About Stage 4 Breast Cancer
Breast cancer is a type of cancer that occurs when the cells in a person's breast start growing uncontrollably.
The stage of breast cancer is based on the size and location of the primary tumor, the spread of cancer to nearby lymph nodes or other parts of the body, tumor grade, and the presence of biomarkers (receptors on the cancer cells).
Stage 4 breast cancer, also known as metastatic breast cancer or advanced breast cancer, occurs when cancer cells from the breast have spread to other parts of the body. This means that the cancer has gone beyond the breast and nearby lymph nodes and has reached distant lymph nodes, tissues, organs, or bones. The most common areas where breast cancer spreads are the bones, brain, liver, and lungs. Stage 4 breast cancer is considered the most serious and life-threatening stage of breast cancer. The symptoms can vary depending on where the cancer has spread but may include fatigue, weakness, unintentional weight loss, and pain at or around the site of metastasis. It is important to work closely with your healthcare professional to develop an individualized treatment plan for stage 4 breast cancer.
The cause of breast cancer is genetic mutation in certain genes that affect the growth of cells in breast tissue. There are multiple factors that increase a person’s chances of developing breast cancer.
Non-modifiable risk factors of breast cancer are those that cannot be changed or controlled. These include:
- Age: Breast cancer risk increases with age, particularly in women over age 50 years
- Sex: Breast cancer is more common in females than males
- Reproductive parameters: Start of menstrual periods before age 12, delayed menopause after age 55, or delayed childbearing (first full-term pregnancy after age 30)
- Genetics: Inherited changes in certain genes (such as BRCA1 and BRCA2) and family history of breast cancer. Having a close relative (such as a mother or sister) with breast cancer increases the risk.
- Exposure to radiation
- High breast density
- Race: While the total number of breast cancer incidences is higher in white women, Black women are at a higher risk of developing more aggressive forms of breast cancer, including stage 3 breast cancer.
Modifiable risk factors are those that possibly can be changed or controlled through lifestyle or behavior choices. These include:
- Excess body weight or high body mass index (BMI)
- Low physical activity or sedentary lifestyle.
- Excessive alcohol consumption
- Smoking, including second-hand smoking
- Unhealthy diets
- Hormone therapy and hormonal birth control: Certain types of hormone therapy and long-term use of hormonal birth control may increase the risk.
It's important to note that while these risk factors may increase the likelihood of developing breast cancer, they do not guarantee that someone will develop the disease. These risk factors may contribute to the development of breast cancer in general and not specifically to stage 4.
Stage 4 breast cancer is the most advanced stage of breast cancer, where the cancer has spread beyond the breast to other areas of the body. The symptoms of stage 4 breast cancer can vary depending on the organs affected by the spread of cancer cells.
Symptoms of stage 4 breast cancer may include symptoms of cancer in the breast as well as the organs affected by the spread of breast cancer:
Breast symptoms:
- Inflammation or skin ulcers on the breast
- Breast pain or discomfort
- Upper-body symptoms including pain, poor range of movement, numbness, stiffness, heaviness, achiness, tightening, tingling, or weakness
Metastasis symptoms:
- Shortness of breath or difficulty breathing (if cancer has spread to the lungs)
- Persistent headaches, seizures, or changes in vision (if cancer has spread to the brain)
- Bone pain or fractures (if cancer has spread to the bones)
- Abdominal pain, jaundice, or swelling (if cancer has spread to the liver)
- Fatigue, weakness, unintentional weight loss (general symptoms of metastatic cancer)
People with stage 4 breast cancer may not experience all of these symptoms. It's important to note that these symptoms can also be caused by other conditions, so it's crucial to consult with a healthcare professional for an accurate diagnosis.
Breast cancer is first diagnosed, then the stage is determined.
To diagnose breast cancer, healthcare professionals use a combination of examinations, tests, and procedures:
- Breast examination: A healthcare professional will carefully examine the breasts and underarm area for any lumps, changes in texture, or other irregularities.
- Mammogram: This is a type of X-ray specifically designed for breast tissue. It creates detailed images that can detect any early signs of breast cancer, such as tumors or abnormalities.
- Ultrasound: Using sound waves, a handheld device called a sonogram creates images of the inside of the breast. This helps doctors differentiate between solid masses and fluid-filled cysts.
- MRI (magnetic resonance imaging): An MRI scan uses strong magnetic fields and radio waves to generate detailed images of the inside of the breast. It provides additional information about the size and location of tumors.
- Biopsy: If initial tests indicate the presence of breast cancer or suspicious findings, a biopsy is performed. During a biopsy, a needle is used to obtain a small sample of breast tissue. A pathologist examines the sample under a microscope to see if cancer cells are present.
To determine the stage of breast cancer, additional tests and procedures may be performed to gather more information. This may include:
- Tests of blood, urine, cerebrospinal fluid (CSF), and other body fluids
- Lymph node biopsy
- Additional imaging tests, such as CT (computed tomography), MRI, PET (positron emission tomography) or bone scans, to look for cancer in other parts of the body.
- Procedures such as endoscopies to examine the inside of certain organs or tissues for signs of cancer.
Staging is based on:
- Tumor size
- Involvement of lymph nodes
- Spread (metastasis) of breast cancer to other parts of the body
To guide treatment, additional testing is performed to determine if the cancer cells
- Have receptors for estrogen or progesterone
- Have human epidermal growth factor receptor 2 (HER2) protein
The specific diagnostic approach may vary based on individual circumstances. It's always best to consult with a breast cancer specialist for personalized guidance and recommendations.
The goals of treatment for stage 4 breast cancer are to control the growth of the cancer, prevent organ damage or pain, and improve quality of life. The treatment plan may include:
Medication:
- Targeted medications: These drugs specifically target certain molecules in cancer cells to block their growth and spread.
- Chemotherapy: It uses drugs to destroy or damage cancer cells, reducing tumor size and preventing further growth.
- Hormone therapy: This treatment blocks or lowers the level of hormones that fuel the growth of hormone receptor-positive breast cancer.
- Immunotherapy: It helps the immune system recognize and destroy cancer cells.
Therapies:
- Radiation therapy: It uses high-energy beams to kill cancer cells or shrink tumors in specific areas of the body.
- Palliative care: This provides support to manage symptoms, improve quality of life, and address emotional well-being.
- Mental health support: Seeking counseling, talking with social workers or psychologists, and joining support groups can help cope with emotions and stress associated with the diagnosis.
It's important to note that while these treatments can slow down tumor growth, improve symptoms, and extend life expectancy, stage 4 breast cancer cannot be cured. Consult breast cancer specialists for personalized advice and treatment plan recommendations based upon your individual situation.
Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Other side effects can occur. Check with your health care professional or read the information provided with your medication for additional side effect information.