Jacqui’s breast cancer spread to her bones. Her doctors can’t cure metastatic breast cancer, but they can control it for years with different treatments.
Breast cancer that spreads to other parts of the body is called stage 4 breast cancer or advanced disease. It usually spreads to the bones, lungs or brain.
Symptoms
When cancer reaches stage 4, it has spread to other parts of the body, or metastasized. Cancer cells can travel through the bloodstream or lymphatic system to reach new places in the body where they form tumors. Metastasis can occur at any point in the course of breast cancer. It usually happens after treatment for early stage breast cancer, such as lumpectomy or lumpectomy plus radiation, but it can also happen years later.
Symptoms of stage 4 breast cancer can include a new lump or enlarged area in one or both breasts. Sometimes the lumps may feel different in size, shape or texture. They may be hard, firm or tender. They can grow to be quite large and may even break through the skin, creating a wound or ulcerated area of the breast (called a pathologic nodule).
Another common symptom of stage 4 metastatic breast cancer is fatigue. People who have fatigue that doesn’t improve with rest, or who are losing weight without trying, should talk to their doctor, as this can be a sign of cancer spreading. Other symptoms can include bone pain that doesn’t ease with over-the-counter medication, or difficulty breathing, especially if it is accompanied by chest pain or a persistent cough.
Women with stage 4 breast cancer who have tumors in the breast or nearby lymph nodes may experience a buildup of fluid in the armpit or underarm, called armpit and nipple swelling (lymphedema). They may also have a feeling of fullness in their arms, hands, abdomen or chest. They can also experience a change in the way their nipple feels, which could be a feeling of pressure or an indentation.
Metastatic cancer that has spread to the bones can also cause changes in the ribs, spine and hips, and may make it harder for you to take deep breaths. You might also have a constant, dry cough. You should seek medical attention if you have these symptoms. It is important to remember that not every symptom is an indication of cancer spreading, and some symptoms may be side effects of your treatment.
Diagnosis
Your doctor will perform a variety of tests to determine the stage of your breast cancer, which describes how far it has spread. Your doctor will also use this information to help plan your treatment. Staging can be complicated, so your doctor may describe your stage using the T, N and M classifications or by discussing a more simplified approach based on the location of the tumor and whether it has reached the lymph nodes or other organs.
The first signs of breast cancer are usually a lump or other noticeable change in your breast or armpit area. Mammograms and other breast cancer screening techniques can detect these changes before they become obvious to you.
If your doctors suspect that you have breast cancer, they will order blood work to measure levels of certain substances in your body. These tests can show if there are higher or lower amounts of certain chemicals than normal, which could indicate that the cancer has spread.
Your doctor will also do an imaging test to see the shape and size of the cancer. Ultrasound and magnetic resonance imaging (MRI) are common testing methods. These imaging tests produce detailed pictures of the inside of your body using sound waves and magnetic fields, respectively. Your doctor will likely also do a biopsy to remove some of the tumor or surrounding tissue for examination under a microscope. A sentinel lymph node biopsy can also be performed, which involves removing one or more of the lymph nodes from under your collarbone for inspection.
A chest X-ray may also be done to check for cancer in the bones. If the cancer has spread to the bones, your doctor will likely give you a diagnosis of stage 4 metastatic breast cancer.
Metastatic breast cancer is an advanced stage of the disease, and it is no longer curable. It can spread to your liver, lungs and brain. Your doctor will most likely treat you with systemic medications, which target the entire body and include chemotherapy and hormone therapy. They may also prescribe local treatments, such as surgery or radiation, depending on your needs.
Treatment
A variety of treatment options are available to people with metastatic breast cancer. Your medical team will suggest treatments based on your needs and work with you to develop a treatment plan. The goal of treatment is to control the cancer, relieve symptoms, and improve your quality of life. There is no cure for metastatic breast cancer, but with advances in medicine and technology more people are living longer by managing the disease as a chronic illness rather than focusing solely on survival.
The weakened cancer cells left behind after your initial treatment can travel through the lymph nodes and bloodstream to settle in new places, where they form a new tumor. This process is called metastasis. Breast cancer cells can spread to other organs in the body, such as the lungs and liver.
Doctors can determine how far your cancer has spread based on the information from your pathological staging. This information is based on the results of tests done before surgery to examine your tissue and lymph nodes, such as physical examinations, mammograms and ultrasound scans, breast biopsy, and chest X-ray. A specialized test, sentinel lymph node biopsy, can help doctors find out whether breast cancer has spread to nearby lymph nodes, such as the axillary, internal mammary and supraclavicular lymph nodes.
If your cancer has spread to the bones, a bone scan or an MRI and X-rays of your lung or liver may be performed. You might also have a CT or PET scan to look for any other areas of your body where breast cancer has spread. If your symptoms indicate the presence of metastatic breast cancer in your brain, a brain MRI and, if possible, a brain biopsy will be done.
If your doctor recommends chemotherapy, you will receive either tablets or IV therapy (intravenous drip). Chemotherapy drugs are designed to destroy cancer cells and stop them from growing or spreading. Common side effects of chemotherapy include hair loss, nail changes, mouth sores, loss of appetite, weight loss and nausea and vomiting. Some chemotherapy drugs may make you tired or numb. Complementary and holistic therapies, such as acupuncture, meditation and yoga, can help you cope with these effects.
Prognosis
Having stage 4 breast cancer can be distressing, but research has greatly improved survival rates. In addition, you may have more treatment options than in the past.
Cancer cells are weak when they first develop, but over time they can grow and spread to other parts of the body. They often move through the lymph system or bloodstream to reach new areas. They also can enter tissues like the lungs, liver and bones, where they form new tumors.
About 6% of women have metastatic disease at the time of their initial diagnosis. This is called de novo metastatic breast cancer. However, most people with metastatic breast cancer get it after a previous diagnosis and treatment of early-stage cancer.
Doctors determine the stage of a tumor by how large it is and whether the cancer has spread to other organs. They use a system known as TNM to describe the stage of the cancer. The T describes the size of the tumor and the N describes whether it has spread to lymph nodes near the breast. The M describes whether the cancer has spread to other parts of the body, such as the brain or bones.
There are different staging systems used in different countries. Your doctor will explain your staging system to you.
For stage 4 breast cancer, doctors also look at a patient’s age and genetics to see how likely it is that the cancer will spread. They may recommend that you take part in a clinical trial to try newer treatments, if they are available.
Although current treatments can’t cure metastatic breast cancer, they can keep the cancer under control for months or even years. You will need regular checkups, and your doctor will monitor you for signs of the cancer coming back.
You should find a support group to help you cope with the stress of living with cancer. Ask your healthcare provider about support groups in your area, or look for online and social media groups for people with breast cancer. Also, consider joining an exercise class for survivors. It can help you stay healthy and strong while reducing your risk of falls, which can cause serious injuries. If you have balance and foot numbness problems from your cancer treatments, it’s best to do exercises that don’t put you at risk for falling. Talk to your healthcare provider before you start an exercise program.
