My diagnosis

My diagnosis

When you understand what your diagnosis means and how it can affect your body, it can help you talk openly with your oncologist about the best care options for you.

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WHAT IS METASTATIC
BREAST CANCER?

Metastatic breast cancer is cancer that has spread from the breast to other parts of your body1,2. A tumor that has spread to another part of your body is called a metastasis (the plural is metastases)1,2.

Metastatic breast cancer is also referred to as Stage IV (or Stage 4) breast cancer or advanced breast cancer1.

What does the diagnosis of metastatic breast cancer mean for me?

Even if you were treated for breast cancer before, some breast cancers may come back. Anyone who has had breast cancer can possibly have a recurrence or relapse at any time3.

Metastatic breast cancer is different from earlier stages of breast cancer – it is a chronic and incurable cancer1. Treatment will slow the growth of the cancer and it may even stop it for a while1.

What tests do I need to confirm my diagnosis and check my progress?

The first thing your oncologist will want to do is to find out as much as possible about your cancer – what type of metastatic breast cancer it is and where it has spread in the body1,2. This will help your oncologist determine the best treatment plan for you.

The types of tests you might have include4:

Laboratory tests – these are tests of the blood, urine or other body fluids.

Imaging procedures – there are a variety of different imaging procedures that can help detect the location and size of tumors. Examples include CT scans and MRI scans.

Biopsy – this is when a sample of tissue is taken from your tumor to test for genetic markers on the tumor cells.

Which tests are performed may vary from one person to another – depending on your signs and symptoms, whether you’ve had breast cancer before and what the usual practice (protocol) is in the hospital where you are being seen5.

The tests and scans used to diagnose your breast cancer may be repeated throughout your treatment at regular check-ups. They can help determine if your treatment is effective and the tumor has shrunk (remission) or stopped growing (stable disease), or if your treatment has to be changed because the tumor is growing again (progression)3,5.

What are the different types of metastatic breast cancer?

The presence (or absence) of particular genetic markers on your breast cancer cells will define which types of breast cancer you have. The two main types of markers are human epidermal growth factor receptor 2 (HER2) and hormone receptors (HR). The two hormone receptors that are important in breast cancer are estrogen receptors (ER) and progesterone receptors (PR)6.

Knowing which combination of these markers you have will help your oncologist select the treatments that will be best for you.

There are four main types of metastatic breast cancer6:

HR-positive, HER2-negative

This is the most common form of breast cancer found in approximately two-thirds of patients7.

HR-negative, HER2-positive

When breast cancer cells make too much HER2 protein, they grow faster than normal cells, and faster than other cancer cells. This is called HER2-positive breast cancer6

HR-positive, HER2-positive

This is cancer that has both HER2 and hormone receptors6.

HR-negative, HER2-negative (also called triple-negative)

This cancer does not have HER2 or the receptors for the hormones estrogen and progesterone6

Even if you had early breast cancer that was tested, your oncologist may want to re-test your cancer cells for HER2 and hormone receptor status since these can often change when your breast cancer recurs3.

What are the common sites and symptoms of breast cancer metastases?

An important part of metastatic breast cancer diagnosis is to find out where the cancer has spread – or where you may have metastases. This will allow your oncologist to give you treatment specifically aimed at minimizing the possible effects of your metastases. For example, treatment can help strengthen your bones if cancer has spread to your bones1.

The most common sites for breast cancer metastases are the bones, the liver, the lungs and the brain1,2. However, there is no set pattern for where breast cancer cells spread – every case is different1.
The symptoms you experience will depend on the location of your metastases.

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  • Brain
  • Lungs
  • Liver
  • Bones
  • BRAIN

    Symptoms will depend on which area of the brain is affected by the cancer. Possible symptoms include headache, nausea, fatigue, weakness, confusion and seizures1,2.

  • LUNGS

    Symptoms can include breathlessness, cough and chest pain1,2.

  • LIVER

    If breast cancer has spread to the liver, you may experience pain, jaundice, exhaustion and loss of appetite1,2.

  • BONES

    A constant ache or pain in the bone is one of the early signs of bone metastases1. Bone is one of the most common places for breast cancer to spread1. As the bones become progressively weaker, fracture risk increases8. Movement is hindered and it becomes more difficult to sleep at nights1.
    Extra calcium may be released into the bloodstream from damaged bone cells and this in itself can cause fatigue, nausea, constipation and irritability8.

It's important to talk to your oncologist if you experience any unusual symptoms - don't wait too long.

 

References
  1. National Breast Cancer Foundation Australia (2020). Stage 4- Metastatic Breast Cancer. Retrieved from https://nbcf.org.au/about-national-breast-cancer-foundation/about-breast-cancer/stages-types-treatment-breast-cancer/stage-4-metastatic-breast-cancer Accessed 13 October, 2020.
  2. Australian Government Cancer Australia (October 2020) Metastatic Breast Cancer. Retrieved from https://www.canceraustralia.gov.au/affected-cancer/cancer-types/breast-cancer/types/metastatic-breast-cancer. Accessed 13 October, 2020.
  3. NCCN Clinical Practice Guidelines in Oncology Breast Cancer, Version 6. 2020- September 8, 2020. Retrieved from https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed 13 October, 2020.
  4. Australian Government Cancer Australia (October 2020). Diagnosis when breast cancer has spread. Retrieved from https://www.canceraustralia.gov.au/affected-cancer/cancer-types/breast-cancer/diagnosis/diagnosis-when-breast-cancer-spreads. Accessed 13 October, 2020.
  5. National Cancer Institute (August 2020). Breast Cancer Treatment -Patient Version. Retrieved from https://www.cancer.gov/types/breast/patient/breast-treatment-pdq. Accessed 13 October, 2020.
  6. National Breast Cancer Foundation Australia (2020). Molecular Markers of Breast Cancer. Retrieved from https://nbcf.org.au/about-breast-cancer/diagnosis/molecular-markers-of-breast-cancer/. Accessed 13 October, 2020.
  7. Howlader, N et al. (2014) US Incidence of Breast Cancer Subtypes Defined by Joint Hormone Receptor and HER2 Status. JNCI 106 (5): 1-8.
  8. Cancer Research UK (December 2017). Symptoms of advanced breast cancer. Retrieved from https://www.cancerresearchuk.org/about-cancer/breast-cancer/stages-types-grades/advanced/symptoms. Accessed 10 December, 2020.

Disclaimer

This health information is provided for reference only and is not intended to replace discussions with a healthcare provider.

All decisions regarding patient care must be made with healthcare provider.