"Advanced breast cancer" is the term most frequently related to breast cancer in the generalized or disseminated stage. It means that the neoplastic outbreaks have appeared outside of its original location, and therefore the patient has metastatic breast cancer. The diagnosis of advanced breast cancer requires an extensive diagnosis to enable the selection of appropriate treatment methods. In advanced breast cancer, additional methods of therapy play an important role in controlling the most burdensome symptoms and complications of the disease.

The severity of breast cancer , like the stage of many other neoplastic diseases, is determined based on the 3 most important factors: tumor size, lymph node involvement and the presence of metastases in other organs. These are the components of the so-called TNM classification, commonly used to describe the staging of different types of cancer. The name of the classification comes from the English names of its criteria:

  • T - tumor - size of the primary tumor
  • N - nodes - lymph node involvement
  • M - metastases - presence of distant metastases

There are 4 stages of breast cancer advancement, marked with Roman numerals from I to IV. When we talk about advanced breast cancer, we usually mean the last, fourth stage. Advanced breast cancer means the presence of the M feature, i.e. distant metastasis of the tumor. From the point of view of the patient's body, this means that the neoplastic disease has spread.

The neoplastic process affects not only the primary organ (in this case - the breast), but also other organs. The sites of metastasis typical of advanced breast cancer are lung, liver, bone and brain. A neoplastic disease at this stage is called systemic or generalized.

The main goal of the treatment of advanced breast cancer is to maximize the patient's survival, but also to reduce symptoms, improve the quality of life, as well as rehabilitation and psychological support. For this reason, patients with advanced breast cancer are usually looked after by a team of many specialists - oncologists, radiologists, surgeons, as well as psychologists and physiotherapists.

Advanced Breast Cancer - Symptoms

The diagnosis of advanced breast cancer means that the disease has been developing in the patient's body for some time - first a primary tumor in the breast has arisen, then the surrounding lymph nodes have spread, and eventually the cancer cells have spread toother parts of the body. The time between the development of the primary tumor lesion and the occurrence of distant metastases depends on many factors. The biological features and aggressiveness of the neoplasm play a very important role in it.

It happens that breast cancer metastases develop after a long period of development of the primary tumor in the breast. In such cases, disseminated neoplastic disease may coexist with high local stage of breast cancer. The breast tumor may then reach considerable size, be palpable on palpation of the breast, and even visible to the naked eye.

The accompanying symptoms are changes in the appearance of the breasts:

  • swelling
  • nipple discharge
  • so-called orange peel symptom

In extreme cases, ulcerations and difficult-to-heal wounds may appear on the breast surface. The involvement of the lymph nodes by the neoplastic process may be manifested by their enlargement, as well as swelling of the upper limb, caused by obstruction of the lymphatic vessels by cancer cells.

We already know that an important feature of advanced breast cancer is the presence of metastases in distant organs. These metastases can cause specific ailments related to their location. It is worth remembering that these symptoms may or may not coexist with the symptoms of local advancement of the cancer in the breast.

Unfortunately, it happens that the first symptoms of neoplastic disease are the result of metastatic foci. Examples of symptoms of advanced breast cancer related to the presence of tumor metastases include:

  • shortness of breath, coughing, rapid breathing and difficulty breathing - with lung metastases
  • headaches, dizziness, impaired consciousness, nausea and vomiting - with brain metastases
  • bone pain (especially in the spine) and the so-called pathological fractures - with bone metastases
  • jaundice, weight loss, abdominal pain - with liver metastases

The advanced cancer process also usually causes systemic symptoms such as chronic fatigue and weakness, low-grade fever, lack of appetite, and weight loss.

Advanced Breast Cancer - Diagnosis

The process of diagnosing advanced breast cancer consists of several stages. Advanced breast cancer can be diagnosed de novo - so it is the first cancer diagnosis in a patient. It also happens that the advanced stage of breast cancer is a relapse of a cancer disease with which the patient has struggled before.

The first stage of diagnostics is, in most cases, primary examinationchanges in the breast. For this purpose, various imaging methods are used - most often mammography and breast ultrasound, and much less often magnetic resonance imaging. The final diagnosis is confirmed by the histopathological examination of the fragment of the lesion.

The material for the test is most often obtained through a biopsy, i.e. taking a small piece of tissue with a special needle. A biopsy is also used to assess lymph node involvement. Alternatively, the material for the histopathological examinations mentioned above can be obtained during tumor removal surgery.

The histopathological evaluation of the lesion is not limited to the diagnosis of the neoplasm only. Its next stage is the assessment of the biological characteristics of cancer cells. As a result, conclusions can be drawn about the "behavior" of cancer - what factors stimulate its growth, how quickly cancer cells multiply and what are their genetic characteristics. All this information is of great importance in planning the treatment of a given patient.

The more we know about the cells of a given tumor, the better a therapy can be tailored to them. Examples of factors influencing the treatment pathway of advanced breast cancer are the so-called estrogen receptors (ER), progesterone receptors (PgR) and HER2 receptors.

In medical records, you can often find the classification of breast cancer regarding the above-mentioned factors. There are 3 basic types of this cancer:

  • luminal (having ER and / or PgR),
  • HER2 positive (having HER2 receptor)
  • and triple negative (not having any of the above-mentioned receptors).

Thanks to this classification, we can initially predict the patient's response to chemotherapy, hormone therapy and immunotherapy and thus select the best treatment model.

The histopathological tests are complemented by genetic tests for mutations that may cause breast cancer (including BRCA1, BRCA2). Genetic factors have a large influence on the course of the disease, therefore they also play a significant role in the selection of personalized therapy.

A diagnosis of advanced breast cancer means that the patient has developed metastatic cancer in her body. For a complete diagnosis, it is necessary to determine the location, number and size of metastases.

For this purpose, imaging tests are used to visualize all tumor foci. Standard computed tomography (CT) of the head, chest, abdomen and pelvis is performed to detect metastases in the most common locations - the brain, liver and lungs.

For examining the skeletal systemthe so-called bone scintigraphy. This test involves the intravenous administration of a radioactive tracer that accumulates in metastatic foci. Nowadays, a very useful test in the diagnosis of advanced breast cancer is the so-called positron emission tomography - abbreviated as PET.

This examination allows you to "scan" the whole body in search of tumor foci, so you do not need to perform separate imaging tests at individual locations. An additional advantage of PET is the detection of small clusters of cancer cells that may not yet cause any clinical symptoms.

Advanced Breast Cancer - Treatment

Despite great advances in modern oncological therapy, a full recovery of breast cancer in the disseminated stage is - so far - unattainable. However, there are many methods of therapy that allow you to slow down the disease and alleviate its symptoms.

The choice of the treatment path is personalized, taking into account the biological characteristics of the cancer, the effectiveness of the treatment so far, the severity of the disease symptoms, as well as the general he alth condition and the patient's preferences.

Advanced breast cancer is a disease of the whole organism, therefore in most cases systemic treatment is used: chemo-, hormone- or immunotherapy. The indications for the use of a given method depend, among others, on on the characteristics of the cancer cells in the patient and the response to treatment so far. For example, if breast cancer cells have estrogen and / or progesterone receptors, hormone therapy is used first.

The presence of HER2 receptors is an indication for immunotherapy with the drug Trastuzumab (Herceptin). The above methods may be supplemented with mono- or multi-drug chemotherapy. In the case of ineffectiveness or intolerance of the first-line treatment, second-line and subsequent treatment regimens are implemented.

In addition to body-wide therapies, a variety of topical treatments are also used in advanced breast cancer. In some patients, there are indications for a surgical procedure aimed at removing the primary tumor site as well as its metastases. Such a procedure is not recommended in all cases - its legitimacy should be individually consulted with the attending physician. An example of a situation where surgical treatment is recommended is single brain metastases in a location that allows their removal.

In some patients with advanced breast cancer, the so-called palliative mastectomy, i.e. removal of the occupied breasttumor. Unfortunately, such an operation will not fully cure the disease as breast cancer cells have spread to other organs. Nevertheless, the procedure may bring a positive aesthetic effect and significantly improve the patient's quality of life.

Another way to control the symptoms of the disease in advanced breast cancer is through various methods of irradiation, or radiotherapy. The most important goal of radiotherapy in advanced breast cancer is to relieve pain.

Local irradiation is used both in the area of ​​the primary tumor and in the metastatic foci. Radiotherapy plays a particularly important role in bone metastasis, reducing pain and reducing the risk of fractures due to weakened bone structure.

In the treatment of advanced breast cancer, besides acting to slow down the neoplastic disease, supportive therapy plays a huge role. It allows you to improve the quality of life and alleviate the discomfort associated with the disease.

In supportive therapy, both pharmacological agents and non-pharmacological measures are used. An example of a group of drugs used in advanced breast cancer are bisphosphonates (including zoledronic acid and pamidronic acid), used in the presence of metastases in the skeletal system. These drugs slow the deterioration and weakening of bone structure, manage pain, and reduce the risk of complications from bone metastases.

Pain therapy is also an important element of supportive pharmacological treatment. In advanced cancer, long-acting opioid painkillers, taken orally, intravenously or transdermally (in the form of patches), play an important role. In addition to pharmacological agents, patients with advanced breast cancer benefit from psychological and spiritual support, various methods of physical rehabilitation and physiotherapy, as well as dietary and nursing advice.

Among lifestyle modifications, research studies have shown beneficial effects of mild exercise (3-5 hours of walking a week), stress reduction methods, yoga, hypnosis and acupuncture.

It is strongly recommended not to use unproven methods, the so-called alternative medicine - dietary supplements, herbs, vitamin infusions. These methods are not proven effective, and in many cases may lead to the deterioration of the patient's he alth.

Advanced breast cancer - prognosis

The prognosis in advanced breast cancer depends on many factors - they are influenced, among others, by the age and general he alth of the patient, the number and size of tumor metastases, and the response to the previously usedtreatment and biological features of the tumor (e.g. presence of ER, PgR and HER2 receptors).

The best prognosis concerns the subtype of luminal breast cancer, in which it is possible to use, inter alia, hormone therapy. A type of breast cancer with a relatively unfavorable prognosis is the so-called triple negative cancer.

Thanks to the advances in modern oncology, many lines of therapy for advanced breast cancer are now available. They allow both to extend and improve the quality of life of patients. Clinical trials are constantly being carried out to expand the knowledge of advanced breast cancer and to search for new drugs.

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Category:

Oncology