What is Metastatic Breast Cancer
A diagnosis of breast cancer can be an overwhelming experience for individuals and their loved ones. Being told that you have metastatic or advanced stage breast cancer can be even more devastating.
However, metastatic disease does not mean one should lose hope. Many individuals continue to live long and productive lives with advanced stage breast cancer. There are a variety of treatment options available and new medicines are being studied to further improve the lives of those affected.
While metastatic breast cancer may not be cured completely, treatment can control it for some time. The health care professionals in charge of the management and care of those affected can suggest the most appropriate treatment option, and if that option fails, another one can be tried. The cancer can be active for some time before going into remission.
What is metastatic breast cancer?
Metastatic breast cancer is also known as stage 4 or advanced cancer. This occurs when cancer cells detach themselves from the original tumor and travel to other parts of the body, mainly the bones, brain, liver, or lungs, through the blood stream or lymphatic system (a network of nodes and vessels that remove the body’s toxins and waste products).
Some individuals after being in remission can have a recurrence of their cancer in another part of the body. Nearly 30% of individuals diagnosed with early-stage breast cancer will later develop metastatic disease.
There are some who have metastatic breast cancer at first diagnosis, which means the cancer in the breast was not detected early enough, before it spread to another part of the body.
What are the symptoms of metastatic breast cancer?
Breast cancer tends to present as a lump, skin changes (swelling, dimpling, irritation or rash) and nipple changes (pulling or retraction and discharge). Metastatic breast cancer is not the same for everyone, and the symptoms depend on the degree and site of cancer spread.
If the cancer has spread to the bones, it can cause severe and progressive bone pain, swelling and fracturing of the bones.
If there is spread to the brain it can cause worsening headaches or pressure to the head, visual disturbance, nausea and vomiting, seizures, and personality changes.
Metastasis to the liver can cause jaundice, skin itching, rash, abdominal pain, nausea, vomiting and loss of appetite. Blood tests are also likely to indicate abnormal liver function.
Spread to the lungs tends to present in individuals as a chronic and progressive cough, chest pain, and nonspecific symptoms, such as fatigue, weight loss and poor appetite. The nonspecific symptoms can also be due to the treatment or low mood (which is common in those with cancer).
Can metastatic breast disease be treated and if so, what are the treatment options available?
Although metastatic breast cancer currently has no cure, there are many treatment options available. Getting the right treatment can improve one’s quality of life and increase longevity.
Treatment approaches for metastatic breast cancer are individualized, taking into consideration the type of cancer it is, parts of the body to which it has spread and personal preference. Treatment options are very similar to the ones used during the other stages of breast cancer.
After being diagnosed with metastatic breast cancer, it is often helpful for individuals to allow some time to process all the information and make an informed decision about their care and treatment. As this is an extremely overwhelming time, it is crucial for family members and friends to be very supportive and understanding towards what their loved one is going through.
The treatments available for metastatic cancer include:
Hormonal treatments — they are commonly given as first line treatment to those with estrogen receptor positive (ER positive) metastatic breast cancer. These treatments work by lowering the amount of the estrogen hormone in the body, and by blocking its action on breast cancer cells. In advanced stage breast cancer, they can help shrink or slow cancer growth. One of the commonly used hormone treatments is called Tamoxifen.
Chemotherapy — this treatment uses anti-cancer drugs to destroy cancer cells. It works by interfering with the cancer cells’ ability to divide and grow. Chemotherapy drugs that treat metastatic breast cancer often differ from those used at the time of initial treatment.
Radiation therapy — this uses high-energy radiation to destroy cancer cells and shrink the tumor. In metastatic breast disease, it may be used to help reduce symptoms. Biologic or Targeted Treatments- this form of treatment uses drugs to target specific genes and proteins that are involved in the growth and survival of cancer cells. Targeted treatments are meant to spare healthy tissues and cause fewer and less severe side effects than chemotherapy.
Breast surgery — in metastatic disease, surgery may not be a good choice of treatment, as it is unlikely to remove all the cancer cells. This is especially true if the cancer has spread to more than one location. Although, this may still be recommended by the doctor to reduce complications such as fracturing of bones and pain.
During treatment, the health care team will of course continue to check to make sure the cancer has not worsened, manage any side effects, and monitor overall health. This may include regular physical examinations, blood tests, or imaging tests.
Living with metastatic breast cancer
Living with metastatic cancer can undoubtedly be quite tough. Each person has their individual concerns and struggles. Family members and carers also find it hard and emotionally challenging. A good first step in dealing with this condition and its challenges is to be able to recognize any fears and maybe talk about them. This may require:
- Understanding the challenge
- Thinking through solutions
- Asking for and allowing the support of others
- Feeling comfortable with the course of action chosen
Individuals with metastatic breast cancer are encouraged to follow a good lifestyle. This includes not smoking, limiting alcohol, eating well, and managing stress.
Regular physical activity is helpful in building strength and energy levels. The health care team can help create an appropriate exercise regime based upon the needs of the individual, their physical ability, and fitness level.
Cancer rehabilitation is also helpful to many. This includes a wide range of services such as physical therapy, career counselling, pain management, nutritional planning and emotional support and counselling. The goal of cancer rehabilitation is to help individuals regain control over many aspects of their lives and remain as independent and productive as possible.
Having a diagnosis of metastatic breast cancer does not mean one should lose hope, as there are many treatment options available and ways to live life as comfortably and productively as possible. With advancements in treatment, the overall outlook is also improving. Health services are getting better in providing a more holistic care pathway, which can be comforting for many.
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