Fourth-Stage or Metastatic Breast Cancer: Symptoms and Treatments 

Metastatic breast cancer, which is advanced or Stage IV breast cancer, is the breast cancer that has spread from the breast or the original location to other parts of the rest of the body, frequently spreading to the lungs, brain, liver, and bones. Although it cannot be cured, modern treatments, such as hormonal therapy, targeted therapy, and chemotherapy, can shrink the tumors and control the disease from worsening.  

Metastatic breast cancer is mostly a breast cancer recurrence when a few of the cancer cells remain in the patient’s bloodstream, nearby tissues, or in the lymphatic system, even after surgery. Since the treatment destroys almost every cancer cell, the tests won’t be able to detect these very few remaining cells. Sometimes these cancer cells remain dormant for years before the symptoms start to appear. 

In several cases, the modern treatments have prevented the cancer from spreading further for years and helped the patient to significantly improve the quality of their life. In this article, let’s check out how metastatic breast cancer is diagnosed, what its treatments are, and how to survive with cancer in your body. 

Diagnostics and Tests for Metastatic Breast Cancer

There are several tests involved in the diagnosis of metastatic breast cancer. They include: 

• Biopsy – Removal of a sample of tissue, which will be examined under a microscope by a pathologist.  
• Blood Tests – This includes a complete blood count and a comprehensive metabolic panel. 
• Bronchoscopy – Examining the insides of the lungs using a scope, if any concerning spots are found in the lungs. 
• Imaging Tests – This includes bone scans, chest X-rays, CT scans, MRI, PET, and ultrasound. 

In cases of fluid buildup in any areas of your body with symptoms, taps will be used to remove the fluid first (eg, a spinal tap to remove fluid from the spinal cord area or a pleural tap to remove fluid from the lungs).

Metastatic Breast Cancer Treatment

Since there is no cure available for the fourth-stage breast cancer, the major focus of the healthcare providers during the treatments will be to reduce the possible side effects of the disease and help to improve the quality of life of the patient. There is no single ideal method of treatment for this. 

The treatments for metastatic breast cancer are focused on systemic therapies and even localized treatments like radiation or surgery to eliminate pain or complications. The oncologist will strategize a treatment plan based on the type of cancer, the cancer’s receptor status (eg., HR+, HER2+, or triple-negative), the location where it has spread, past breast cancer treatment, and lab test results.   

The treatments for metastatic breast cancer include the following: 

• Hormone Therapy/Endocrine Therapy: This is primarily used for patients with hormone receptor-positive (HR+) cancer. With drugs like aromatase inhibitors, SERDs, or tamoxifen often paired with targeted therapies like CDK4/6 inhibitors, this treatment prevents the body’s natural hormones from becoming the fuel for cancer growth. 

• Targeted Therapy: This is targeted to attack special proteins or genetic mutations within the cancer cells. For HER2+ cancers, drugs like trastuzumab, pertuzumab, and antibody-drug conjugates like fam-trastuzumab deruxtecan are highly effective. While PARP inhibitors like olaparib are used frequently for BRCA mutations, targeted drugs like alpelisib may be used for PIK3CA mutations. 

• Chemotherapy: This is often used for triple-negative breast cancer or against cancer that spreads aggressively through other organs. This can kill rapidly multiplying cancer cells throughout the body.  

• Immunotherapy: It is used to strengthen the body’s immune system of the body and use it to fight against the cancer cells. It is often used against triple-negative breast cancer along with chemotherapy. 

Local Treatments for Fourth-Stage Breast Cancer

While systemic drugs are used to treat the whole body, local treatments are used when a particular area is having chronic complications due to the tumor growth. It targets specific spots to reduce pain, prevent fractures, or relieve blockage. 

In local treatments, radiation therapy is the most common and is often used to target cancer that has spread to the bones or the brain. Whereas surgery will be needed if the tumor has already spread, to stabilize bones, to remove tumors that are causing severe blockages, or to treat if the metastases are very few.  

Conclusion

If you find yourself diagnosed with metastatic or Stage IV breast cancer, the first thing you must do is to consult with your medical team and ensure that you have all the support you need. After the diagnosis, it is very important and very helpful to gather as much information as you need to make the right decision regarding your further treatment and life. 

Talk about the risks and benefits, and listen to the experts carefully. Taking second opinions is also a good idea if you are not satisfied with the treatment plans your doctor suggested or if you cannot come to an agreement with your doctor’s opinion. 

FAQ

Reference Links:

Metastatic Breast Cancer

https://my.clevelandclinic.org/health/diseases/21497-metastatic-breast-cancer

Treatment of Stage IV (Metastatic) Breast Cancer

https://www.cancer.org/cancer/types/breast-cancer/treatment/treatment-of-breast-cancer-by-stage/treatment-of-stage-iv-advanced-breast-cancer.html