ADVANCED BREAST CANCER

Advanced Breast Cancer

What is advanced breast cancer? Advanced, or metastatic, breast cancer is cancer that has spread beyond the breast and past the lymph nodes, to form metastases in other parts of the body, such as lungs, liver, brain, and bones. This stage is called Stage IV cancer. About one in ten breast cancers are Stage IV when they are first diagnosed.

Advanced breast cancer may also be a cancer that “came back.” In this case, it is also called recurrent cancer.

Recurrent Breast Cancer

Sometimes, after the initial treatment, your physician may find evidence that the cancer “came back”—in other words, that you have a recurrence. The recurrence may be local (a small lesion in the breast, along the incision, or near the chest wall), regional (in and around the lymph nodes), or it may be in the form of distant metastases in remote organs of the body. Cancer recurrences usually occur within two to six years after the initial diagnosis, but sometimes even decades later.

You will undergo additional testing to make sure that there are no cancersites elsewhere in your body. The tests are probably already familiar to you from your first encounter with breast cancer. They include MRI, CT, bone scans, and other means of pinpointing areas where cancer may have spread—locally or to distant areas. At that time the decision will be made regarding additional treatment.

A local recurrence will generally be treated with the same approach as an original cancer: surgery, with or without radiation therapy, and possibly chemotherapy or hormone therapy, depending on the size of the tumor and cell grade.

In advanced stages, breast cancer spreads to the lungs, liver, brain, bones and soft tissues. If the recurrence is in another part of the body, rather than in the breast area, treatment will require a systemic approach targeting the entire body. Recurrences that are found in other organs have a much more serious impact on the course of your disease than local recurrences such as may be found near the lumpectomy scar.

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Treatment of Advanced/Metastatic Breast Cancer

Sometimes, despite the best efforts for early detection, the cancer is not found until it is Stage IV and it has spread to other parts of the body. The reality of Stage IV cancer (advanced breast cancer and recurrent breast cancer with regional and distant metastases) is that it is usually not possible to remove this cancer completely from your body. Most treatments for advanced/metastatic breast cancer will try to shrink the tumor or to stop it from growing. The good news is that today there are many treatment methods that can greatly improve your quality of life, and extend the time that you remain free of any evidence of the disease.

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Surgery

Surgery in the form of a lumpectomy or mastectomy is the key treatment in early breast cancer. But it is not as useful in advanced breast cancer, that presents with metastases outside the breast. If you were diagnosed with a breast cancer that is present in your breast and in other parts of your body, it is possible that your healthcare team may suggest that you forego a mastectomy. The reason is that the greatest threat to your health comes not from the tumor in the breast, but from the distant metastases that damage other organs, which generally are difficult to treat surgically.

Surgery may play a role in removing a small, solitary tumor from your lung or liver, or another part of the body where it is applying pressure on another organ. This is called palliative surgery.

Radiation Therapy

Radiation therapy may be used to shrink metastases in distant organs. The treatment will be done by external beam rather than by brachytherapy. You may need only a few treatments, rather than the entire five to seven week course.

Chemotherapy, Hormone Therapy and Targeted Therapy

In early cancer, chemotherapy is given to destroy undetectable cells that may or may not have spread through the body, and there is no way to monitor the success of the therapy.

In advanced cancer, your healthcare team may be able to use X-rays or CT scans to observe the tumor as it shrinks from the chemotherapy. If progress is unsatisfactory, the team will be able to switch to another drug, or a combination of drugs. You may want to review the Chemotherapy section for tips on how to deal with the side effects.

Bones are common first sites to which breast cancer tends to spread. You may be treated with additional drugs called bisphosphonates that specifically target bone metastases, and are given with your regular chemotherapy or hormone therapy.

Hormone therapy as well as targeted therapy can also be used effectively to control the growth and spread of advanced breast cancer.

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Coping with Advanced Breast Cancer

It is important for you and your healthcare professionals to be realistic about the probable course of advanced breast cancer. But it is just as important for you to remember that every woman is different, and every cancer runs a different course. Your task now is to avail yourself of all possible resources, and become determined to work toward the best outcome possible.