Advanced Breast Cancer

Breast Cancer is well recognized as one of the commonest causes of deaths due to cancer in women. In the United Kingdom, just under 50,000 women are diagnosed with breast cancer every year, while in the United States over 230,000 new cases were expected to be diagnosed in 2011.

While awareness about this illness has risen and research continues to find a cure, it can still have a significant impact on women once diagnosed.

In this article, concentrate on advanced stage 4 breast cancer, its symptoms and how it is diagnosed and treated.

Stage 4 breast cancer

This is the advanced form of breast cancer that has grown from being just a small lump in the breast to something a lot larger involving neighboring tissues and lymph nodes. At stage 4, breast cancer can also involve other parts of the body (such as the bone and liver) as well. Stage 4 cancer is also called metastatic cancer.

Clinical features

Patients with stage 4 cancer will have noticed a change in the shape or size of the breast, along with obvious changes in the overlying skin. Lymph nodes may be felt as small swellings in the armpit. In stage 4 cancer, patients may also complain of pain at different parts of the body where the cancer has spread to such as the back or the hip.

Diagnosis

In most cases of breast cancer, the initial diagnosis is often made by the patient themselves when they notice a lump in the breast. However, certain tests will help confirm whether the lump is cancerous, and how bad it really is.

1. Mammogram – This is commonly used X-ray examination of the breast tissue that reveals the nature of the lump and how large it is. It is also useful to determine the extent of breast tissue involvement.

Patient undergoing a mammogram

2. Fine Needle Aspiration Cytology (FNAC) – Here, a small amount of breast tissue is taken out using a very fine needle and the specimen is then analyzed under a microscope.

FNAC procedure

3. Biopsy – This is similar to FNAC, but a larger amount of tissue is actually taken out for analysis. It can performed using a needle or by wire excision.

4. X-rays – This test is useful to assess any bone involvement from the spread of breast cancer.

5. CT scan – A CT scan will help analyze the involvement of other organs and the extent to which the lymph nodes have been involved in advanced breast cancer.

Hormone Receptors

Before discussing treatment, it is good to have an understanding of what hormone receptors are. On the surface of the breast cancer cells are little receptors that can bind to estrogen. This binding only facilitates further growth of the tumor. The presence of these receptors make the cancer Estrogen Receptor- Positive (also called ER
positive).

Breast cancers that are ER –positive are responsive to hormonal treatments.

Human Epidermal Growth Factor – 2 (HER-2) receptors

Certain breast cancers are positive for the presence of HER-2 receptors. These are protein receptors on the surface of the cancer cells and can be blocked by a drug called Trastuzumab (Herceptin®).

Treatment

Treatment of breast cancer is most often with surgery. Surgery is usually combined with other forms of treatment such as chemotherapy or radiotherapy to ensure that the cancer does not recur. Results with surgery are usually very good.

1. Chemotherapy

This refers to treatment using medication called chemotherapeutic agents. This is the treatment that is prescribed most often and is helpful in slowing down the growth and spread of the cancer. However, it brings with it a number of side effects that include nausea, vomiting and hair loss.

It is important to understand that chemotherapy or any other forms of therapy in stage 4 breast cancer do not offer a cure – they only help slow down the growth of the cancer.

Chemotherapy agents that are commonly used include Doxorubicin and Cyclophosphamide.

Most of the times, chemotherapy is combined with hormone therapy and with radiation therapy.

2. Hormone therapy

This refers to treatment using agents that block hormones in the body that can help growth of the cancer. As previously discussed, breast cancer tissue can be positive for hormone receptors and it is only these that will respond to hormone therapy. The commonly used drug is Tamoxifen which blocks the effect of estrogen on the breast tissue. While this drug is commonly used in pre-menopausal women, once they are post menopausal they may be shifted to an alternate group of drugs called aromatase inhibitors. These include Anastrazole, Exemestane and Letrozole.

In addition to Tamoxifen and aromatase inhibitors, patients with stage 4 breast cancer may be offered drugs that can block the pituitary gland from stimulating the ovaries to release estrogen. The commonly used drug that does this is Goserelin, and is offered as a monthly injection.

3. Biological treatments

In the recent years, biological treatments are becoming a lot more popular especially for patients who are HER-2 positive. Trastuzumab is the drug that is used as is called a monoclonal antibody that acts against the proteins in the cancer cells and inhibits their growth. It is administered to patients as an injection and is usually offered to patients along with other treatments.

4. Surgery

In some cases of stage 4 breast cancer, a radical mastectomy is performed. This
involves total removal of the breast tissue along with the muscle tissue and the lymph nodes nearby that have been affected. Following this, patients may undergo a breast reconstruction procedure for cosmetic reasons. However, the surgical approach is rarely performed as other measures are a lot less risky.

Prognosis

Unfortunately, despite available treatment, stage 4 breast cancer cannot be cured. According to studies, only 15% of women who have stage 4 cancer survive up to 5 years and beyond.

Support groups

There are many breast cancer patient support groups that are willing to help and support patients. In the United Kingdom, the Macmillan cancer support team help to provide patients with all the information and support they need to get through the cancer and its treatments.

Conclusion

Stage 4 breast cancer is an advanced form of breast cancer that carries a poor prognosis. Patients can avail treatments that only slow down the disease but offer no cure. Support groups are plenty and help patients through these tough times by providing advice and support any time they need it.