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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 – it does not mean that you received the wrong treatment for your initial breast cancer, or that you didn’t look after yourself. Anyone who has had breast cancer can possibly have a recurrence or relapse at any time.

Metastatic breast cancer is different from earlier stages of breast cancer – it is a chronic, incurable cancer1. Treatment will slow the growth of the cancer and it may even stop it for a while1,2.

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

The first thing your oncologist will want to do is 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 you1,2,..

The types of tests you might have include:

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 seen1.

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).

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 type 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).

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 cancer1,2,3:

HR-positive, HER2-negative

This is the most common form of breast cancer found in approximately two-thirds of patients3.

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 cancer. Between 15–20% of breast cancers are HER2-positive.

HR-positive, HER2-positive

This is cancer that has both HER2 and hormone receptors.

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

This cancer does not have HER2 or the receptors for the hormones estrogen and progesterone. Between 10–20% of breast cancers are triple-negative.

Even if you had early breast cancer and this 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 recurs.

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 bones.

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, memory loss, speech problems and seizures1,2.

  • LUNGS

    Sometimes breast cancer cells spread to one or both lungs through the blood or lymph system.

    Symptoms can include breathlessness, cough, pain and loss of appetite1,2,4.

  • LIVER

    If breast cancer has spread to the liver, you may experience pain, nausea, loss of appetite, hiccups, jaundice, exhaustion and itchy skin1.

  • BONES

    Bone metastases are the most common site of cancer-related pain and occur in approximately two-thirds of women with metastatic breast cancer.

    You may experience pain, bone fractures due to bone weakening, spinal cord compression, anemia and fatigue1.

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 (2019). 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 February 12, 2019.
  2. Australian Government Cancer Australia (September 2017) Metastatic Breast Cancer. Retrieved from https://breast-cancer.canceraustralia.gov.au/types/metastatic-breast-cancer Accessed February 12, 2019.
  3. Howlader, N et al. (2014) US Incidence of Breast Cancer Subtypes Defined by Joint Hormone Receptor and HER2 Status. JNCI 106 (5): 1-8.
  4. National Cancer Institute (2019). Breast Cancer Treatment -Patient Version. Retrieved from https://www.cancer.gov/types/breast/patient/adult/breast-treatment-pdq Accessed February 6, 2019.