Metastatic breast cancer (MBC) is cancer that began in the breasts, but has spread to other areas of the body. More than 150,000 people in the U.S. are currently living with MBC.
Hearing that you or a loved one has MBC is a difficult diagnosis to receive and a difficult topic to talk about. Although there is no cure for MBC, there are effective treatments that can slow the progress of the cancer, minimize symptoms, improve quality of life, and prolong a person’s life. For caregivers, knowing what questions to ask at an appointment with your loved one's healthcare provider can help you better understand the diagnosis and what treatment options are available.
What parts of the body has cancer spread to?
Breast cancer cells can spread to any part of the body, though the most common areas are the liver, lungs, bones, and brain. To learn where cancer has spread, healthcare providers will likely use an imaging test or a combination of imaging tests, such as CTs, MRIs, PET scans, bone scans, or X-rays. These diagnostic tests will also help determine the location and size of the tumors.
Do the cancers need to be biopsied?
MBC can be present when a person is initially diagnosed with breast cancer, but often occurs when the original cancer relapses. A healthcare provider may want to perform a biopsy of the suspected metastasis for confirmation before a treatment plan is formulated. However, a biopsy may not be necessary, depending on the situation. In most cases the metastatic tumors will be similar in type to the original tumor. Occasionally, the tumor receptors will change over time or after the original treatment. Tumors may be tested for various biomarkers that can tell you more about the cancer, how it is behaving, and how it can be treated:
- ER/PR-positive: When a cancer is estrogen-receptor/progesterone-receptor-positive—or ER/PR-positive—it uses the hormone estrogen to fuel its growth. There are a number of treatments that prevent these cancer cells from getting the estrogen they need to grow.
- HER2-positive: Human epidermal growth factor receptor 2, or HER2, is a protein that promotes the growth of normal cells. Some cancers produce an excess of this protein, which makes them more aggressive. Specific treatments are designed to target these cancer cells.
What treatment options are available?
Chemotherapy, hormone therapy, and biologic therapy are all used to treat MBC, but treatment depends on a number of important factors, including the biology of the cancer. A treatment may change over time. If the cancer stops responding to one or more treatment types, it may respond to another. If a person has side effects that are hard to control, another treatment may be recommended. Surgery and radiation therapy are not common treatments, but may be needed to remove or shrink specific tumors that are causing severe symptoms or are life threatening, such as tumors in the brain or the spinal column. A treatment plan will include medications to help with pain management and side effects of therapy. Many people prefer to get a second opinion before committing to a treatment plan.
Early on, talk to your loved one's healthcare provider about palliative care. Palliative care is different than hospice or end-of-life care—though the two terms are sometimes confused. Palliative care helps address the spiritual and emotional challenges of cancer, provide support for making treatment decisions, and help people with MBC and caregivers access counseling. Care teams may include doctors, nurses, counselors, dietitians, social workers, and chaplains. Palliative care helps with managing symptoms and has been shown to improve quality of life.
How will they know if the treatment is working?
Healthcare providers will monitor symptoms and order follow-up scans periodically. Blood work will monitor blood counts and liver function tests. In some cases, there may be tumor markers present in the blood. Ask your loved one's healthcare providers what tests are needed and how often these tests need to be performed.
What is the prognosis?
Prognosis is different for every person and depends on many factors. Your loved one's healthcare provider will explain what the prognosis is and what that prognosis means. Remember that there is still much to be learned about breast cancer, and researchers are constantly working to find new ways to treat this condition. People today who are living with MBC have access to treatment options that did not exist even a few years ago.
