Metastatic breast cancer: Symptoms, treatment, and outlook

Date: Mar-25-2017 Metastatic breast cancer is when the cancer has spread to other parts of the body. Also referred to as stage 4 or advanced cancer, it can occur if initial treatment for breast cancer has not been successful.

Breast cancer can spread when cancer cells do one of the following:

invade nearby healthy cells and replicate

travel throughout the body in the bloodstream

lodge in capillaries and move into nearby tissue

form new tumors in other places around the body

Contents of this article:

Symptoms

Treatment

How is it monitored?

Outlook

Symptoms

Symptoms of metastatic breast cancer depend upon where the cancer has spread to. The areas it often spreads to are the brain, bone, lungs, or liver.

Brain

Metastatic breast cancer, also known as stage 4 breast cancer, is when the cancer cells spread to other areas in the body.

Depending on where in the brain the cancer spreads to, it can cause:

headaches

seizures

changes in behavior

disturbed vision

vomiting

nausea

Bones

If cancer spreads to the bones, it can cause:

severe pain

increased chance of fractures

swelling

decreased mobility

spinal cord compression

Lungs

If cancer spreads to the lungs, it often shows no symptoms but can cause:

shortness of breath

coughing up blood

chest pain

Liver

If cancer spreads to the liver, it can cause:

pain

loss of appetite

yellowing of the skin

itchy skin or rash

vomiting and nausea

bleeding

Other symptoms

Other general symptoms of metastatic breast cancer can include:

tiredness

loss of appetite

weight loss

However, these symptoms can also be caused by medication and depression associated with the condition.

It's important to identify these symptoms early and contact a doctor so the right treatment can be arranged.

Treatment

There are several ways to treat metastatic breast cancer. Treatment depends on the hormone receptor status or type of breast cancer.

Around two in three cases of breast cancer test positive for hormone receptors. These cancers are named as either:

Estrogen receptor positive (ER+): where the cancer cells have receptors for the hormone estrogen.

Progesterone receptor positive (PR+): where the cancer cells have receptors for the hormone progesterone.

A third type of breast cancer is known as HER2 positive (HER+). This is where there is a higher level of a particular protein, called human epidermal growth factor receptor 2 (HER2). It makes up around 15 to 20 percent of breast cancer cases where the cancer is likely to spread.

Another type of breast cancer is triple negative breast cancer (TNBC). This is where the cancer cells do not have receptors for estrogen, progesterone or HER2.

About 10 to 20 percent of breast cancers are TNBC. These cancers can't be treated with hormone therapy, but other treatments can be used.

A decision on treatment will be made after the hormone receptor status has been determined.

Hormone therapy treatment

Hormone therapy may be taken as a tablet or injected into a muscle.

Hormone therapy either lowers the level of estrogen or progesterone in the body, or blocks their effects on the body.

It is generally used when the breast cancer cells have ER+. In the case of metastatic breast cancer, it is used to control the cancer.

There are four main types of hormone treatment:

Tamoxifen

This treatment is usually taken as a tablet and is used when a person has:

ER+ cancer cells

not reached menopause

not previously had tamoxifen treatment

Aromatase inhibitors (AIs)

This treatment is also taken in tablet form and is used when someone has:

ER+ cancer cells

reached menopause

already had tamoxifen treatment

Fulvestrant

This treatment is injected into the muscle and is used when a person has:

ER+ cancer cells

reached menopause

already had tamoxifen or AI treatment

Progesterone

This can be taken as a tablet or by injection. It is used if the cancer has stopped responding to tamoxifen or AIs.

Side effects

Side effects are common in hormone therapies and vary depending on which drug is being taken.

They will generally be worse at the start of treatment and lessen as it goes on. The doctor may be able to help limit them.

The main side effects are:

hot flushes and sweating

changes to periods for pre-menopausal patients

less interest in sex

vaginal dryness or discharge

feeling sick

painful joints

mood changes

tiredness

Chemotherapy

Chemotherapy aims to destroy cancer cells in the body. It targets both where the cancer started and where it has spread to.

Known as a systemic therapy, it affects the whole body because it is sent around via the bloodstream.

As the American Cancer Society explain, chemotherapy can stop the spread of cancer and prolong survival. However, there can also be side effects such as nerve damage and heart problems. Also, cancer cells can become resistant to chemotherapy.

Targeted drug therapy

Unlike chemotherapy, which attacks all growing cells cancerous or not, targeted drugs just work on cancerous cells. They are designed to block the growth of these cells and stop them spreading.

As such, they can work when chemotherapy does not. They can also help improve the effects of other types of treatment.

In the case of HER2+ breast cancers, there are a number of drugs that target this protein:

Targeted drugs only attack cancerous cells, unlike chemotherapy, which attacks all growing cells.

Trastuzumab

often used alongside chemotherapy

given into a vein

Pertuzumab

can be used with trastuzumab

given into a vein

Ado-trastuzumab emtansine

used if already treated by trastuzumab and chemotherapy

given into a vein

Lapatinib

typically used when trastuzumab is no longer working

used alongside certain chemotherapy and hormone therapy

taken as a tablet

Side effects

Trastuzumab, pertuzumab, and ado-trastuzumab emtansine can all cause heart damage. As such, patients should let their doctor know if they are experiencing:

shortness of breath

leg swelling

severe fatigue

Lapatinib can cause severe diarrhea, so patients should tell their doctor if this occurs. It can also cause hand-foot syndrome, where hands and feet become red and sore and can blister and peel.

In cases of ER+ and PR+, targeted drug therapy can be helpful alongside hormone therapy:

Palbociclib

For patients who have reached menopause, this drug slows cancer growth. Taken as a pill, it can cause:

anemia

tiredness

nausea

mouth sores

hair loss

diarrhea

increased chance of infection

Everolimus

For patients who have reached menopause, this can limit the growth of tumors. It also often helps hormone therapy work better. Taken as a pill, it can cause:

mouth sores

diarrhea

nausea

fatigue

low blood counts

shortness of breath

a cough

increased chance of infection

Surgery

There is some debate about whether surgery in cases of metastatic breast cancer improves survival rates. However, due to the negative effects of surgery it is not often offered as a treatment.

How is it monitored?

Monitoring, or follow-up care, is extremely important. This will check to see if the cancer has spread further, help to manage side effects, and monitor overall health.

The doctor will often examine the neck, chest, underarm, and breast area at check-ups. They will also check the general health of the patient.

If there are any new health problems, or changes to the treated area or other breast, then the doctor should be informed straight away.

Outlook

Outlook depends on the type of breast cancer, where it has spread to, and how much the tumor is affecting these areas.

The average survival time is 18 to 24 months, but it can vary widely. The American Cancer Society found that 22 percent of people who have metastatic breast cancer survive for 5 years or more.

Many people can live long and productive lives with metastatic breast cancer, and treatment can control the cancer.

Survival rates will vary depending on the individual, and the best thing to do is speak to the doctor to get a better understanding of specific circumstances.

Written by Tom Seymour

Courtesy: Medical News Today Note: Any medical information available in this news section is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional.