Module 2. Understanding Metastatic Breast Cancer

*This slide show represents a visual interpretation and is not intended to provide, nor substitute as, medical and/or clinical advice.

When breast cancer spreads to other parts of the body, such as the bones, liver, lungs, or brain, it is called metastatic breast cancer. It is also called advanced, secondary, or stage 4 breast cancer.

Metastatic breast cancer is a life-threatening disease that cannot be cured.

About 4 in 10 people with metastatic breast cancer are alive 5 years after diagnosis, compared to 9 in 10 with Stage 1 to 3 breast cancer.

Some people have metastatic breast cancer when they are first diagnosed with breast cancer.

About 30% of women who previously had treatment for early stage breast cancer will develop metastatic breast cancer.

Symptoms of metastatic breast cancer may include tiredness and a poor appetite.

You might have specific symptoms depending on where the cancer spreads.

Signs cancer might have spread to the lymph nodes are:

• A lump under your arm or in your breast.

Signs of spreading to the bones are:

• Pain or broken bones.

Signs of spreading to the liver are:

• Abdominal pain or swelling and
• Itchy or yellowish skin, called jaundice.

Signs of spreading to the lungs are:

• Shortness of breath, and
• A cough that doesn’t go away, with or without blood.

Signs of spreading to the brain are:

• Headaches
• Weakness or numbness in the arms and legs
• Vision problems, and
• Changes in personality or behavior.

Anyone can have these types of symptoms for other reasons. If you have them for more than a few weeks, or you or your primary doctor feel worried, contact your oncologist for advice.

Treatment for metastatic breast cancer can help reduce symptoms, make you feel better and sometimes, help you live longer. However, it will not cure the cancer.

Treatment depends on:

• The tumor type, size and where it is located,
• The treatments you already received,
• Your general health,
• If you are in menopause and what stage, and
• If the cancer is growing slowly or quickly.

To decide about treatment, you need to understand:

• The potential benefits,
• Its side effects, and
• How it might affect your life in general – Doctors call this your “quality of life.”

The main treatment for metastatic breast cancer is called “systemic therapy.” This is treatment that affects your whole body, such as hormone therapy, chemotherapy, or targeted therapy.

“Local therapy,” is treatment for specific areas of your body with surgery or radiation.

You might have both local and systemic therapy.

Hormone therapies are given if your tumor responds to the hormones estrogen and progesterone. Tumors that respond are often called estrogen- or progesterone-receptor positive. These hormones allow the cancer to grow, but hormone therapies block their growth. They can help shrink or slow the spread of metastatic breast cancers.

Hormone therapy is also given with earlier stage breast cancer to lower the risk of cancer coming back.

If you have metastatic breast cancer, you can take hormone therapy as long as you need to control the growth of the cancer.

Your doctor might suggest chemotherapy if your cancer is not estrogen or progesterone positive. The goal is to relieve symptoms, control the cancer, and give you a better quality of life.

Once your cancer has spread, you might need chemotherapy for a long duration. But you might also change chemotherapy medicines or stop chemotherapy depending on how it’s working or how well you tolerate the side effects.

Chemotherapy can be given as an IV or a pill. You might take one drug or a combination. Side effects depend on the drug, but there are medicines to help with side effects. Some types of chemotherapy used for metastatic breast cancer are:

• Taxanes
• Anthracyclines
• Platinum agents
• Plant alkaloids, and
• Capecitabine

Targeted therapies are drugs that control cancer by changing the way cells work. For example, you might have targeted therapy for HER2 positive breast cancer, an aggressive type of cancer. The therapy targets a protein called HER2 that makes the cancer grow.

Targeted therapy can be given as a pill or an IV drip in your arm.

Radiation therapy can shrink breast cancer tumors, relieve symptoms, and help you feel more comfortable. You might have it if cancer spreads to

• The skin,
• The lymph nodes,
• Parts of the brain, or
• The bones.

If cancer spreads to several places in the bones, you might get an injection of radiation to kill cancer cells and control pain.

Breast cancer that spreads to the bones can weaken them. You may break a bone or have persistent bone pain.

Two types of drugs are used to keep bones from getting thinner or breaking down from metastatic breast cancer. These drug types are called “bisphosphonates” and “osteoclast inhibitors.”

If you have metastatic breast cancer, you will likely need to remain on treatment, unless you choose to stop it. If one treatment stops working you can change medications, try a different type of treatment, or join a clinical trial. Clinical trials may give you access to new treatments that are not yet available to the public.

The goal of treatment is to control metastatic breast cancer for a number of years.

Today, many people live well with metastatic breast cancer while getting ongoing treatment for the cancer and any side effects.

Researchers are discovering more information through clinical trials, and treatments for metastatic breast cancer are becoming more effective.