The ABCs of Metastatic Breast Cancer

The ABCs of Metastatic Breast Cancer


ANYONE can be diagnosed with MBC: young or old, male or female.


BONE is a common site of metastatic disease in patients with MBC, making this type of metastasis a significant concern. In addition to other recommended treatments, patients with MBC and bone metastases should receive Denosumab, Zoledronic Acid or Pamidronate — and all with Calcium and Vitamin D supplementation). These agents are given to preserve bone, reduce symptoms and decrease osteoclast activity and skeletal complications. They are generally well-tolerated, though influenza-like symptoms can occur a few days after administration. Regular monitoring of renal function is required.


CHOICES of treatment are guided by breast cancer type, location and extent of metastasis in the body, as well as previous treatments and other factors.
CHEMOTHERAPY: initial chemotherapy should be considered for patients with HR+ MBC who are exhibiting clinical signs of aggressive visceral disease requiring a faster treatment response (i.e. visceral crisis). Chemotherapy is also recommended rather than endocrine therapies in patients with HR- MBC, or HR+ disease when there has been no response after 3 consecutive hormonal therapies.


DIFFERENT : There are many different types of MBC, just like early stage breast cancer. Each person also has a DIFFERENT experience of their own particular cancer, treatment and emotional journey — all of which are normal.


EARLY detection does not guarantee a cure. Metastatic breast cancer can occur 5, 10 or 15 years after a person’s original diagnosis and successful treatment check-ups and annual mammograms.
ENDOCRINE treatment is a treatment strategy focused on interference with oestrogen and its tumor-promoting properties in HR+ disease. Endocrine therapy is considered first-line therapy due to a less toxic side-effect profile and comparable efficacy to chemotherapy.


FRACTIONATION means dividing the total dose of radiation therapy into smaller, equal doses. The smaller doses are usually given over a period of weeks.


GRADING is a system of classifying cancer cells in terms of how abnormal they appear when examined under a microscope. The point of a grading system is to provide information about the probable growth rate of the cancer and its tendency to spread. The systems used to grade cancers vary with each type of cancer. Grading is important for treatment decisions.


MBC is a HETEROGENOUS disease which means that one tumour can have many different types of cells in it. This happens because tumour cells can have genes and proteins that are very different from one another – and they can grow at different rates. This is why different treatments are used to destroy the different cells that can exist in one tumour.


INCURABLE: Because MBC is incurable, the goals of therapy revolve around quality of life – as well as stabilising the disease, prolonging survival and managing symptoms.
IMMUNITY: Cancer treatment weakens the immune system by causing a low white blood-cell count, leaving the body vulnerable to viruses. (Zovirax is administered to help the body fight viruses.)


JAUNDICE: chemotherapy, Tamoxifen (a hormonal therapy) and Kadcyla (a targeted therapy) can cause liver damage, allowing too much bile into the blood which causes the skin and the whites of the eyes to turn yellow.


KILLER cells are white blood-cells which attack cancer cells and body cells that have been invaded by foreign substances.
Ki-67 is a test that shows how fast cancer is growing.


LIFELONG: Treatment for metastatic breast cancer is life-long.


MAXIMISE the benefits of treatment & MINIMISE the side-effects!


NUMBERS: 20% to 30% of people initially diagnosed with early stage disease will develop metastatic breast cancer.


OCCURRENCE: Metastatic breast cancer can occur 5, 10 or 15 years after a person’s original diagnosis and successful treatment check-ups and annual mammograms.


PARTICIPATING PATIENTS: Whenever possible, patients should be active participants in treatment decisions.

PROGRESSION of disease: Possible indicators of disease progression include: worsening symptoms; declining performance status; weight loss; increasing alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, or bilirubin; hypercalcemia, as well as increasing tumor markers.

PROLONGATION of survival: Although MBC is currently incurable, prolongation of survival with good quality of life can be achieved with aggressive monitoring and intervention.


QUALITY of life & control of the disease is what treatment is focused on in a holistic, patient-centred approach.


REGULAR assessments: Patients should be assessed regularly for symptoms, including laboratory testing and imaging studies.


SPREAD: MBC (Stage IV disease) is defined as breast cancer that has spread to other sites in the body. After lymph nodes, the most common sites of metastasis are bone, liver, and lung – with bone most commonly affected. Other sites of metastasis include the skin and brain.
STATISTICS: About 6% to 10% of people are Stage IV from their initial diagnosis.
SURVIVAL: Overall survival can vary from a few months to many years and is affected by several factors, including patient age and stage at diagnosis. While overall breast cancer mortality rates have decreased over the last several decades, the 5-year survival rate for MBC is currently estimated at less than 25%. The 10-year survival rate has been estimated to be 5% to 10% following detection of metastatic disease.
SUPPORT: Supportive care may include treatment for symptomatic anaemia or leukopenia, psychological support, or for amelioration of menopausal symptoms. If a patient shows signs of symptomatic anaemia, they should also be evaluated for other possible reasons for fatigue – including poor nutrition and treatment side-effects. In addition, psychological support should be available to all patients to address depression, anxiety, stress, and social isolation. Benefits of psychological support can include improved mood and pain control. Finally, nurses can enhance patient-care in general by providing patients with personal support, respect and partnership.


It TRAVELS & THREATENS: No-one dies from breast cancer that remains in the breast. Metastasis occurs when cancerous cells travel to a vital organ and that is what threatens life.

TREATMENT: Systemic treatment options include endocrine (i.e. hormonal) therapy, chemotherapy, targeted therapy (e.g. monoclonal antibodies) and agents which help preserve bone, especially for patients with bone metastases.
TARGETED THERAPIES inhibit some of the pathways that promote tumor cell growth and proliferation, such as the HER2 receptor signaling pathway or growth factor signaling pathways involving mTOR. The side-effect profiles of these agents and combinations must also be factored into treatment decisions.


UNIQUE: There are no definitive prognostic statistics for metastatic breast cancer. Every patient and their disease is unique.


From VAGINA to VIRUS to VOCAL CHORDS: read much more here!


WELLCOVERIN: A drug that works by enhancing the anti-cancer effects of certain chemotherapy medicines and helps protect healthy cells from other chemotherapy medicines. It belongs to a group of drugs called folic acids (B-9 vitamin).


X-RAY THERAPY: The use of high-energy radiation from X-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor, or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation or brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radio-labeled monoclonal antibody which circulates throughout the body. (X-ray therapy is also called radiation therapy, radiotherapy, and irradiation.)


YOU: Implementing appropriate treatment that is in line with your (the patient) preferences is the first priority – and hence why communication between the healthcare specialists team, as well as with the patient, is of paramount importance.


ZINECARD: a drug used to protect the heart from chemotherapy drugs that can cause heart damage.
ZOLADEX: A drug that lowers the amount of oestrogen made in the body before menopause. It works by stopping the brain from telling the ovaries to make estrogen. This can slow down the growth of breast cancers that need estrogen to grow.

ZOMETA: A drug that works by limiting the activity of certain bone cells, called osteoclasts, which help cause the bone-weakening and destruction that can happen when breast cancer spreads to the bone. It belongs to a group of drugs called bisphosphonates.

If you have any questions – or would like to add to this mets alphaphet, get in touch with us on our Facebook page or leave your (much welcomed!) comments below!


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