-stage breast cancer, it cant be cured. However, treatments can keep it under control, often for months at a time. People with MBC report fielding questions from family and friends such as, When will you finish your treatments? or Wont you be glad when youre done with all of this? The reality is they will be in treatment for the rest of their lives.
A typical pattern is to take a treatment regimen as long as it keeps the cancer under control and the side effects are tolerable. If it stops working, a patient can switch to another option. There may be periods of time when the cancer is well-controlled and a person can take a break. But people with MBC need to be in treatment for the rest of their lives.
As Breastcancer.org Community member Vlnprh of Wisconsin comments: The vast majority of people have no idea what MBC treatment involves. They somehow think that you will undergo something similar to early-stage patients surgery, radiation, chemo, whatever and then be done. They want to see you as a pink-tutu-wearing cheerleader jumping up and down declaring that you have beaten this disease
Amarantha of France writes: The one I get over and over is, How long will you be on this chemo? I mean doesn’t it end sometime? Yes, it ends when it stops working and then we go on to another treatment lather, rinse, repeat I guess until we run out of options.
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Where Can Breast Cancer Go
Breast cancer mostly spreads to the bones, lungs, liver, and brain. When it does, you may start to notice symptoms that affect that area of your body.
Bones: swelling, intense pain, bones that break easily, and pain in your bones, back, neck, or joints
Lungs: long-lasting cough, trouble breathing, chest pain
Liver: Jaundice, or skin with a yellow tint, rashes and itchy skin, not feeling hungry, stomach pain
Brain: headaches that wonât go away, problems with your vision, seizures, vomiting and nausea, memory troubles, feeling dizzy
Other, less common, places where breast cancer spreads include:
- Ovaries
- Adrenal glands
- Pancreas
- Skin
Let your doctor know as soon as you can if you have any of these symptoms. They donât always mean your cancer has moved to another organ, but your doctor might want you to take some tests to make sure.
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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Metastatic Breast Cancer Symptoms In The Liver:
This can be a bit trickier to identify because the symptoms can be similar to other stomach and gastrointestinal issues, says Dr. Taiwo. Often a person will have abdominal pain, nausea, and vomiting, or even jaundice , depending on how much the cancer has spread in the liver. By the time that a patient tends to present with symptoms, they already have a fairly significant burden of disease, she saysâmeaning that their cancer has already progressed to make them very sick.
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.
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Stages Of Breast Cancer: Stage Iiic
Stage IIIc breast cancers basically involve tumors of any size with significant metastases to:-
- the lymph nodes behind the sternum
- lymph nodes under the arm
- the lymph nodes above or below the collarbone
The extent and depth of lymph node involvement make these patients unsuitable candidates for surgical treatment as a primary mode of therapy.; Chemotherapy is the treatment of choice for women with stage IIIb and IIIc breast cancers.
However, up to 70% of patients with stage III breast cancers who have chemotherapy remain alive and disease-free after 7 years.
How Quickly Breast Cancer Develops
You may have heard remarks that cancer has been present for five years before it is diagnosed, and this may sometimes be true.
The actual time it takes for breast cancer to grow from a single cancer cell to a cancerous tumor is unknown, as estimates based on doubling time assume that this is constant throughout the duration of tumor growth.
If doubling time were constant, cancer with a doubling time of 200 days would take 20 years to develop into a detectable tumor, and a doubling time of 100 days would take 10 years to be evident on exam.
In contrast, a breast tumor with a doubling time of 20 days would take only 2 years to develop.
Since the majority of studies have found the average doubling time to be between 50 days and 200 days, it’s likely that most breast cancers that are diagnosed began at least 5 years earlier .
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Can Liver Metastases Be Treated And If So How
One option, if there is disease restricted to the liver, is stereotactic radiation, which goes directly to the cancer cells. Ablation is another option, although rarely used, and it uses coldness, heat, or electrical currents to destroy the tumor. Chemotherapy, is the standard, and most common way that liver metastases are managed.
Where Does Breast Cancer Metastasize To
Sometimes, breast cancer spreads to other parts of the body. This does not always happen, but when it does, it is known as metastatic breast cancer.
Metastatic breast cancer is treated differently than localized breast cancer. As a result, oncologists typically check for evidence of metastasis during the diagnostic/staging process. Additionally, breast cancer can spread after a patient has been diagnosed. To watch for potential signs of metastasis, patients are typically scheduled for frequent imaging scans during and after treatment.
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Where Is The First Place Breast Cancer Spreads
The first place that breast cancer commonly spreads to outside the breast are the lymph nodes in the armpit . Surgery is usually needed to remove one or more lymph nodes to help check for breast cancer spread. This operation to remove lymph nodes in the armpit is known as axillary surgery.
Breast cancer found in the lymph nodes will impact the breast cancers staging, and the treatment plan will often be affected as well.
If cancer is found in the lymph nodes, there is a higher chance that cells have travelled through the lymphatic system and bloodstream to spread to other parts of the body. In this instance, treatment with systemic therapies, such as; chemotherapy, is likely to be recommended.
If cancer is found in a large number of axillary nodes, radiotherapy may also be recommended to kill any breast cancer cells that remain in the armpit but cannot be removed by surgery.