Answering Common Questions about Metastatic Breast Cancer
Monique Simpson, RN
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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.
