Not long ago, the main goal of treating metastatic breast cancer -- meaning the disease has spread well beyond the breast -- was to keep a woman comfortable. But a lot has changed in the past decade. Now treatment can help many women live longer, better, and disease-free for periods of time.
Pamela Drullinsky, MD, a cancer doctor at Memorial Sloan Kettering Cancer Center in New York, says many doctors now see metastatic breast cancer as a chronic illness, because it can be managed for years. “This is similar to [people with diabetes] taking insulin,” she says. “It is still incurable but can be controlled.”
Here's how to take charge of your diagnosis and live better with metastatic breast cancer.
Make a Breast Cancer Treatment Plan
The uncertainties of having metastatic breast cancer can make you feel like you've lost control of your life. A treatment plan will help you feel more in control. To create one:
- Learn as much as you can about where your cancer has spread and what type of tumor you have. Your treatment will depend largely on these things.
- Think about the main goal of treatment. Do you want to get rid of the new cancer, or relieve symptoms? Talk to your doctor about realistic goals.
- Decide whether you want to use the same medical team or add other doctors.
Even if you're happy with your doctors, it's a good idea to get a second opinion to confirm that you're getting the best treatment possible. "It is also important to be evaluated at an academic or research institute that may have cutting-edge trials,” says Tiffany Troso-Sandoval, MD, a cancer doctor at Memorial Sloan Kettering Cancer Center.
Metastatic Breast Cancer Treatments
Anti-estrogen therapies, also known as hormone therapy. If your breast cancer is hormone receptor-positive, your body's estrogen makes the cancer cells grow faster. In that case, there's a good chance the cancer will respond to an anti-estrogen drug like anastrozole (Arimidex), exemestane (Aromasin), fulvestrant (Faslodex), letrozole (Femara), tamoxifen (Soltamox, Nolvadex), or toremefine (Fareston). These drugs prevent cancer cells from getting the estrogen they need to grow. Clinical trials are also using newer medicines in combination with these.
Targeted therapies. Trastuzumab (Herceptin), pertuzumab (Perjeta), and lapatinib (Tykerb) are likely treatments if breast cancer has high amounts of the protein HER2, which helps cancer cells grow. When used alone or with chemotherapy, these drugs can shrink tumors, slow cancer growth, and, in some cases, help you live longer than chemotherapy alone. If your breast cancer doesn't have the HER2 protein, your doctor may use another type of targeted therapy, everolimus (Afinitor). In combination with exemestane, it can help stop the growth of some types of advanced breast cancer. Albociclib (Ibrance) is yet another drug used in cases of HER2-negative cancer in combination with letrozole.
Chemotherapy. This can control cancer and improve quality of life with metastatic cancer. If your cancer is hormone receptor-negative (meaning an anti-estrogen treatment is unlikely to work), you may get small doses of one chemotherapy drug at a time. “This can minimize side effects and make the drugs more effective over a longer period of time,” Troso-Sandoval says.
Other treatments. You may get surgery to remove tumors at the original cancer site or another site where it has spread. This can prevent or ease symptoms and may extend your life. Radiation can shrink tumors and ease pain. Other medications can ease painful symptoms where cancer has spread.
Dealing With Fear and Uncertainty
Even with better treatments, living with metastatic breast cancer can be an emotional roller coaster -- especially at first. Time can help. These tips may also:
Don't obsess about survival statistics. “Since statistics apply to groups of people rather than to a single cancer patient, it is hard to know what those numbers mean for any single person,” says Karen Hartman. She is senior clinical social worker at Memorial Sloan Kettering Cancer Center in Commack, NY. “This is one part of understanding your disease that is not always helpful.”
Get emotional support. Hartman recommends individual counseling with a social worker who specializes in cancer, especially if you are newly diagnosed. You can also get practical and emotional support by joining a support group. Make sure it's for women with metastatic breast cancer.
Live in the present. Turn fear of the future on its head: Focus on doing the things you love now.
Stay healthy. Eat well and exercise regularly to boost your mood and energy. Remember that treatments for metastatic breast cancer keep improving, and there may be a new approach for you on the horizon.