Sometimes, despite the best efforts for early detection, the cancer
is not found until it is Stage IV —it has spread to other parts
of the body. The reality of Stage IV cancer (advanced breast cancer
and recurrent breast cancer with regional and distant metastases)
is that it is usually not possible to remove this cancer completely
from your body. Most treatments for advanced/metastatic breast cancer
will try to shrink the tumor or to stop it from growing. The good
news is that today there are many treatment methods that can greatly
improve your quality of life, and extend the time that you remain
free of any evidence of the disease.
Surgery in the form of a lumpectomy or mastectomy is the key treatment
in early breast cancer. But it is not as useful in advanced breast
cancer, that presents with metastases outside the breast. If you were
diagnosed with a breast cancer that is present in your breast and
in other parts of your body, it is possible that your healthcare team
may suggest that you forego a mastectomy. The reason is that the greatest
threat to your health comes not from the tumor in the breast, but
from the distant metastases that damage other organs, which generally
are difficult to treat surgically.
Surgery may play a role in removing a small, solitary tumor from
your lung or liver, or another part of the body where it is applying
pressure on another organ. This is called palliative surgery.
Radiation therapy may be used to shrink metastases in distant organs.
The treatment will be done by external beam rather than by brachytherapy
(see Chapter 6). You may need only a few treatments,
rather than the entire five to seven week course.
Hormone Therapy and Immunotherapy
In early cancer, chemotherapy is given to destroy undetectable cells
that may or may not have spread through the body, and there is no
way to monitor the success of the therapy.
In advanced cancer, if your healthcare team may be able to use X-rays
or CT scans to observe the tumor as it shrinks from the chemotherapy.
If progress is unsatisfactory, the physician will be able to switch
to another drug, or a combination of drugs. You may want to review
Chapter 7 for tips on how to deal with side effects of chemotherapy.
Bones are common first sites to which breast cancer tends to spread.
You may be treated with additional drugs called bisphosphonates that
specifically target bone metastases, and are given with your regular
chemotherapy or hormone therapy.
Hormone therapy as well as immunotherapy can also be used effectively
to control the growth and spread of advanced breast cancer. The principles
are described in Chapter 8.
A new direction in chemotherapy is oral chemotherapy. One such agent,
a form of 5-FU is called Xeloda. It is taken as a twice-daily pill
at home, rather than by injection into a vein at the chemotherapy
facility a time-saving and discomfort-reducing feature that many women
appreciate. The drug has a unique activation mechanism that makes
it active mostly within tumor cells, which reduces the side-effects.
So women taking Xeloda have minimal hair loss, and their blood producing
bone marrow is affected little, if at all, minimizing their chances
of infections. As with any self-administered therapy, Xeloda does
require that the patient and her caregiver be particularly attentive
to proper dosages, timing, and any side effects.
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