Stage 4 breast cancer, also known as metastatic breast cancer (MBC), occurs when our breast cancer spreads to other organs in our body. The places that breast cancer spreads to most often are the brain, the bones, the liver and the lungs.
Getting Ready for Treatment
Although metastatic breast cancer (MBC) is unlikely to be cured, today’s treatments can extend our life and improve our quality of life. New treatment options offer hope. Many in the cancer Horizons community have been able to enjoy much more time with their families than any of the medical professionals predicted, some of their stories can be found here.
Treatment for MBC is customized and personalized. Before treatment starts, many tests are utilized to determine which treatments will be most effective. Because MBC is most likely to spread to the brain, bones, liver and lungs, these tests focus on discovering the extent of our disease. Tumor marker tests help determine which treatments work best. Be prepared for some of these tests:
- CT scan of the thoracic (chest) and abdominal region
- Brain MRI
- Spinal MRI
- Bone scan or PET scan
- Tests for hormone and HER2 receptors
- Possible advanced genetic testing if other members of your family have had MBC
- Biopsy of distant site tumor
Before treatment begins, work on logistical issues for keeping the household running smoothly during treatment. Here are some suggestions:
- Find someone to take our young children to daycare on our chemotherapy days
- Start a notebook to keep organized – include names and numbers of our doctors, lists of medications, upcoming appointments and bloodwork results
- Plan transportation to and from appointments on days we are unable to drive
- Eldercare arrangements if a parent or in-law is living with us
- Find affordable lodging if our treatment requires an out-of-town location
Before treatment is the best time to review our health insurance coverage. Learn what is covered and our potential copays. Many newer treatments are in pill form and are not covered in the same manner as IV treatments. Oral chemotherapy is covered under our prescription drug plan. Patients face high out-of-pocket costs until the max-out-of-pocket amount is reached. It’s best to be prepared and have a plan. Patient assistance is often available.
Ask about employee short-term and long-term disability coverage. Some patients are able to continue working; many won’t be able to work due to side effects. Stage 4 breast cancer is an automatic qualifier for Social Security disability if you have sufficient work credits.
Because our cancer has spread (via our bloodstream and/or our lymph nodes), it is considered a systemic disease. Chemotherapy treats our whole body and will attack cancer cells wherever they are located. A key factor in determining which chemotherapy medicine is appropriate for us is our hormone receptor status, which may be either positive or negative.
Men with breast cancer often receive the same treatments as postmenopausal women, with one important exception. They also receive aromatase inhibitors which prevent the production of testosterone.
Radiation therapy offers symptom relief for MBC patients. It provides pain relief and may offer relief from neurological issues like numbness or cognitive issues if cancer has spread to the brain. Surgery is appropriate in specific instances.
Many patients seek clinical trials. Search for a clinical trial that right for you with this clinical trial finder.
Visit NCCN.org and download the Guidelines for Stage IV breast cancer. The NCCN is a consortium of 27 leading cancer treatment centers in the U.S. who have joined together to share treatment resources with both physician and patients. This 50+ page definitive Guideline provides specific treatment recommendations based on the specific characteristics of metastatic breast cancer.
The Value of a Second Opinion
We, as patients, may feel rushed to begin treatment. Treatment for Stage 4 breast cancer is complex and may take a long time. It’s prudent to get a second opinion before beginning treatment to ensure that we are getting the best possible option. Getting a second opinion won’t offend your doctor. In fact, some insurance companies require a second opinion.
What if our second opinion is in complete disagreement with the first opinion? Seek a third opinion to act as a tiebreaker to provide peace of mind when making a treatment decision.
Living with Our Diagnosis
Although our Stage IV diagnosis is not what we hoped for, it is our new reality. We have to find a balance between our fears and our desire to live fully every day.
Elizabeth Edwards probably said it best, “A positive attitude is not going to save you. What it’s going to do is, every day, between now and the day you die, whether that’s a short time from now or a long time from now, that every day, you’re going to actually live.”
“Living in the now” helps anyone living with a Stage 4 diagnosis focus on the good things that happen today rather than allowing them to slip away. Concentrate on the good of today. Savor that first cup of coffee. Luxuriate with a nice, warm bath. Practice the simple art of saying “thank you.”
Keeping a journal helps us express emotions we are unwilling to share with others. Start a Caring Bridge page to share updates with friends, family and co-workers. Writing a blog or creating a Facebook page will allow us to find ourselves while helping others understand the emotional ups and downs of cancer treatment.
I love this quote from Leo Buscaglia, “Worry never robs tomorrow of its sorrow, it only saps today of its joy.”
It’s only natural to feel anxious and/or depressed. Ask your oncologist for a referral to a mental health professional who can prescribe appropriate anti-anxiety or antidepressant medications. Don’t try to go this diagnosis along.
Talk to the social worker at your cancer treatment center about issues like gas money, transportation to and from treatment, child care issues and financial issues.
Avoid negative people. Surround yourself with inspirational quotes. Practice deep breathing. Take a walk when you are able. Ask your oncologist for a referral to physical therapy to learn stretch exercises to keep you flexible. Enjoy the small joys of everyday life. Never forget that miracles happen.