KEERTHI GOGINENI: I think
of stage 4 breast cancer
and metastatic breast cancer
as being interchangeable.
These mean the same thing
from the standpoint of where
the cancer is,
and we mean that it has left
the breast and the lymph nodes
in the underarm
and found its way
to another part of the body.
The treatment options that are
available that are the most
effective depend on the type
of the breast cancer.
So we have breast cancers that
are sensitive to estrogen
and using certain medications
to block that can be a really
effective way to treat
those kinds of breast cancers.
There are some women who are
going to have a subtype
of breast cancer
that's called HER2-Positive
There are a lot of drugs that
target that specific kind
of breast cancer.
And there are women who have
Triple-Negative breast cancer,
and there are new advances
coming for this kind of breast
cancer, as well,
So what might be the best option
for one patient who has
may not be the best option
for the patient that's coming
So really trying to combine what
evidence is out there for what's
quote, unquote, best,
but also making sure you're
pairing that with the person's
needs that are in front of you.
Being told you have metastatic (stage IV) breast cancer is a lot to take in. It means your cancer has spread to other parts of your body. Although there is no cure, your doctor has ways to slow the disease's growth and help you keep a good quality of life. And thanks to better treatments, people are living longer than ever.
To manage your treatment and life on your own terms, learn about the disease and what to expect.
Difference With Metastatic Breast Cancer Treatment
When you have early-stage cancer, your treatment focuses on a cure and preventing the cancer from coming back.
With stage IV breast cancer, the goal of treatment is to slow the disease’s growth for as long as possible, with the least amount of side effects or pain.
As medical therapies improve, experts hope someday to treat this form of cancer like diabetes and other ongoing, "chronic" conditions, which doctors can manage for several years or even decades.
The options your doctor recommends for you will depend on:
- Where the cancer is in your body
- The kind of cancer cells you have
- Your symptoms
- Breast cancer treatments you’ve had in the past
- Your health and age
- Your preferences
How to Pick the Right Treatments
It’s your decision. Doctors will offer choices tailored for your condition. Learn as much as you can about your options, and find out about possible side effects before you decide.
Ask to work with a palliative care team as well. Their focus is to help coordinate your care and help you work through decisions about what types of care you want to receive and how to handle the side effects.
These common treatments are often used alone or in combination:
Hormone therapy. If your cancer is fueled by estrogen or progesterone, hormone therapy medications can help shrink the tumors. They starve cancer cells by targeting the hormones they need to grow.
Anti- HER2 targeted treatment. Some breast cancer cells have too much of a protein called HER2. This makes them more likely to grow and spread. Drugs that target this protein can help slow the growth of HER2-positive breast cancers.
Chemotherapy . These medications kill cancer cells as well as any other fast-growing cells. A benefit of chemo is that it often can shrink tumors fast. But the treatment usually has more side effects than hormonal or targeted therapy. Common ones include hair loss, vomiting or nausea, and tiredness.
You get chemo in cycles. After each treatment period, you get a rest to give your body time to recover.
Breast cancers that aren't fueled by hormones or the HER2 protein are called triple negative. They generally need chemo.
Radiation and surgery. These therapies are used for specific reasons like treating cancer that has spread to the liver, bone, or brain.
Targeted therapy. Targeted drugs block the growth and spread of cancer cells. They work differently from chemotherapy in that they only attack the cancer and have different side effects. Sometimes they work when chemo drugs don’t. They can also help other types of treatment work better.
Immunotherapy. Immunotherapy boosts the body’s own immune system to help target cancer. Currently immunotherpy is being used along with chemotherapy for treatment of some triple negative breast cancers.
Comfort is important, too. Medication can help with your symptoms or complications of cancer, and also to manage side effects.
You may want to consider joining clinical trials. Ask your doctor if she knows of one that may be a good match for you. All of today’s standard treatments were first tested in research studies. It’s possible you may get a cutting-edge therapy before it’s available to everyone.
How to Tell If the Treatment Is Working
Every few months, you’ll get X-rays and other scans to see if the cancer has grown, shrunk, or stayed the same. You’ll get a physical exam, too. Tell your doctor if you notice any symptoms.
Your doctor may order a test to check for "tumor markers." Some cancer tumors release these signs, which can show up in your blood. If the test shows that these markers are rising, it could mean that the cancer is growing or spreading.
Doctors will look at all your test results and your symptoms to decide whether your treatment is working.
Sometimes cancer can no longer be seen on scans. Your doctor may say you have “no evidence of disease.” This is something to celebrate, but the cancer isn't gone. Cells are still circulating in your body, so you’ll continue treatment.
Break From Treatment
Yes, it’s possible. You might need one, especially if side effects bother you.
Talk to your doctor about it if an important occasion is coming up, like a wedding or a milestone birthday. A break may be just what you need to enjoy this special time.
If Treatment Stops Working
Cancer sometimes learns to outsmart a drug and finds a way to grow or spread again. If this happens, your doctor will talk to you about other options.
You’ll stick to a treatment for as long as it works. When it doesn’t, you’ll move on to another one. If the time comes when there aren’t other options or the side effects are too much, let your doctor know how you feel and that you want your treatment to focus on comfort.
How to Feel Better in Body and Mind
Each person is different. But there are things that seem to help most people feel as good as possible, with or without cancer. See how many of these are helpful to you now:
Eat well and stay active. You can keep it gentle. This may help you handle treatment better. Exercise relaxes muscles and keeps you strong. Easy stretches and yoga can make you feel less tired and stressed and help you sleep better.
Lean on loved ones. Your friends and family can support you when you need it the most. Share a meal or watch a movie together to help remind you that life is more than just about cancer.
Get emotional support. Consider joining a support group for people with metastatic breast cancer. Talking to others who are in the same situation, whether it’s online or in person, can help you feel more connected. It also helps to talk to a professional counselor who can help you manage your feelings as you go through treatment.
Stay spiritual if it gives you strength. A religious leader you know and trust, a spiritual counselor, or your small group can help you process what’s happening and stay connected with your community and core beliefs.
Be present. Mindfulness meditation uses deep breathing and relaxation to lessen stress. You can learn it in a class or simply take a few minutes each day to quietly focus on something, such as your breath or a calming word or phrase, letting other thoughts and feelings come and go. It may help you stay in the moment.
Savor life. Take the time to do the things that bring you joy. Paint a picture. Dance to your favorite tunes. Drink in that beautiful sunrise. If it puts a smile on your face, it’s worth doing.