When we hear about breast cancer, we are very shocked. And when we hear that it is stage four, that is, the cancer has spread to other parts of the body, it is even more scary and burdensome. This is a really serious situation. But with this advanced medical science, there are many treatments that can be done at this stage, which can help control the disease and extend life. So let's talk about this today, to find simple answers to the questions you have in mind.
What exactly is Stage IV?
Simply put, stage 4 means that cancer cells that started in the breast have spread through the blood or lymph vessels to other parts of the body. This spread is called `Metastasis`. The most common places where cancer can spread in this way are the bones, brain, lungs, or liver .
The important thing to understand here is that the main goal of treatment at this stage is not to cure the disease completely, but to control the growth of the cancer, reduce symptoms, and give you a good quality of life for as long as possible. Some patients live for many years with this treatment. Therefore, it is important not to panic when you hear about this possibility, but to talk carefully with your doctor about the available treatment options.
What are the main treatments available?
In stage 4, because the cancer has spread to multiple sites, it is difficult to achieve successful results with treatments that only target one site, such as surgery or radiation therapy. Therefore, systemic treatments that affect the entire body are most commonly used.
Chemotherapy
Chemotherapy is often the main treatment at this stage. It works by killing rapidly dividing cancer cells. This can slow the growth of the cancer. Chemotherapy is given in different ways. It is sometimes given as pills, but most often it is given intravenously (through a vein) .
This treatment is not given continuously. It is usually given in several cycles . After one cycle is completed, the body is given a short rest period to recover. Only then does the next cycle begin.
Hormone Therapy
This treatment is not suitable for everyone. It is most effective in women with a type of cancer called hormone receptor-positive . This means that hormones like estrogen in their bodies stimulate the growth of cancer cells. Think of it this way: hormones are like a key, and the receptor on the cancer cell is like a lock. When you put the key in, the lock opens and the cancer grows.
So what these hormone treatments do is either stop the production of that key (hormone), or block it from fitting into the lock. The main types of medications given for this are:
- ``Tamoxifen''
- Aromatase inhibitors (for postmenopausal women) - Examples: Anastrozole (Arimidex), Exemestane (Aromasin)
- Drugs such as `Fulvestrant (Faslodex)` that block hormone receptors.
Sometimes, surgical removal of the ovaries is recommended for women who have not yet reached menopause, as it is a good way to stop the production of hormones that help cancer grow.
Targeted Therapy
This is a relatively new and very effective treatment. Instead of damaging healthy cells like chemotherapy, it targets and attacks specific proteins or genes found only in cancer cells . This results in relatively few side effects.
About 20% of women with breast cancer have too much of a protein called `HER2`. This causes the cancer to spread quickly. For these `HER2-positive` cancers, drugs such as `Trastuzumab (Herceptin)` are given. It stops the `HER2` protein from working and controls the growth of cancer cells.
Remember, stage four does not mean the end of treatment. This is a time to focus on treatments that help control the disease and maintain a good quality of life.
Let's look at some other types of targeted therapies in the table below.
| Targeted therapy type | Goal and function | Use cases |
|---|---|---|
| CDK4/6 Inhibitors | Blocks proteins called CDK and controls cancer cell division. For example: Palbociclib (Ibrance), Ribociclib (Kisqali) | For hormone receptor-positive and HER2-negative cancers. |
| PARP Inhibitors | Targets the PARP protein, which helps cancer cells grow. For example: Olaparib (Lynparza) | For cancers that are HER2-negative and have a BRCA gene mutation. |
| mTOR Inhibitors | Blocks the mTOR protein and stops cancer cell growth and spread. For example: Everolimus (Afinitor) | With hormone therapy for specific types of cancer. |
| Antibody-drug conjugates | A chemo drug is attached to an antibody, which delivers the drug directly to the cancer cell and destroys it. Example: Sacituzumab govitecan (Trodelvy) | For advanced breast cancer. |
Immunotherapy
This is also a very advanced treatment. Instead of giving drugs from outside to kill the cancer, it stimulates your own immune system to find and destroy the cancer cells. Some cancer cells know how to hide from the immune system. So these drugs disable those hiding methods and allow the immune cells to recognize the cancer.
Surgery and Radiation
As we mentioned earlier, these are not used as the main treatment at this stage. However, if there is severe pain in a place where the cancer has spread, for example in a bone, radiation therapy is given to control the pain and other symptoms . Also, surgery may be done only if it is necessary to control any complications.
Other important points
- Side effect management: All of these treatments can have side effects, such as nausea, vomiting, and fatigue. But there are medications available to manage them. So tell your doctor about any discomfort you feel.
- Clinical Trials: Sometimes, you may be able to participate in `Clinical Trials`, which test new treatments that are not yet widely used. These may give you the opportunity to receive cutting-edge treatments. Ask your doctor about this as well.
This journey is not one you go through alone. Your family, friends, doctors, nurses, and the entire medical team are with you. Get their support. Share your feelings. It will be a great strength to get through this difficult time.
Take-Home Message
- Stage IV breast cancer means that the cancer has spread to other parts of the body.
- The main goal of treatment at this stage is not to completely cure the disease, but to control the cancer, reduce symptoms, and extend life with a good quality of life.
- Chemotherapy, hormonal therapy, targeted therapy, and immunotherapy are the main treatment methods.
- Your doctor will determine the most appropriate treatment for you based on the nature of your cancer (e.g., HER2-positive or hormone receptor-positive).
- There are also medications to manage side effects from treatment, so talk to your doctor about any discomfort you may be experiencing.
- It is very important to stay mentally strong and seek support from family and the medical team.
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