Women diagnosed with stage 4 breast cancer often describe pain in their bones. This is usually a dull, persistent ache in the ribs, spine or pelvic bones and may be accompanied by tiredness or weight loss.
Although metastatic breast cancer is not curable, advances in treatment options are prolonging lives for many women. These treatments shrink new tumors, keep cancer from spreading and help manage symptoms.
Symptoms
People with stage 4 breast cancer may experience different symptoms depending on where the cancer spreads to. Also known as metastatic breast cancer, this stage of the disease is not curable. But treatment can help control the cancer and ease some of the symptoms.
The nipple area is often affected by breast cancer in its later stages. It can cause pain, swelling, changes in skin texture, or discharge from the nipple. The fluid may be clear or bloody and can feel like pus. It may also appear thick or hard to the touch and feel painful when touched.
Cancer that has spread to the bones can cause pain, numbness in arms and legs, and fatigue. It can also cause bones to fracture more easily. Some people with this stage of the disease have problems with their heart or lungs. If the cancer has spread to the brain, it can cause headache, memory problems, or seizures.
Some of these symptoms can be caused by medicines used during chemotherapy or radiation therapy. But others can be a sign that the cancer is getting worse. If the person you care for has a new symptom, talk to their doctor.
When a person has stage 4 breast cancer, it’s common to worry that every physical change is a sign of the cancer growing and spreading. But it’s important to remember that many of these changes are normal. Fatigue, for example, is a common side effect of most cancer treatments.
It’s also a good idea to help the person you’re caring for get enough sleep. They might need to stay in bed more or have trouble sleeping through the night because of symptoms such as pain, vomiting, or exhaustion. You can also encourage them to exercise if they’re feeling up for it. Plan their workouts at times when they’re most energetic, and make sure to drink plenty of water to prevent dehydration. You might also consider palliative care, which helps manage physical and emotional symptoms to improve quality of life. It can be especially helpful for people who have advanced cancers.
Diagnosis
Doctors determine the stage of breast cancer by looking at how much cancer is there, where it’s located and whether it has spread. Staging helps doctors decide on the best treatment for each person. There are several ways to stage breast cancer, but the most common is the TNM system. It combines information about the tumor (T), lymph nodes (N) and metastasis (M). There are also different systems used in other countries.
Doctors use two types of tests to diagnose breast cancer: clinical and pathological. Clinical staging is based on information doctors get before surgery and may include physical examinations, mammograms, ultrasounds and blood chemistry studies. Pathological staging is based on what doctors find during surgery to remove tissue and lymph nodes, and is usually done within days of the surgery.
A lump or mass in the breast is the main symptom of stage 4 breast cancer. Some women may also develop a hard, painful lump in the chest wall or nipple area. Others may experience nipple pain or discharge, which may look like pus or be bloody.
If a woman has stage 4 breast cancer, doctors will often recommend a biopsy to confirm the diagnosis. This involves inserting a needle into the tumor and taking samples for analysis. A biopsy can reveal the type and grade of the cancer, as well as how far it has grown.
The next step is to find out if the cancer has spread beyond the breast tissue into other parts of the body, which is called metastasis. This can be local recurrence, meaning the cancer comes back in the same place where it started, or regional recurrence, which means that the cancer returns to tissue and/or lymph nodes near where it first developed.
When cancer has spread, doctors will perform a series of tests and scans to learn more about the extent of the disease. Often these tests will be similar to those done at the time of the original diagnosis. Depending on the symptoms, doctors may order a brain MRI or, in rare cases where this is possible, a biopsy of the liver, lung or bone.
Treatment
Breast cancer cells can break away from the original tumor and travel through your lymph nodes (found under your arm, inside your breast, and near your collarbone) to distant parts of your body. These cancer cells can form new tumors in the lungs, liver, bones, or brain. This is called metastatic or advanced breast cancer.
Your doctor will use your symptoms, health history, and results of tests to develop a treatment plan. A medical oncologist specializing in treating breast cancer is the best person to help you with this decision.
The first step is to find out if the cancer has spread. Your doctor will order a series of tests to check the size of the tumor and how far it has grown, or metastasized.
Your healthcare team will also need to know if the cancer is hormone receptor positive or negative, if your tumor is inflammatory, or if you have any other genetic mutations that may influence how the disease behaves.
Stage 4 is an advanced stage of breast cancer, but there are many different treatments available. The goal of treatment is to control the cancer and reduce symptoms. Your doctor will prescribe one or more systemic treatments, which are drugs that can treat your cancer from outside the body.
Your doctor might also recommend surgery to remove the tumor and a small area of healthy tissue around it, depending on your situation. This is called a lumpectomy or partial mastectomy. If your cancer is invasive, your doctor might recommend radiation to the remaining breast tissue after surgery.
Your doctor might suggest targeted therapy or other localized treatments to help relieve pain or other specific symptoms. These treatments may include radiation, ablation therapy, or chemotherapy.
Survival
Breast cancer is not curable once it reaches stage 4. It spreads, or metastasizes, when cells from a primary tumor in the breast travel through the bloodstream and lymphatic system to establish secondary (metastasized) tumors elsewhere in the body. Depending on the type of breast cancer, these tumors may form in bones, lungs or liver, and can also affect brain tissue. Breast cancer that spreads to the bones is usually hormone receptor-positive (ER+ or PR+). Breast cancer that spreads to the lungs or brain is often HER2 positive.
In addition to the physical effects of the disease, those diagnosed with metastatic breast cancer face psychological and emotional challenges. They must accept that their cancer is not curable and work to manage the symptoms that can occur. Fortunately, with newer treatments and support from a medical team, some people can live for years with metastatic breast cancer.
The survival rates associated with stage 4 breast cancer are typically lower than those for stages 1 through 3, but it is important to remember that these figures are based on a large population of women and will vary from woman to woman. Additionally, these numbers are constantly changing as researchers find newer and more effective treatment options.
A person with stage 4 breast cancer will likely continue to receive treatment for the rest of her life. The treatment plan may include chemotherapy, radiation and surgery. A doctor may also recommend that a person take medication such as tamoxifen or aromatase inhibitors to reduce estrogen levels in her body, which can fuel cancer growth.
It is important to continue regular screening for breast cancer. If a person notices any new symptoms, she should contact her doctor immediately. If a woman does not get regular screenings, her risk of cancer will increase dramatically.
A person who is being treated for stage 4 breast cancer should consider participating in clinical trials of promising new therapies. A qualified oncologist can help a person find a clinical trial that may be right for her. These studies allow doctors to test out different treatment approaches before they are widely available.
