Topics: Breast Cancer
May 6, 2020
Metastatic breast cancer, which may also be referred to as Stage IV breast cancer, indicates that cancer has spread from the breast tissue and the nearby lymph nodes to other organs in the body, most commonly the bones, lungs, liver or brain. Any type of breast cancer (estrogen-positive, HER2-positive, etc.) can metastasize (spread) to other areas of the body.
When a tumor is found outside of the breast, it's made up of breast cancer cells. For example, if you have a tumor in the lungs that is metastasized breast cancer, it contains breast cancer cells, not lung cancer cells. These cells may no longer react to the treatments given in the past, meaning that new cancer therapies may be necessary.
The sooner you can detect cancer that has spread to other areas of the body, the easier it will be to contain and treat. That means it's important to know some of the signs of metastatic breast cancer.
What Are the Signs of Metastatic Breast Cancer?
You will usually show some of these signs before receiving confirmation that the breast cancer has spread. However, you may not associate these symptoms with metastatic breast cancer when only one or two appear. Be sure to talk to your oncologist if you notice any of the following:
- Consistent back, joint, or bone pain
- Severe headache
- Difficulties urinating. This can include incontinence or not being able to urinate at all. This happens when the cancer pinches the nerves in your back.
- Numbness or weakness anywhere in your body
- Difficulty breathing
- Chest pain
- Bloating, pain, or tenderness in the abdominal region
- A constant dry cough
- Vision issues, such as blurry vision, loss of vision, or double vision
- Shortness of breath
- Chest pain
- Loss of appetite
- Balance issues
- Signs of jaundice, such as a yellow tinge to your skin or the whites of your eyes
- Consistent nausea, vomiting, or weight loss
These symptoms can also develop from other medical issues. After talking to your oncologist, he or she may ask for some tests to be run to see if there are breast cancer cells in other areas of the body.
How Does Your Oncologist Determine Metastatic Breast Cancer?
If you’re seeing a different cancer care provider than you did on your last round of treatment, it’s a good idea to bring all of your medical records with you from the previous oncologist. This will help your current cancer specialist understand the type of cancer, its stage, and what was done to treat it. This information can have an impact on what steps are taken next.
After meeting with the oncologist, there are likely some tests to be run to determine what may need to be done next. Here are some common tests for breast cancer detection:
- Blood tests. This can include tumor markers in some patients.
- Whole-body bone scan and this can include X-rays of specific bones
- PET scan
- MRI of the spine or brain
- Biopsy of any suspicious area
- CT scan of the chest, abdomen, pelvis, and/or brain
- Bronchoscopy for patients with a constant cough or trouble breathing
- Spinal tap to remove fluid from around the spinal cord
- Pleural tap checks the fluid between the chest wall and lungs
- X-ray or ultrasound of the abdomen or chest
Your doctor may start out by ordering a couple of tests and based on the results may request further testing. This is so they can get a clear picture of how extensive the cancer has spread throughout the body. This also helps your oncologist come up with the treatment plan they feel will work best for you.
Treatments for Metastatic Breast Cancer
Once you have confirmation of metastatic breast cancer, and your oncologists have the information they need, a treatment plan can be created. In some cases there is a combination of treatments required. One or more of the following may be included in your treatment plan for metastatic breast cancer:
- Hormone therapies: The most common approach and treatment for metastatic estrogen or progesterone receptor-positive breast cancer is hormone therapy. You may have already used one or more of these in your previous treatments. Based on your history, the oncologist may recommend a new hormone therapy. The most common hormone therapies are:
- Tamoxifen: This treatment blocks estrogen in both pre and postmenopausal women. It's used primarily in young women who haven't had hormone therapy before, and it's designed to contain and shrink the tumors.
- Fulvestrant: After attaching to the estrogen receptors, this drug changes the shape of the receptors and degrades it preventing further tumor growth. This should slow the growth of cancer cells.
- Aromatase inhibitors: These hormones stop the actions of the enzyme aromatase, which is responsible for the conversion of androgens to estrogens. The hope is that this will lower levels of circulating estrogen and stop the growth of cancer cells.
- There are other hormone therapies being introduced for advanced breast cancer. Talk to your oncologist about what is available if you have used these other hormone therapies already.
- Chemotherapy drugs: If you've already battled breast cancer, you may find some drugs you're familiar with while others are used more often for metastatic breast cancer. This is the most common approach for metastatic breast cancer that is :
- Hormone-receptor negative
- Hormone-receptor positive, but doesn’t respond to hormone therapies
- HER2-positive, in combination with a targeted therapy
- Chemotherapy tends to work quicker than hormone therapy, which may also be a consideration for whether it’s used right away.
- Targeted therapies: Most commonly used for HER2 positive breast cancers, this category of drug targets the HER2 protein on the cells which fuels cancer cell development.
- Immunotherapies: These drugs, which help your immune system fight the cancer, are less commonly used for breast cancer, but may be used in combination with other treatments.
- Surgery: Sometimes surgery to remove a tumor that has developed in another area of the body is necessary to avoid further growth. The location of the tumor dictates if surgery is a possibility.
There may also be the possibility of a clinical research trial available through Arizona Oncology for advanced-stage breast cancer. You can discuss your openness to clinical research during your appointment.
If you've been previously diagnosed with breast cancer, it's critical that you attend your regularly scheduled check-ups, even years later. At the first signs of metastatic breast cancer, you need to contact your oncologist.
At Arizona Oncology, we understand your apprehension, and we're ready to help you at each step of the process.