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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 body. A tumor that has spread to another part of your body is called a metastasis (the plural is metastases).

Metastatic breast cancer is also referred to as Stage IV breast cancer or advanced breast cancer.

WHAT DOES THE DIAGNOSIS OF METASTATIC BREAST CANCER (MBC) MEAN TO 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.

WHAT TESTS DO I NEED TO CONFIRM MY MBC 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 you.

The types of tests you might have include:

Laboratory tests – these are tests of the blood, urine of 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 for breast cancer.

Biopsy – this is when a sample of tissue is taken from your tumor to test for genetic markers on the tumor cells. Tests performed may vary from one person to another depending on the signs and symptoms of your metastatic breast cancer and your oncologist’s recommendation.

Tests and scans used to diagnose your breast cancer may be repeated throughout your treatment duration. This will help to determine if you are responding to your treatment for example tumor shrinkage and stable disease (tumor neither growing or shrinking) and not responding when the tumor starts to grow again.

WHAT ARE THE DIFFERENT TYPES OF 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).

By knowing the combination of your genetic markers, it will help your oncologist in selecting the right treatment and prognosis for your metastatic breast cancer.

There are four main types of breast cancer:

HR-positive, HER2-negative

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

HR-negative, HER2-positive

Human epidermal growth factor receptor 2 (HER2) is found within the cell membrane. When HER2 is activated, it causes breast cancer cells to grow and divide. When breast cancers have cells with more than 2 copies of the HER2 gene, this will generate too many HER2 receptors, and subsequently breast cancer cells grow and divide fast. This cancer is called 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. Triple-negative breast cancer typically has a worse prognosis and is more aggressive. That being said, a large proportion of triple negative breast cancer patients will receive a relatively positive looking prognosis should the cancer be localized.

WHAT ARE THE COMMON SITES OF METASTATIC BREAST CANCER AND SYMPTOMS?

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 bones, liver, lungs and brain. The symptoms you experience will depend on the location of your metastases.

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  • Brain
  • Lungs
  • Liver
  • Bones
  • BRAIN

    Symptoms of stage 4 breast cancer 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 seizures.

  • 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. An effective prognosis for stage 4 breast cancer can greatly improve your quality of life.

Frequently Asked Questions

Where can I go for breast cancer screening tests like an MRI scan?

Breast cancer is one of the most common types of cancer in Thailand, and we recommend regular screening for early detection and diagnosis. You can get screened for breast cancer by scheduling an appointment at a clinic or a hospital.

Although breast cancer screening cannot prevent breast cancer, the general guidelines is that, frequently checking your breasts for cancer before there are any signs or symptoms can help you catch the disease early. And by seeking out the right oncologist and treatment will hopefully prevent the disease from progressing further.

How often should I do breast cancer self-exams?

Aim to check yourself once a month. For women, this would ideally be 7-10 days after each menstrual cycle, which is when breasts are the least tender and lumpy.

During your breast cancer self-exams make sure to follow proper guidelines and look for any changes in breast tissue, such as changes in size, any lumps, dimpling or puckering of the breast, inversion of the nipple, redness or scaliness of the skin or nipple area, or discharge from the nipple.

If you see any changes mentioned above, it is imperative that you consult with your physician immediately.

What is the prognosis of metastatic breast cancer?

Despite there being no cure for metastatic breast cancer after being diagnosed, many treatment options that can extend a patient’s life have been available in Thailand since the 1990's. Consult with your oncologist to choose the right treatment course for you.

What kind of treatments are available to alleviate metastatic breast cancer symptoms?

Treatments for this type of stage IV cancer encompass many of the same treatments as other stages of breast cancer.

  • Chemotherapy
  • Radiation therapy
  • Hormone therapy
  • Biologic targeted therapy
  • Breast surgery
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.