Advanced Breast Cancer

Overview

Finding out you have advanced breast cancer will change your life. Your diagnosis will lead you down a path filled with challenges you hadn’t planned on, but the promising news is that you are not alone. Surrounding yourself with a skilled medical team you trust and supportive family and friends will enable you to face this diagnosis head on.

Advanced breast cancer is also referred to as metastatic and Stage IV breast cancer. Although Stage III cancers are considered locally advanced and treated with curative intent, some of this information may be helpful. In most cases, it is diagnosed during a follow-up appointment after treatment for early-stage disease or during evaluation of symptoms, such as persistent cough, shortness of breath or bone pain. In some people, breast cancer is advanced at the time of initial diagnosis.

Where a cancer starts, or its primary site, often plays a role in where it will metastasize (spread). Most cancer cells that break free from the primary tumor are carried in the blood or lymph until they get trapped in nearby lymph nodes or organs. This is why breast cancer often spreads to lymph nodes in the underarm but rarely to lymph nodes in the groin. When breast cancer metastasizes farther, it typically lands in the liver, lungs, bones or brain.

Breast cancer that spreads to another part of the body is still considered breast cancer. For example, breast cancer that has metastasized to the lung is still breast cancer, not lung cancer, and will be treated with the breast cancer therapy you decide on with your medical team.

A cure is not yet available for advanced breast cancer. Because of this, the goal of treatment is to control the growth of the cancer while providing the highest quality of life possible. In this way, advanced breast cancer is like many other chronic health conditions. Your doctor will work closely with you to select the treatment that will be most effective at controlling the cancer and making you feel your best. Ongoing advances in research are resulting in treatments that let many people with advanced breast cancer live longer, with a good quality of life.

Molecular Testing

Once advanced breast cancer is diagnosed, staging is next. Doctors also recommend molecular testing to see if specific protein receptors are present in or on the breast cancer cells. These protein receptors are estrogen and progesterone receptors (ER and PR) and human epidermal growth factor receptor-2 (HER2). If ER and/or PR receptors are present in your cancer cells, the hormones estrogen and progesterone are stimulating the growth of the cancer cells. If too much of the HER2 protein (or extra copies of the HER2 gene) are found on the surface of the breast cancer cells, the cells are growing and dividing in an uncontrolled way.

Your cancer will respond to types of treatment differently depending on the presence of ER, PR and HER2, so this information is crucial in helping your doctor recommend the type of treatment that is best for you (see Table 1).

Table 1. Receptor and Treatment Response

Receptors Likely treatment response
ER+ and/or PR+, HER2- Typically responds to hormone (anti-estrogen) therapy
ER+ and/or PR+, HER2+ Typically responds to hormone therapy and anti-HER2 drugs (targeted therapy)
ER-/PR-, HER2+ Typically does not respond to hormone therapy but typically will respond to anti-HER2 drugs
ER-/PR-, HER2- (triple negative) Typically treated with chemotherapy, as response to hormone therapy and anti-HER2 drugs is less likely

 

Most people with advanced breast cancer have HER2-negative (HER2-) disease. If your HER2- breast cancer is hormone receptor-positive (ER+ and PR+), the most common treatment is hormone therapy, but chemotherapy and targeted therapy may also be options. If you have ER+, PR+ and HER2+ breast cancer, your doctor may recommend a combination of hormone therapy and an anti-HER2 drug.

Less often, an advanced breast cancer is negative for ER, PR and HER2. This type of cancer is called triple negative breast cancer. Triple negative breast cancer does not respond to the hormone or targeted therapies typically used to treat advanced breast cancer, so chemotherapy is the only treatment option. Often, triple negative breast cancer responds better to chemotherapy than other breast cancers do. Read more on triple negative breast cancer here.

Another less common type of breast cancer is inflammatory breast cancer (IBC). With this very aggressive type of breast cancer, cancer cells block the lymph vessels in the skin. Named because the breast often looks red or inflamed and feels warm, IBC may also cause the breast skin to be thick and look pitted, much like an orange peel looks.

Most IBCs are invasive ductal carcinomas, which means they developed from cells that line the milk ducts of the breast and then spread beyond the ducts. IBC progresses rapidly and is always staged as at least Stage IIIB (locally advanced) when first diagnosed because the breast cancer cells have metastasized into the skin. If cancer has spread to the lymph nodes, surrounding tissues or other body parts, it is diagnosed as Stage IV. The advanced stage of IBC, along with its tendency to grow and spread quickly (sometimes in a matter of weeks or months), makes it more challenging to treat than most other types of breast cancer.

IBC accounts for about 1 to 5 percent of all breast cancers. Some experts believe it actually may be more common, but diagnosing it can be difficult because of its atypical symptoms. Breast lumps are not common, and it may not show up on a mammogram. Additionally, the swelling and tenderness often lead to a misdiagnosis of mastitis, an infection of the breast tissue that is accompanied by breast pain, swelling, warmth and redness.

More about inflammatory breast cancer:

  • Compared with other types of breast cancer, IBC tends to be diagnosed at younger ages. It is also diagnosed at a younger age in African American women (average age, 52 years) than in Caucasian women (average age, 57 years).
  • Obesity is a risk factor for IBC.
  • Treatment usually includes a combination of chemotherapy drugs, surgery and radiation therapy. Inflammatory breast tumors are frequently hormone receptor-negative, which means that hormone therapy may not be effective.
  • Like other types of breast cancer, IBC can occur in men, but it is usually diagnosed at an older age (after 67 years) than in women.

Because IBC is rare, patients are encouraged to take part in a clinical trial for access to the most leading-edge treatments. To learn more about clinical trials and where to find information about available trials, click here.

Ongoing Care

Because advanced breast cancer is treated somewhat like a chronic condition, treatment is continual. This means that treatment is typically given until disease starts to progress or until you cannot tolerate treatment-related side effects. This also means that close, ongoing care is needed to keep track of how the cancer is responding to treatment. If the cancer stops responding or starts to progress, other treatment options are available. You will have routine visits with your doctor and/or medical team, which will likely include regular testing. You can learn more about these tests here.

When you’re faced with an advanced breast cancer diagnosis, knowledge is empowering. This website is filled with valuable resources that will help you better cope with your disease. You can learn more about the available treatment options, including clinical trials and side effects and how to manage them, along with helpful suggestions and support resources for you, your caregiver and your loved ones. Talk to your health care team for additional resources.

Advanced Breast Cancer in Men

Breast cancer in men is rare and, as in women, occurs when malignant cells invade the breast tissue. Although breast cancer can develop in men at any age, the average age at diagnosis is between 65 and 70 years.

Although a lump is easier to feel because men have less breast tissue than women, they may ignore breast changes or not report them to their doctor because they don’t realize they are at risk. As a result, breast cancer in men is often at a late stage when diagnosed. That delay in diagnosis can allow the cancer to spread to lymph nodes under the arm or around the collarbone, even before the original tumor in the breast tissue is large enough to be felt.

Most breast cancers in men are hormone receptor-positive, meaning that the growth of cancer cells is stimulated by estrogen and/or progesterone. Typical treatments for hormone receptor-positive cancers include the following:

  • Surgery to remove the tumor
  • Chemotherapy to kill the cancer cells
  • Hormone therapy to stop cancer cell growth
  • Radiation therapy to help reduce the risk of recurrence, relieve symptoms and avoid complications from areas of metastases

Because breast cancer in men is less common, fewer clinical trials have taken place than for female breast cancer. Most treatments for men are modeled on treatments for women because the disease tends to respond similarly in both men and women, but researchers are investigating ways to treat the disease in men. Talk with your doctor about each type of treatment, potential side effects and clinical trials so you can make an informed treatment decision.

When a man hears his diagnosis, his shock at learning he has cancer is often compounded by embarrassment at having what is traditionally known as a “woman’s disease.” It is crucial to remember that you’re not alone. Your feelings are valid. Discussing them and comparing notes with other men who have breast cancer can be immensely helpful. Talk openly with your medical team about support groups and other resources.

 

Additional Resources

 

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