Advanced (Metastatic) Breast Cancer and Recurrences
Courage is as often the outcome of despair as hope; in one case we have nothing to lose, in the other, all to gain.
— Diane DePoitiers
Advanced (Metastatic) Breast Cancer
A diagnosis of advanced breast cancer means that cancer cells have metastasized (spread) outside of the breast to other parts of the body. If breast cancer spreads to a different part of the body, it is still regarded as breast cancer. (For example, if breast cancer spreads to the lungs, it is not lung cancer; it is still breast cancer.) Advanced or metastatic breast cancer is also sometimes referred to as Stage IV breast cancer.
When breast cancer metastasizes or spreads, it usually goes to the bones, lungs, liver, as well as to the skin and underlying soft tissue around the surgical scar and to lymph nodes. Less commonly, it may also spread to the brain, spinal cord and eye.
What are some of the symptoms?
Metastatic breast cancer can be the initial diagnosis (Stage IV). More commonly, it may also be a recurrence (return) of breast cancer following initial treatment. (Recurrence will be discussed in more detail later in this section.) Diagnosis of metastatic breast cancer is generally done using some combination of the following tests: bone scan, chest X-ray, CT scan, MRI scan or PET scan. Some symptoms of metastatic breast cancer may include:
- bone pain that does not go away;
- shortness of breath, chest pain, or cough;
- pain or discomfort under the right side of the ribcage that won’t go away;
- lack of appetite;
- unexplained weight loss;
- neurological pain or weakness and headaches;
- irregular gait.
These symptoms, if they persist for more than two weeks, may be possible signs of metastasis to the bone, lung, liver, brain or other parts of the body. However, this does not mean that every woman who experiences them will have metastatic breast cancer. There can be a variety of other reasons why you might experience the above symptoms that may have nothing to do with cancer of any kind. Short-lived aches and pains and lumps often have nothing to do with cancer, but can be a normal part of aging or other conditions. If something serious is happening, it will most likely persist and get worse. The important thing is that you listen and pay attention to your body and that you see your doctor to determine the cause of the symptoms.
How is metastatic breast cancer treated?
Since every woman is different, and each situation is unique, the treatment options may vary. However, treatment of Stage IV breast cancer involves systemic (whole body) treatment such as chemotherapy. Other treatment options may include additional surgery, radiation, hormonal therapy or use of other drugs that may shrink or stabilize the tumors and provide symptom relief.
The type of treatment you receive to treat your disease depends on your physical condition, how the disease has progressed, options available to you and your doctors, and your own choice. You can decide what is right for you.
What is inflammatory breast cancer? Is it considered advanced breast cancer?
Inflammatory breast cancer has the appearance of inflamed breasts (red and warm), and the skin of the breast looks thick and sometimes pitted. It is sometimes difficult to distinguish from benign (non-cancerous) conditions such as mastitis (a breast infection). For this reason, misdiagnosis or delayed diagnosis may occur.
Inflammatory breast cancer is a rare form of breast cancer and accounts for only one to three percent of all breast cancer cases. However, it is an aggressive breast cancer and may spread quickly to other parts of the body.
Inflammatory breast cancer is usually classified as Stage III breast cancer (meaning it has spread to nearby lymph nodes). If it has spread to distant organs or lymph nodes that are not near the breast, it would be classified as Stage IV. Inflammatory breast cancer usually requires aggressive treatment.
What are the chances of surviving metastatic breast cancer?
Some women have lived many years with metastatic breast cancer, with a small percentage of them in complete remission (no symptoms). While the average length of survival is only three to four years, thanks to increased treatment options available, many women can live for an extended period of time with advanced disease. Metastatic breast cancer can respond well to treatment.
In the 1990s, there were significant advances in the treatment of metastatic breast cancer. New drugs such as Taxol, Taxotere, Herceptin and aromatase inhibitors were developed. Many of these therapies were first introduced in clinical trials for women with metastatic breast cancer. Currently, there are new hormonal therapies, new chemotherapy drugs, new vaccines and other targeted biological treatments being developed.
Women with metastatic breast cancer may want to consider entering a clinical trial for one of the promising new drugs. Sometimes the treatments are more effective than the standard of care, and sometimes they are not. Regardless, women in clinical trials usually receive state-of-the-art care and are helping to identify new and better treatments for women with breast cancer in the future. (For more information, see Chapter 2: Breast Cancer Risk, Diagnosis and Treatment.)
It is important for every woman—whether she has been diagnosed with advanced breast cancer or not—to be proactive with regard to her health and healthcare. To this end, you can:
- Establish and maintain healthy lifestyle habits, including good nutrition and exercise;
- Become very familiar with your own body and be aware of what is “normal” for you;
- Trust your instincts and seek medical attention when unusual changes occur;
- Be persistent in communicating your concerns to your doctors and do not give up until you are satisfied that your concerns are adequately addressed;
- Remember that you have the right to choose—your doctor as well as your treatment.
If you are not happy with your treatment, you can go somewhere else. Different medical centers offer different experimental treatments. It is always a good idea to seek a second opinion from a breast oncologist at a major cancer center when you are making a difficult treatment decision. Ask your doctors, and do some research. There may be a new treatment or clinical trial offered at a different hospital, even one out of state, that will work better for you.