Treatment for metastatic breast cancer has come a long way from the days when doctors sent a woman home with instructions to get her affairs in order. Today there are many approaches depending on the location of the metastasis (met), the characteristics of the tumor, and the overall health of the patient. The following overview is not meant to be a treatment guide. Only a woman's oncologist has all the facts about her condition. However, understanding the big picture may help you be prepared for your discussion with your doctor.
Usually treatment for metastatic breast cancer will include some form of systematic treatment like chemotherapy or hormone therapy. Because doctors know that some of the cells of the original cancer survived the initial treatment, they want to try to kill any other surviving cells that cannot yet be seen on an imaging test.
A task force of European doctors recommend that oncologists use one chemotherapy at a time saying, "Because metastatic disease can require ongoing chemotherapy, the task force noted the importance of maintaining quality of life when choosing treatments. It concluded that single-agent therapy is preferable to combination therapy for women who do not have rapid disease progression, life-threatening tumors in the liver or lung or an urgent need to control symptoms." The study noted that there is no difference in overall survival rate for metastatic patients between combination chemos and single chemos.
For women whose tumors are estrogen receptor positive, the National Cancer Institute recommends drugs like tamoxifen or an aromatase inhibitor as a systemic treatment with or instead of chemotherapy. The factors that determine the best drug for a specific woman can be complicated to interpret, so your oncologist can give you the information about your specific situation.
If the tumor is Her2neu positive, doctors will often prescribe a chemo drug plus Herceptin (Trastuzumab) which has shown to be effective in improving survival rates when compared to treatment with chemo alone.
What about surgery? Can't those mets just be cut out? Sometimes they can. If the new tumor is isolated and in an area accessible for surgery, sometimes surgery is an option. The problem is that often metastasized breast cancer shows up as many tiny dots in the organ they spread to instead of one tumor that is easy to isolate.
That is why radiation is often used because it can get to a larger region and to areas that are hard to reach with surgery. Radiation is also useful in reducing pain from bone mets.
So treatment for Stage IV breast cancer is just like treatment for other stages: systemic treatment, radiation, and surgery, right? Well, sort of.
When you are first diagnosed with a Stage I, II, or III cancer, the goal of cancer treatment is curative. A curious change happens in the language of doctors if the cancer spreads to distant organs. The National Cancer Institute website section about metastatic breast cancer starts like this, "Treatment for systemic disease is palliative in intent. Goals of treatment include improving quality of life and prolongation of life."