ADVANCED (METASTATIC) BREAST CANCER

A diagnosis of advanced breast cancer means that cancer cells have metastasized (spread) outside of the breast to other parts of the body (such as the bones or other organs) or to the lymph nodes that are not near the breast (such as those above the collarbone). If breast cancer spreads to a different part of the body, it is still regarded as breast cancer. (For example, if breast cancer spreads to the lungs, it is not lung cancer; it is still breast cancer.) Advanced or metastatic breast cancer is referred to as Stage IV breast cancer.

When breast cancer metastasizes or spreads, it usually goes to the bones, lungs and liver. Less commonly, it may also spread to the brain, spinal cord and eye.

What are some of the symptoms?
Metastatic breast cancer can be the initial diagnosis. It may also be a recurrence (return) of breast cancer following initial treatment. (Recurrence will be discussed in more detail later in this section.) Diagnosis of metastatic breast cancer is generally done using some combination of the following tests: bone scan, chest X-ray, CT scan, MRI scan or PET scan. Some symptoms of metastatic breast cancer may include:

• bone pain that does not go away;
• shortness of breath, chest pain, or cough;
• pain or discomfort under the right side of the ribcage that won’t go away;
• lack of appetite;
• unexplained weight loss;
• neurological pain or weakness and headaches;
• confusion;
• irregular gait.

Facing Your Own Mortality

Hearing the words "You have cancer," can suddenly move an abstract inevitability to a very real possible outcome in the blink of an eye.  For many women, such as myself, breast cancer is the first close brush with mortality.  Suddenly, one's sense of safety, security and optimism about life and the future is shaken. 

Uncertainty seems to dwell at the core of these feelings, and can persist for years to come.  Even when there is no recurrence, the fear persists, affecting us in odd ways long after treatment is over.  Many women live with the long lasting fear of breast cancer recurrence, the worry that awakens them in the middle of the night before a doctor's appointment, the misery of waiting for test results, fear of being diagnosed with metastatic disease, or when the friend she made during chemo dies of breast cancer.

When treatment ends, the sense of physical compromise that began with diagnosis can begin to resolve, at last.  Gradually, the nausea fades and the energy returns.  Hair begins to grow back and the surgical scars are beginning to fade.  Radiation burns are starting to heal. Doctors start to tell you that it's now time to focus on family and work and getting back to normal now.  If only it were that easy.  The truth is, many of us find ourselves profoundly changed by our diagnosis and struggling to come to terms with what has happened to us.

We still have questions that remain unanswered, and fears that keep us up at night.  Even after hair and fingernails grow back and reconstructive surgery has been completed, we may still be feeling emotionally fragile.  Our bodies our psyches are different than they were, and we need time, sometimes lots of time, to make sense of the changes and what they mean to us.

It is the treatments, not the disease that make you sick so naturally an end to treatment can feel like a big step down the road toward feeling well again.  Clearly, the end of treatment marks a transition not a closure. For many women, especially those with higher risks of recurrence, breast cancer remains an intimate and ongoing concern.  It confronts us in the mirror daily, affects how we feel in our bodies, appears in our dreams and ambushes us as we approach our follow up oncology visits especially before each PET scan. 

By far my strongest fear was, now that treatment was over, nothing stood between me and the threat of recurrence. With the end of treatment my family and friends found it to be a cause for celebration, while for me I had mixed feelings. 

When we are diagnosed we are suddenly faced with our own mortality, which we might not have given much thought to until then.  For  a while we are cocooned in a surreal world of doctors

Breast Cancer - Facing Breast Reconstruction

Those of us who need -- or choose -- a total or radical mastectomy will probably consider having that breast 'rebuilt' through breast reconstruction.

Breast reconstruction

Breast reconstruction can be done either during your surgery or at a future time, and they are generally made from your own tissues or by using implants filled with saline. (Because of the controversies over the potential dangers of silicone breast implants, the US Food and Drug Administration will only allow silicone breast implants to be used in clinical trials).

Whether to reconstruct and how is a decision each of us needs to make for ourselves, along with input from our support network, our oncologist and other medical professionals such as a plastic surgeon.

Share your experience!

If you've had a breast removed and have had -- or decided not to have -- reconstructive surgery, share your experience. Telling your story will help others when it comes time for them to make this important decision.

Managing Treatment Side Effects

Side effects, like treatment programs, vary from person to person. They can be unpleasant, but most often they are temporary, and most are treatable. Typical side effects for the most common cancer treatments include:

Surgery: During surgery, complications may include bleeding, organ damage and organ dysfunction. After surgery, side effects include pain and infection.

Radiation therapy: Fatigue, nausea and eating problems, mouth sores, localized hair loss in the area of radiation, skin irritation, and dryness.

Chemotherapy: Nausea and vomiting, hair and nail loss, fatigue, eating problems, mouth sores, infection, bleeding or easy bruising, low white blood cell count, and anemia (low red blood cell count).

Coping with Common Treatment Side Effects

• Fatigue
• Hair, Nail and Skin Issues
• Infections
• Lymphedema
• Mouth Sores
• Nausea and Vomiting, and Eating Problems
• Neuropathy
• Neutropenia
• Pain

As with all drug treatment, the risks must be weighed against the benefits. In most patients with cancer, the potentially toxic effects of chemotherapy are justified in order to get the cancer into remission. This is not always the case, and you should tell your doctor whether you’ve ever had any type of heart condition, including high blood pressure. You should also inform him/her about any radiation treatment to the chest area that you might have received in the past.

Fatigue

• To avoid fatigue, plan your days so you have time to rest, especially around treatment times. Save your energy for activities that are most important to you and ask for help with the rest.