Answering Common Questions about Metastatic Breast Cancer

What is Metastatic Breast Cancer?

Breast cancer occurs when healthy cells change and form abnormal malignant cells

within breast tissue. When those cancer cells spread from the breast to another part

of the body, it is called metastatic breast cancer.

Once breast cancer is diagnosed, a process called staging determines how much of

the cancer is within the breasts and lymph nodes and whether it has metastasized,

or spread to other areas of the body. Your oncologist will conduct several tests to

determine your breast cancer stage.

Metastatic breast cancer, also referred to as stage 4 breast cancer, is the most

advanced stage of breast cancer. Breast cancer cells from the initial tumor site travel

to other parts of the body and begin to grow new tumors. Although metastatic breast

cancer is not curable, it is treatable.

If you are diagnosed with metastatic breast cancer, you can be optimistic with

greater hope than ever before. Recent progress in treatments tailored for advanced

breast cancer enables people to enjoy a longer and improved quality of life.

How Does Breast Cancer Metastasize (spread)?

Breast cancer can spread locally to nearby areas of the body or travel to distant

areas using the body’s blood vessels or lymphatic system. When breast cancer cells

invade other nearby healthy cells, they take over and start making more abnormal

cells.

However, when breast cancer cells get into the bloodstream or lymphatic system,

they travel through the walls of nearby veins and blood vessels. They can get stuck in

tiny blood vessels. When they stop moving, they can begin growing small tumors in a

new place.

Breast cancer can metastasize to any area of the body. However, the most

commonly affected areas are bones, brain, liver, and lungs. Although breast cancer

cells can spread to other parts of the body, they retain the name of their source

location. So, when breast cancer spreads to the bones, it is still called metastatic

breast cancer, as opposed to bone cancer.

What is De Novo Metastatic Breast Cancer?

If you are newly diagnosed with breast cancer that has already spread to another

area of your body, it's called "de novo" metastatic breast cancer. De novo is a Latin

phrase that can be used to describe a biological process that has begun again. This

refers to the process of tumor formation beginning again in another area of your

body.

Is It Possible to Get a Metastatic Breast Cancer Diagnosis Even After Treatment of a Primary Tumor?

Yes, in some cases, people who were previously diagnosed and treated for breast

cancer are later diagnosed with metastatic breast cancer. This can happen when

cancer cells remain in the body after the initial treatment.

Some cancer cells that survive can stay inactive or hidden, making them hard to find

until they start growing and spreading again. When they do, they usually first move to

nearby lymph nodes or blood vessels. Then, they can travel through the lymphatic

system or bloodstream to other parts of the body.

What are the First Signs of Metastatic Breast Cancer?

The first signs of metastatic breast cancer may differ based on where the cancer has

spread in the body. Make sure to tell your breast cancer specialist about any new

symptoms you have so they can plan the best treatment.

Here are some potential signs and symptoms to watch for based on the area

affected:

Bone Metastasis

When breast cancer has spread to the bones, it usually causes a new pain in that

location. The most common bones affected are the ribs, spine, pelvis, arm, and leg

bones. However, any bone can be affected.

Brain Metastasis

Some symptoms that breast cancer has spread to the brain can include headaches,

speech or vision changes, and memory problems. It can also cause dizziness, loss of

balance, and seizures.

Liver Metastasis

Breast cancer that has spread to the liver might go unnoticed. Otherwise, it may

cause jaundice (yellowing of the skin and eyes), itchy skin, abdominal pain, tiredness,

weight loss, or loss of appetite.

Lungs Metastasis

Likewise, when breast cancer spreads to the lungs, it doesn't always cause

symptoms. When there are symptoms, it can cause chest pain, trouble breathing, or

a constant dry cough.

Other General Metastasis Symptoms

There are also nonspecific symptoms that can be caused when breast cancer has

metastasized. They may include fatigue, unintentional weight loss, nausea, or

vomiting.

What if I Don’t Have Any Symptoms? How Would My Oncologist Know if My Cancer Has Spread?

During the follow-up visits with your breast cancer specialist, they'll do blood tests to

check for "tumor markers." If the numbers go up, it could mean the cancer is

spreading somewhere in your body. More tests will be done to find out exactly where.

Imaging studies such as X-rays, bone scans, CT scans, PET scans, and MRIs can be

used to look inside your body to help pinpoint any new tumors.

What Questions Should I Ask My Oncologist After a Metastatic Breast Cancer Diagnosis?

If you have been diagnosed with metastatic breast cancer, feeling overwhelmed,

anxious, and not sure what to ask your doctor is normal. However, it's important to

gain a better understanding of your diagnosis and treatment options. Asking the

right questions and getting accurate answers can help you feel less anxious and

more in control of the situation.

Meeting with a breast cancer specialist is the best way to get the answers you need,

so you can make informed decisions about your care. Your oncologist is there to

help, so don’t be afraid to speak up with any questions or concerns about your

condition.

As you weigh your options, here are some questions to ask your oncologist to help

you kickstart the conversation:

● Based on where my cancer has spread, what is my prognosis?

● Are there lifestyle changes I can make to reduce my symptoms?

● What tests will you do before deciding on my treatment plan?

● Will I need surgery?

● How soon do I have to decide about my treatment?

● What are the main goals of the treatment you suggest?

● Can you explain the risks and side effects of the treatment?

● How much downtime should I expect for the treatment?

● Will I need to arrange help from family or caregivers?

● How will we know if the treatment is helping?

● What if the treatment does not doesn't work?

● Should I think about getting another doctor's opinion before starting the

treatment?

● Is there a clinical trial available for my diagnosis?

Having a notebook is a helpful way to remember all the information you'll get at your

appointments. You can write down any questions you have and bring them with you

so you don't forget anything. Bringing a friend or family member with you can also

give you some extra support.

What Are the Treatment Options for Metastatic Breast Cancer?

People with metastatic breast cancer have many treatment choices available. These

treatments are often called systemic therapies because they fight cancer all over the

body. Some of these therapies have been approved recently, especially for stage 4

breast cancer patients whose cancer has come back after prior treatment.

Once your unique situation has been reviewed, your breast cancer specialist will

meet with the other providers in your cancer care team to create a personalized

treatment plan. The aim is to ensure that this plan fits your needs and gives you the

best results.

The decision about cancer treatment will include considering things like:

● the type of breast cancer you have

● the size and location of the new tumor

● your age and overall health

● the treatments you had before and how well they worked or didn't work

● how you wish to proceed and your quality of life

Some of the most common treatment options for Metastatic Breast Cancer include

systemic medications and localized treatments:

Systemic Medications

Oncologists typically treat metastatic breast cancer that has spread to any area of

the body with medicines that work throughout the entire body called systemic

medications.

Chemotherapy, hormonal therapy, targeted therapy, and immunotherapy

are all examples of systemic medications. They are usually given intravenously

(injected into your vein) or by mouth. Since these medications travel through the

bloodstream, they can reach nearly every part of the body. This makes them effective

against cancers that have spread to different areas of the body.

Chemotherapy works by killing cancer cells or by stopping them from multiplying.

This can serve as the primary treatment for women whose cancer has spread from

the breast and underarms to distant organs like the liver or lungs. It can be

administered when breast cancer is first diagnosed or after initial treatments.

Targeted therapy stops cancer growth by targeting proteins found on breast cancer

cells. Biomarker testing can check for gene mutations to see if a medication can

target them for metastatic breast cancer. If the cancer is hormone-positive,

HER2-positive, or triple-negative, there may be a medication that can slow the growth

of those “targeted” breast cancer cells.

Targeted drugs may work when chemotherapy drugs don't. Additionally, some targeted

medications can improve the effectiveness of other types of treatment.

Hormone therapy slows down or stops the growth of tumors that are sensitive to

hormones, like estrogen and progesterone, by either stopping the body from making

hormones or by stopping hormones from affecting breast cancer cells. This can be

done by stopping the ovaries from working or by blocking estrogen production.

Tumors that don't have hormone receptors cannot be treated with hormone therapy.

Immunotherapy helps boost the immune system to recognize and fight cancer cells.

Checkpoint inhibitors are the most commonly used form of immunotherapy

medication. They work by removing the natural barriers that restrict how the immune

system can manage cancer cells.

Scientists are continuing to research how to support the immune system's response to

breast cancer to enhance immunotherapies.

Localized Treatments

Localized treatments like surgery and radiation, focus on a specific part of the body

where breast cancer cells have traveled to. They can be used together with systemic

medications or on their own to treat metastatic breast cancer.

Radiation therapy uses high-energy rays to destroy cancer cells. It can shrink a

breast cancer tumor and help control specific spots where the cancer has spread.

Depending on the location, it can provide relief for tumors that have spread to the

bones, brain, or spinal cord. In many cases, the goal of radiation therapy is to relieve

nerve compression and pain caused by the growing tumor.

Surgery almost always plays a part in the treatment of people diagnosed with breast

cancer. After initial diagnosis, tumors can be surgically removed by

breast-conserving surgery or mastectomy (entire breast removal). However, surgery

is not commonly used to treat metastatic breast cancer. When breast cancer cells

metastasize to areas that are difficult to access or close to essential organs, surgical

removal may not be an available option.

Depending on the location, surgery can be used to remove tumors that cause pain or

neurological problems.

While there's no cure for metastatic breast cancer, treatment can keep it in check for

many years. If one treatment doesn't work, there could be another choice available.

Sometimes, the cancer is active, and sometimes, it goes away for a while.

Breast cancer specialists commonly use various treatments, alone or combined, based

on your condition. If your cancer is under control and you're feeling good, your

oncologist might even recommend taking a break from treatment.

When you are treated at a specialized cancer care center, your individualized

treatment plan will be arranged using a multi-disciplinary approach.

How Can I Practice Self-Care While Living with Metastatic Breast Cancer?

Living with metastatic breast cancer can be challenging. It's a condition that can

surprise you with a reappearance after you may have thought it was resolved. The

treatment may alter your appearance and how you feel about yourself. It affects your

relationships and your perspective on life. Metastatic breast cancer often forces you

to shift your priorities, leaving self-care at the bottom of the list.

It's not unusual to feel like self-care, the things we do for our emotional, mental, and

physical wellness, must be set aside to focus on treatment. However, it’s imperative

that you look after yourself both physically and emotionally, especially now.

● Support your body by eating well, staying active, and getting plenty of rest.

● Think about talking to a therapist or spiritual guide for emotional support.

● Talk to your doctor about any pain, trouble sleeping, anxiety, or sadness you

might be feeling, and ask if there are medications that can help.

At Cancer Care Centers of Brevard, we believe it's crucial to prioritize self-care

practices that make you feel good throughout and beyond your breast cancer

journey. Your overall health should be your top priority. Finding time for the little

things, like spending time with people you care about or doing the things you enjoy,

can significantly impact your mood, self-esteem, and overall quality of life.

Make sure to discuss self-care with your cancer care team. They can offer useful

resources such as nutrition and exercise guidance, stress management techniques,

support groups, and approved complementary therapies to enhance your quality of

life.

Is There a Cancer Care Center Available in Brevard County?

Cancer Care Centers of Brevard offers the latest in breast cancer treatment,

conducts clinical research, as well as provides education and support for people who

are concerned about or diagnosed with cancer. We also have a cancer survivorship

clinic that may help you manage the physical and emotional changes you may

experience after your cancer treatment.

If you are diagnosed with metastatic breast cancer, schedule a consultation with one

of our breast cancer specialists at any one of our 6 locations throughout Brevard

County, Florida. We have offices in Melbourne, Merritt Island, Palm Bay, and

Rockledge. We can help you review your options and create your personalized breast

cancer treatment plan.