Metastatic breast cancer refers to cancer that resurfaces in or spreads to another part of your body after treatment. Medical experts refer to the process of cancer spreading as metastasis. You can get a metastatic breast cancer diagnosis after receiving treated for early stage breast cancer, or after your cancer has already spread to other parts of the body (metastasized). The treatment options available to treat your metastasis will typically be dependent on some factors, the most important of which is the hormone receptor levels in the tumor.
Some breast cancer cells are very receptive to the hormones progesterone and estrogen. These cancerous cells flourish and spread when they encounter significant amounts of these hormones. These types of cancer cells are typically called hormone receptor-positive cells. If you have more of these cells, your tumor is likely to grow faster. However, while this may sound ominous, treatments such as hormonal therapy can counter them. This article analyzes the metastatic breast cancer treatment options available to you when you are diagnosed with metastatic breast cancer, and how to deal with your illness.
Understanding Hormonal Therapy
Hormonal therapy medicines reduce levels of progesterone and estrogen in the body thereby cutting them off from the cancer cells. If the cancer cells do not receive the hormone signals, they cease to grow. You will have a variety of hormonal treatment options for metastatic breast cancer. Since estrogen is the most important hormone, the determination of what therapies would be suitable for you would depend on whether you have undergone menopause or are still menstruating. If you have not been through menopause, ovarian suppression is the main way to stop the production of estrogen.
Ovarian suppression may be achieved through either of two methods: You may take luteinizing hormone or gonadotropin releasing hormone (LHRH or GnRH) that cause temporary menopause, by stopping the production of estrogen from the ovaries for periods ranging from 1-3 months. For a more permanent solution, you also could have surgery to remove the ovaries, which permanently and immediately stops estrogen production.
Hormonal Treatment for Metastatic Breast Cancer
In general, you physician will recommend that you undergo hormonal therapy if you have hormone receptor-positive breast cancer. Treatment options available to you will be dependent on the severity of the spread of your cancer and whether you have any complications that need medical management; the period between treatment and the reoccurrence of cancer; type of therapy you are receiving or have already received; and your overall health. The initial treatment that the doctor will prescribe after you are diagnosed with metastatic cancer is referred to as first line therapy. After the diagnosis finds that you have metastatic hormone receptor receptive breast cancer cells, the physician may recommend several therapies including a combination of letrozole, anastrozole, and fulvestrant if you have never had hormonal therapy for cancer.
If you are already premenopausal, your doctor may recommend hormonal therapy and ovarian suppression with either tamoxifen or an AI. AI may be a viable recommendation if you are postmenopausal. If the first line of treatment fails to treat your cancer, the physicians may prescribe a different type of hormonal therapy if the metastasis has not yet affected the normal functioning of the body’s organs.
Other Types of Treatment Along with Hormonal Therapy
In some instances, you may need to combine hormonal with targeted therapy to treat metastatic breast cancer. However, chemotherapy and hormonal therapy shouldn’t be a combination treatment for cancer, as the chemo may counteract the hormonal therapy. If you are a menopausal woman, Palbociclib, i.e. Ibrance, may be an effective metastatic breast cancer treatment in combination with fulvestrant, letrozole, and anastrozole if you have never used such drugs before. If you are a menopausal woman and happen to have your cancer worsen during treatment with either letrozole or anastrozole, a combination of exemestane alongside Everolimus may be a good option. Additionally, if you have HER2-positive cancer and do not need to undergo chemotherapy, a combination of AI and targeted therapy may work well.
Questions to Ask the Doctor:
- How severe is the metastasis?
- What are the hormone receptor levels of cancer? What are the implications?
- What are the implications of my HER2?
- What is your chance of recovery (the prognosis)?
- What treatments am I on?
- What are my options going forward?
- What are the risks and benefits of each option?
- Are there any clinical trials that I could participate in? In which city or states hold them and how do I find more information about this?
- What are your recommendations on the best treatment?
- What should be the objective of each treatment? Should it be to help me feel better, to eliminate the tumor or both?
- What will be my next move should I receive the treatment and have cancer recur?
- What are the side effects of the recommended treatments?
- What is the best way to manage the side effects of the treatments and symptoms of the illness?
- What are the metastatic breast cancer survival rates?
- What This Means for Patients
Getting a diagnosis of metastatic cancer can be very stressful, and you may find it difficult to accept. However, modern treatments now allow people with metastatic cancer to have a high quality of life, regardless of their condition. Your chance of discovery is dependent on several factors, the most important of which is the effectiveness of the treatment administered in slowing down, controlling, or halting cancer growth. Ensure that you have consulted your physician so that you get all the information you need prior. This way, you can have a clear idea of the goals of the metastatic breast cancer treatment; metastatic breast cancer survival rates; what happens if the treatment does not work; and how to maintain the quality of your life while undergoing treatment.
Lastly, it may be prudent to talk with the social workers, nurses, doctors, other members of the health care team and support group and tell them about your feelings. This will ensure that you do not manage the therapy treatments alone, which can make it hard for you to follow through with the program, therefore resulting in reduced quality of life.
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