Oncology

Finding the Best Treatment for Metastatic Breast Cancer

Insights from breast medical oncologists on living with stage 4 breast cancer

When cancer cells spread from the breast to other areas of the body, it is referred to as metastatic breast cancer (also known as stage 4 breast cancer – the most advanced form of the disease – or secondary breast cancer). Breast cancer itself is caused by abnormal cells that divide and multiply; a mass of these cells is a tumour.

Areas of the body to which the abnormal cells can spread, resulting in metastatic breast cancer, include the lungs, brain, bones and liver.

How common is metastatic breast cancer?

When breast cancer is first diagnosed, the cancer is found to have spread or metastasised in around six per cent of women and nine per cent of men. Around 168,000 women had metastatic breast cancer in the USA in 2020. In the UK the figure is 35,000.

Metastatic breast cancer can develop when the original breast cancer returns and cancer cells spread via the lymph nodes or blood vessels (a system the body uses to get rid of toxins). If the abnormal cells aren’t detected soon enough, they can multiply in their new locations, causing tumours to develop.

Signs and symptoms of metastatic breast cancer

The symptoms of metastatic breast cancer are manifold and vary depending on what areas of the body the cancer is causing problems in. For instance, cancer that has spread to the bones can result in pain and swelling. Cancer in the lymph nodes in the armpit causes swelling (lymphoedema).

Cancer in the brain can result in headaches, seizures, sight problems and vomiting. If it’s in the liver, then jaundice is a common symptom along with itchy skin, nausea and stomach pain. With cancer in the lungs, shortness of breath, a persistent cough, and even chest pain are common.

Other general symptoms can be weight loss, lack of appetite and constant fatigue.

Management and treatment of metastatic breast cancer

There is no cure for metastatic breast cancer. It is impossible to eliminate all the abnormal cells once they have spread to other parts of the body. Cancer can, however, be managed with the right ongoing treatment. In fact, around one-third of women with metastatic breast cancer in the USA live at least five years after their diagnosis and some women live twice that long and more post-diagnosis.

Cancer experts from the Oncology Institute, Cleveland Clinic Abu Dhabi, provided Medical Travel Market with the following insights:

Some patients can live a long time with metastatic breast cancer. Survival depends on the type of breast cancer, the location and number of metastatic lesions. New treatments are offering hope for improvements in outcome for patients with metastatic breast cancer.

Dr Stephen Grobmyer, Institute Chair, Oncology Institute, Cleveland Clinic Abu Dhabi

There is strong evidence that implementing supportive measures early in the treatment journey, preferably with involvement of palliative care services and appropriate clinical follow up improves patient survival too.

Dr Bassel Jallad, Staff Physician, Oncology Institute, Cleveland Clinic Abu Dhabi

The course of treatment for metastatic cancer is focused on preventing tumours from growing larger and shrinking them if possible. At the same time, the symptoms of the disease have to be managed.

Treatment could involve chemotherapy sessions, hormonal therapy (depending on the type of breast cancer), immunotherapy or targeted therapy using drugs such as Herceptin or Palbociclib to block particular types of cancer cells. In certain cases, surgery may be appropriate, for example, to treat a liver blockage.

The treatment for metastatic breast cancer can go on indefinitely and is dictated by the location of the cancer cells, the patient’s previous treatment when they had breast cancer, and their current symptoms.

What causes metastatic breast cancer?

There is no one particular cause for breast cancer but metastatic breast cancer is caused by the original cancer returning (even years later) and spreading.

It’s important to point out that not all breast cancer that returns is metastatic. If the cancer returns to the region of the original cancer, then it is termed a local recurrence. If it returns to the lymph nodes in the armpit, the lower part of the neck, or near the breast bone, then it is called a regional recurrence. Local and regional recurrences are not considered metastatic breast cancer, since the abnormal cells haven’t spread to other organs in the body.

The longer cancer goes undiagnosed, the more likely the abnormal cells are to spread. The speed at which it spreads depends on what type of tumour it is in the first place, whether it’s a fast or slow-growing version.

Age appropriate cancer screening can help detect asymptomatic cancers at an earlier stage and by then ensure the start of appropriate therapy before the cancer spreads.

Dr Bassel Jallad, Staff Physician, Oncology Institute, Cleveland Clinic Abu Dhabi

Prevention is always better than cure, and that means having regular breast checks, including mammograms. The idea is to stop the abnormal cells from spreading to other parts of the body.

Best hospitals for treating metastatic breast cancer

There are several cancer specialist hospitals, particularly in the USA and the UK, which have a good reputation in the treatment of metastatic breast cancer. These include but aren’t limited to:

The London Clinic

As one of the largest private cancer hospitals in London, The London Clinic is often at the forefront of introducing specialized technologies and emerging therapies to provide life-saving cancer diagnosis and treatment. The hospital treats around 120,000 patients a year from all around the world and recently celebrated its 90th year in the capital’s Harley Street in January 2022.

The Royal Marsden, London

The Royal Marsden is a global leader in cancer care and groundbreaking research and is rated by the UK’s Care Quality Commission as’ Outstanding’. The hospital has dedicated units for each cancer types and a highly specialized service is offered to patients with metastatic breast cancer, including access to a dedicated clinical nurse specialist.

Mayo Clinic, Arizona, US

Around 10,000 people a year attend the clinic for breast cancer, and almost 1,500 individuals a year undergo breast cancer surgery. Dedicated breast cancer specialists draw up treatment plans based on the latest research, innovations and technological advances.

John Hopkins, Maryland, US

Specialists at the hospital’s Kimmel Cancer Centre offer new treatment approaches, individual & family counselling and access to an elite group of breast cancer specialists.

Cleveland Clinic, Ohio, US

This century-old medical facility has more than 700 physicians, researchers and nurses caring for thousands of cancer patients every year in the United States. The Cleveland Clinic foundation’s expertise will soon be available to patients in the newly inaugurated Cleveland Clinic London and also at the Cleveland Clinic Abu Dhabi campus, where a flagship oncology center is set to open in November 2022.

In his closing remarks, Dr Grobmyer reminds readers of the importance of seeking the opinion of a team of experts at a highly experienced center.

Optimal breast cancer treatment involves proper diagnosis (pathologists) and staging (radiologists) working alongside expert breast medical oncologists, surgeons, and radiation oncologists. In addition, experienced centers can provide critical supportive services to patients.

Dr Stephen Grobmyer, Institute Chair, Oncology Institute, Cleveland Clinic Abu Dhabi

Around 290,560 Americans (287,850 women and 2,710 men) are expected to receive a breast cancer diagnosis this year. It’s the second most common cancer in the USA and the UK (excluding skin cancer). On a global scale, it has now surpassed lung cancer as the biggest cancer threat.

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