Treatment of advanced and recurrent breast cancer

• Advanced breast cancer
• Recurrent breast cancer
• Treatment of advanced and recurrent breast cancer
• Understanding treatment options
• Moving forward

Advanced breast cancer

What is advanced breast cancer? The term "advanced breast cancer" refers to stages of breast cancer labeled IIIB, IIIC and IV. Cancer spread may be present at first diagnosis, or after recurrence.

• Stage IIIB/C (locally advanced cancer): Tumor may be any size, but has spread into the skin of the breast or tissues of the chest wall.
• Stage IV (metastatic disease): Cancer that has also spread from the breast to other organs of the body, such as bone, liver, lung, or brain.

Fully understanding your treatment options will help arm you with information that may alleviate some of your fears. The goal is to live as long as possible with the best quality of life.  This means relieving symptoms and helping treat cancer with the fewest possible side effects.

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Recurrent breast cancer

Why does breast cancer come back? Emotionally, it’s hard to make sense of exactly why your cancer has come back or spread. But there are scientific reasons as to why this can occur. Despite the fact that you may have had surgery to remove the tumor and a portion of the surrounding tissue, some cancerous cells may have remained undetected. While a form of adjuvant therapy, such as radiation or chemotherapy, is often used to eliminate any remaining cancerous cells, some may escape the effects of treatment and move to other parts of the body. Over time, these tiny cells grow and spread until they are large enough to be detected.

When cancer comes back. Recurrence is the term used to describe the return of cancer following initial treatment, either at the same site as the original tumor or somewhere else in the body. There are three types of recurrent breast cancer — local, regional, and distant.

• Local recurrence: Occurs in the breast where the cancer first started, or in the skin and underlying tissues where the breast used to be. This type of recurrence can happen even if you’ve had a mastectomy
• Regional recurrence: Occurs in the lymph nodes near the affected breast. These regional lymph nodes include nodes found under the arm (axillary nodes), in the neck, and in the chest wall
• Distant recurrence: Occurs in other parts of the body, such as the bone, liver, lung, or brain

It’s important to realize that even though you’ve had breast cancer before, it may not be exactly the same this time around. Just as you needed to understand all of the details of your original diagnosis, you’ll need to learn as much as you can about your current situation. That way, you can make the best decisions about your treatment.

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Treatment of advanced and recurrent breast cancer

Whether you are newly diagnosed with advanced breast cancer or are facing a recurrence, receiving the diagnosis can feel devastating, to say the least. But know that with appropriate therapy, many women with recurrent or advanced breast cancer continue to go on with their lives, thanks to many available treatment options. These therapies are aimed at lengthening and maintaining the best possible quality of life. So remember that there is hope. Depending on your unique situation, you and your doctor will decide on treatment that is right for you.

• Talk Back to Fear. These tips from breast cancer experts will help you cope with the normal fear that may accompany a diagnosis of recurrent or advanced breast cancer

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Understanding treatment options

Treatment for recurrent and metastatic disease may include one type of therapy or a combination of therapies. Some of the therapies available for women with recurrent and metastatic disease are described below:

Hormonal (estrogen-blocking/reducing) treatment. In advanced breast cancer, the goal of hormonal treatment is to slow or delay disease progression. It is used as a way to block the effect of estrogen and keep it from helping cancer cells to grow and spread. The best way to predict the likely response to hormonal treatment is through the presence of hormone receptors (message-carrying proteins that may stimulate tumor growth) in the cancerous tumor. There are several hormonal treatment options available. Ask your doctor about these options and whether hormonal treatment may be right for you.

Chemotherapy. Chemotherapy is the use of drugs to destroy cancer cells, particularly those that have spread to areas other than the breast. It is sometimes used in locally advanced breast cancer to shrink the tumor and make it operable. For tumors that have spread and cannot be removed by surgery, chemotherapy may be the main type of treatment. There are many different chemotherapy drugs and regimens. Chemotherapy can be used alone or along with hormonal treatment, as well as with other treatments.

Novel targeted therapy. This term covers several new options that fight cancer by targeting specific features of cancer cells, such as certain proteins. One type of targeted therapy, for example, works only against breast cancer cells that make too much of a protein called HER2/neu. This particular type of therapy is used specifically for the treatment of recurrent or metastatic breast cancer. It works by binding to HER2/neu proteins on tumor cells, causing them to stop working. Tumor cells are then unable to grow, or their growth is slowed. This type of therapy can be used together with chemotherapy.

Radiation therapy. Radiation therapy uses x-rays to kill or hinder the growth of cancer cells. In metastatic disease, some patients may receive radiation therapy to treat symptoms at sites where the cancer has spread. For example, if breast cancer has spread to the bone, radiation may be used to lessen bone pain.

Surgery. In some cases, a physician may recommend surgery to remove tissue from the breast or to remove lymph nodes. While surgery may help control cancer by removing cancerous tissue, if the cancer has spread to other parts of the body, surgery is generally not an option.

Palliative care. Palliative care is meant to relieve common symptoms that patients may experience in advanced stages of the disease. Some of these symptoms may include pain, shortness of breath, lack of appetite, weakness, anxiety, and depression. These symptoms may be managed with appropriate medications, including hormonal treatment in some patients.

Find out more about treatment options for recurrent and metastatic disease: the different types, how they work, and which option may be right for you. Visit www.breastcancer.org/rcr_intro.html.

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Moving forward

It’s OK to be scared. Learning that you have a recurrence or metastatic disease can be devastating. But it’s important to realize that there are many women — just like you — who are moving forward and fighting this disease with everything they’ve got. We want to help you do the same. Learn more about living with recurrent and metastatic disease and coping tips. Then get the answers to frequently asked questions about recurrent and metastatic disease and the recommended resources women like you rely on to gain strength for the fight.

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Advanced breast cancer: living and coping with the disease

Learn more about your diagnosis, treatment options, and how to move forward living life to its fullest. Download a free patient checklist brochure.