Stage 4 breast cancer is cancer that has spread beyond the original site, typically to distant lymph nodes, the brain, liver, lungs, or bones. Other terms you may have heard for this stage are metastatic or advanced. Stage 4 breast cancer is considered to be incurable, but many treatment options exist that can extend lifespan and improve quality of life.
Because there are many types of breast cancer, there are many types of treatment options. Not every treatment is right for every patient, but here is a list of options:
- radiation therapy
- hormone therapy
- targeted therapy
- clinical trials
- pain management
Chemotherapy uses one or more drugs to kill cancer cells and slow cancer growth. Given either orally or through an IV, the drugs travel through the bloodstream. In this way, the drugs can target not only the original site of the cancer, but also any areas in the body where the cancer cells have spread. Unfortunately, chemotherapy drugs affect other cells in the body besides the cancer cells, which is the reason for the common side effects of chemotherapy. Once chemotherapy is completed, however, the side effects will subside.
Radiation therapy uses strong X-rays or other forms of radiation to both destroy cancer cells and slow cancer growth. The radiation can either be focused on the area where the cancer is growing from the outside of the body, or inserted in or near a tumor with a needle, tube, or pellet. Radiation is most useful in situations when the cancer is located in a specific confined area. It is commonly used on brain and bone metastases.
Surgical options for stage 4 breast cancer depend on where the cancer has spread and associated symptoms. A well-defined tumor, for example, in the lung or liver, could be removed through surgery, but this is not common. Sometimes brain metastases are removed surgically. Cancerous lymph nodes may also be removed.
Hormone therapy is used in cases where the cancer is hormone receptor-positive. This means that estrogen or progesterone produced in the body is facilitating the cancer to grow and spread. Tamoxifen is one drug that blocks the estrogen receptors in breast cancer cells, which stops the cells from growing and dividing. Other drugs, called aromatase inhibitors (AIs), stop estrogen production and lower estrogen levels in the body. Common AIs include:
- anastrozole (Arimidex)
- letrozole (Femara)
- exemestane (Aromasin)
Targeted therapies are drugs that work by targeting very specific sites on a cancer cell. One example is Herceptin, which can be used in HER2-positive breast cancer. This is an aggressive type of cancer that has elevated levels of a specific protein on the cell surface that signal cell growth. Drugs like trastuzumab (Herceptin) target this protein and can slow or stop the growth of the cancer. Targeted therapies are often used in combination with other treatments, like chemotherapy. Other examples used in HER2-positive breast cancer are Pertuzumab, Lapatinip, and Ado-trastuzumab emtansine. Palbociclib and Everolimus are targeted therapies used in hormone-positive breast cancer.
Clinical trials are research studies using new drugs, or new combinations of drugs, that have been approved for use in human research. Trials are conducted when researchers believe that a drug has the potential to be better than current standard treatment. While it can be scary to think about being part of a research study, it’s important to remember that each one of today’s standard treatments is only available for women with breast cancer because it was tested in a clinical trial.
Pain management is an important component of most cancer treatment regimens. While the treatments described above may help prolong your life, pain management can improve your quality of life. There are many options for pain management, depending on the source and type of pain. Be sure to talk to your doctor about your pain, sooner rather than later, so that proper steps can be taken to help you feel better.