When Breast Cancer Spreads: What to Expect
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Breast cancer that has spread to another part of the body is considered metastatic breast cancer, also called advanced or stage 4 breast cancer, according to the National Breast Cancer Foundation. In many cases there's no cure, but that doesn’t mean there isn’t reason for hope. Newer treatments are allowing many women to live with advanced breast cancer for years, says Otis W. Brawley, MD, chief medical and scientific officer for the American Cancer Society (ACS).
In fact, women with metastatic breast cancer could live for a decade or more, Dr. Brawley says. “When people have metastatic disease to multiple sites, the goal is to get to a point where they can live in peaceful coexistence with the disease,” says Brawley, who is also a member of the Centers for Disease Control and Prevention Advisory Committee on Breast Cancer in Young Women.
The number of women living with metastatic breast cancer increased by about 30 percent from 1990 to 2013, according to research published in June 2019 in the journalCancer Epidemiology, Biomarkers & Prevention. The researchers point out that the five-year survival rate for younger women with metastatic breast cancer doubled between 2005 and 2012 relative to 1992 to 1994.
Understanding the Diagnosis
After undergoing successful treatment for early-stage breast cancer, some women will relapse and develop metastatic disease months or years later, Brawley says. “The longer a person goes without relapse, the more likely they aren’t going to relapse,” he says.
Unfortunately, there are no guarantees. Tiny groups of cancer cells can break away from a breast tumor at an early stage. These cells evade treatment and stealthily travel to another part of the body through the blood or lymphatic system.
“Women with early-stage breast cancer may have disease that’s spread but isn’t visible on diagnostic tests, such as a CT scan or MRI,” Brawley says. “That metastatic growth can sit there for years before it starts growing and becomes detectible.”
When breast cancer metastasizes, it most commonly spreads to the bones, lungs, brain, or liver, according to the National Cancer Institute (NCI). Even if the cancer spreads to another part of the body, it’s still breast cancer and treated accordingly. For example, breast cancer that spreads to the liver is not liver cancer. The tumor may be in a different part of your body, but it’s still made up of breast cancer cells, Brawley explains.
Advanced breast cancer can cause general symptoms like loss of appetite and weight loss, but symptoms of the disease can vary depending on where it’s located.
For example, breast cancer that spreads to the bone can lead to bone or joint pain as well as numbness, weakness, and bone fractures. If the disease spreads to the lungs, it can cause a dry cough, trouble breathing, and chest pain. If it spreads to the liver, you may have bloating or jaundice. Breast cancer that spreads to the brain can trigger headaches, vision problems, seizures, loss of balance, and confusion.
Setting Treatment Goals
In many cases, advanced breast cancer can’t be cured or completely eliminated, but it can be managed. Treatment involves controlling tumor growth and prolonging life. It’s also a balancing act between treatment expectations and your tolerance for side effects, says Jame Abraham, MD, a breast oncologist and director of the breast oncology program at the Cleveland Clinic.
“When I see someone with metastatic disease, I want to know who that person is and learn about her expectations, hopes, and dreams,” Dr. Abraham says. When determining the best course of treatment, additional considerations include other medical issues you may be facing, what type of breast cancer you have, where it’s spread, and the extent of the disease, he says.
Treatment for advanced breast cancer usually involves one or more therapies used one after another or in combination, Brawley says. These may include:
- Hormonal therapy.This is often used to shrink or slow of the growth of hormone receptor-positive cancers. It works by blocking the body’s ability to produce hormones or interfering with the effects of hormones on breast cancer cells, according to the NCI. Some hormone-responsive breast cancers can be effectively treated with drugs that manipulate hormones, allowing women to live symptom-free with good quality of life for many years, Brawley says.
- Chemotherapy.This is often part of the initial treatment for those struggling with serious symptoms of metastatic breast cancer, such as trouble breathing, according to the ACS. “This is the kind of disease where the goal is to prolong life as much as possible,” Brawley says. “Sometimes the disease is like a smoldering fire. Chemotherapy may be given every couple of weeks to keep it under control.”
- Targeted therapy.As the name suggests, these treatments target specific characteristics of cancer cells that fuel their growth. Targeted therapies are less likely to destroy healthy cells than chemotherapy, Brawley says.
In some cases, surgery and radiation may also be needed, the ACS notes.
Clinical trials are an important option for people with advanced breast cancer that could help prolong their lives and improve their quality of life, Abraham says. “Clinical trials aren’t a last resort," he says. "They’re the gold standard of cancer treatment. Tremendous improvement in new treatments has been seen from clinical trials.
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