Stage IV (Metastasized Cancer)
In Stage IV the cancer has spread from the breast to other parts of the body. In about 75% of cases, the cancer has spread to the bone. The cancer at this stage is considered to be chronic and incurable, and the usefulness of treatments is limited. The goals of treatment for Stage IV are a complete or partial response, stabilization of the disease, or slowing disease progression.
Treatment Options for Stage IV. (1) Surgery or radiation for any localized tumors in the breast. A 2006 study indicated that surgical removal of the primary tumor immediately after metastatic cancer diagnosis can dramatically improve survival.
(2) Chemotherapy, hormonal drugs, or both are appropriate for most patients (durable and complete remission possible in 10 - 20% of cases but cure is very rare). Chemotherapy in patients with hormone receptor-negative disease or who have extensive metastasis that requires rapid tumor shrinkage. Ovarian ablation (in premenopausal women) or other hormonal therapies in patients with hormone receptor-positive cancer and no or minimal organ involvement. (Aromatase inhibitors, taxanes, and other drugs used in combination or in innovative schedules are improving results.) In 2004, the cancer drug gemcitabine (Gemzar) was approved for use in combination with paclitaxel (Taxol) as a first-line treatment option for women with metastatic breast cancer.
(3) Metastasis to the brain may require radiation and high-dose steroids.
(4) Metastasis to the bone (which occurs in 75% of cases) may be helped with radiation and bisphosphonates. Such treatments can relieve pain and help prevent bone fractures.
(5) Clinical trials: Standard hormonal or chemotherapy drugs used as initial treatment, newly developed chemotherapeutic or hormonal drugs, monoclonal antibodies, total hormone blockade using surgery, high-dose chemotherapy with stem-cell support, immune cell transplant.
Recurrent Breast Cancer
Recurrent breast cancer is considered to be an advanced cancer. In such cases, the disease has come back in spite of the initial treatment. Most recurrences appear within the first 2 - 3 years after treatment, but breast cancer can recur many years later. Treatment options are based on the stage at which the cancer reappears, whether the tumor is hormone responsive or not, and the age of the patient. Between 10 - 20% of recurring cancers are local. Most are metastatic at presentation. All patients with recurring cancer are candidates for clinical trials.
The Effects of Emotions and Psychological Support
Recent evidence has not supported early reports of survival benefits for women with metastatic breast cancer who engage in support groups. However, studies have suggested that psychotherapy, group support, or both can relieve pain and reduce stress, particularly in women who are suffering emotionally.
Stress has been ruled out as a risk factor either for breast cancer itself or for recurrence. The role of depression, however, is unclear. A 2000 study suggested that women who had a history of major depression were four times as likely to develop breast cancer as those without clinical depression. One expert suggested the association may be based on common hormonal factors that affect both conditions. A 2003 study, however, reported a slightly higher risk for a poorer outcome in patients with breast cancer who had pre-existing depression. Those with bipolar disorder had the highest risk. Such findings are unlikely to be related to hormonal issues. More research is needed to determine if treating depression in such women will improve their prognosis.
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