Metastatic (stage 4) breast cancer

诊断

To diagnose metastatic breast cancer, also called stage 4 breast cancer, a healthcare professional might start by asking about your symptoms and doing an exam. Most people with this cancer were treated for breast cancer in the past. So the healthcare professional might ask about a previous cancer diagnosis and any treatments you had.

The tests you need may depend on your symptoms and your situation. Tests may include blood tests, imaging tests and a biopsy procedure to remove a sample of tissue.

Blood tests

Your healthcare professional may use blood tests to learn more about your overall health and look for signs that breast cancer may have spread. Blood tests alone usually can't confirm a metastatic breast cancer diagnosis.

Blood tests may include:

• Complete blood count. This test measures the number of blood cells in a blood sample. It gives the healthcare team clues about your overall health.
• Liver function tests. These tests measure how well the liver is working. The results may help the healthcare team understand whether cancer is affecting the liver.
• Circulating tumor DNA (ctDNA) test. This test looks for tiny pieces of DNA from cancer cells in the blood. Results can help the healthcare team choose a treatment.

Imaging tests

Imaging tests make pictures of the body that healthcare teams can use to look for signs of cancer. What imaging tests you'll have depends on your specific situation. Imaging tests may include:

• Bone scan.
• Computerized tomography (CT) scan.
• Magnetic resonance imaging (MRI).
• Positron emission tomography (PET) scan.
• X-ray.

Not everyone needs every test. Your healthcare team will choose the imaging tests based on your symptoms and the results of other tests.

Biopsy

A biopsy is a procedure to remove a sample of tissue for testing in a lab. How the healthcare team does the biopsy may depend on where the cancer spreads. A healthcare professional may put a needle through the skin and into the cancer to get the sample. Sometimes surgery is needed to get the sample. In some situations, a blood test might find pieces of the cancer cells.

Lab testing

The sample from a biopsy goes to a lab for testing. Tests can show whether the sample contains metastatic breast cancer cells. Other tests give more details about the cells. The testing is done by pathologists. Pathologists are doctors who look for disease in cells, fluids and tissue removed from the body.

Lab tests might look for:

• Hormone receptor status. Most breast cancer cells use the hormones estrogen and progesterone to help them grow. Cells that do this have receptors that help them catch the hormones circulating in the bloodstream. If testing finds receptors for one or both hormones, the cancer is hormone receptor (HR) positive. If testing doesn't find receptors, then the cancer is HR negative.
• HER2 status. Some breast cancer cells use a protein called human epidermal growth factor receptor 2 (HER2) to help them grow. Healthy breast cells make some HER2, but cancer cells can make a lot more. If tests show the cancer cells have extra copies of the HER2 gene or increased levels of the HER2 protein, the cancer is HER2 positive. If testing doesn't find these, the cancer is HER2 negative.
• DNA changes in the cancer cells. Some targeted therapy and immunotherapy medicines may work better against cancer cells that have certain changes in their DNA. Your cells might be tested for changes that can affect your treatment choices.

If you've had breast cancer before, your cancer may have been tested for HR status and HER2 status at that time. When the cancer comes back, these tests are often repeated. Sometimes the cancer changes between the first diagnosis and the recurrence.

Genetic testing

Some cancer medicines work better in people who are born with certain DNA changes. Your healthcare team may recommend genetic testing to see if your DNA has these changes. This testing uses a sample of blood or saliva to look for changes in your DNA. Unlike tests that look at changes in the DNA inside cancer cells, this genetic testing looks at DNA that's in all the cells in the body. The results also may provide information about cancer risk that can be helpful for your blood relatives.

治疗

Metastatic breast cancer treatment usually starts with medicines. This may include estrogen blocker therapy, targeted therapy, chemotherapy or other medicines. Other treatments, such as surgery and radiation therapy, are used in certain situations.

Metastatic breast cancer typically can't be cured. Treatments may help slow the growth of the cancer. The treatments may extend your life and help you live as well as possible, for as long as possible.

Your treatment plan may depend on the cancer's characteristics, where and how far it has spread, and whether it is causing symptoms. If you've had breast cancer in the past, your plan also may depend on which treatments you have already received.

Your goals and priorities also help guide treatment decisions. Some people want treatment that may help them live as long as possible, even if it causes more side effects. Others place greater importance on maintaining quality of life and limiting treatment side effects. Talk openly with your cancer care team and the people close to you about what matters most to you so that everyone understands the goals of your care.

Once you and your care team have talked about your treatment goals, the next step is choosing medicines that are most likely to work against your cancer. Your team uses the results of tests on your cancer cells, such as the hormone receptor (HR) status and the HER2 status, to identify the type of breast cancer you have. The type guides the treatment options your care team may recommend.

• HR-positive, HER2-negative cancer: Treatment for this type may start with estrogen blocker therapy combined with targeted therapy, such as CDK4/6 inhibitor medicines.
• HR-positive, HER2-positive cancer: Treatment for this type, which includes triple-positive cancer, may start with estrogen blocker therapy or chemotherapy combined with targeted therapy, such as anti-HER2 medicines.
• HR-negative, HER2-positive cancer: Treatment for this type may start with chemotherapy combined with targeted therapy, such as anti-HER2 medicines.
• HR-negative, HER2-negative cancer: Treatment for this type, called triple-negative cancer, may start with chemotherapy. Immunotherapy or antibody-drug conjugates also may be options for some people.

If the first treatment stops working, your care team may adjust your medicines or try new medicines. There are many treatments for metastatic breast cancer, and more are being tested in clinical trials.

Treatments also may depend on where the cancer has spread. Breast cancer most often goes to the bones, brain, liver and lungs.

• Cancer that has spread to the bones: Bone-building medicines can help lower the risk of broken bones. Radiation therapy or surgery may be used to treat cancer that has spread to the bones, called bone metastasis, that causes symptoms or complications.
• Cancer that has spread to the brain: Radiation therapy or surgery may be used to treat cancer that has spread to the brain, called brain metastasis.
• Cancer that has spread to the liver: Chemotherapy, surgery or radiation therapy may be used to treat cancer that has spread to the liver, called liver metastasis, that causes symptoms or complications.
• Cancer that has spread to the lungs: Chemotherapy or surgery may be used to treat cancer that has spread to the lungs, called lung metastasis, that causes symptoms or complications.

There may come a time when you and your care team decide treatment has little chance of prolonging your life or that the side effects are more than you're willing to accept. The focus of your treatment may switch to comfort and helping you achieve the highest possible quality of life. Choosing to stop cancer-directed treatment doesn't mean giving up. It may allow you to spend more time and energy on the people, activities and experiences that matter most to you.

Estrogen blocker therapy

Estrogen blocker therapy treats breast cancer that is sensitive to hormones. This means the cancer cells have proteins called receptors. The receptors bind to the hormones estrogen and progesterone. The cancer grows in response to these hormones. Healthcare professionals call these cancers hormone receptor positive. Most breast cancers are sensitive to hormones.

Estrogen blocker therapy also is called endocrine therapy and hormone therapy for breast cancer.

Estrogen blocker therapy treatments can include:

• Medicines that lower hormone production. These medicines are called aromatase inhibitors.
• Surgery or medicines to stop the ovaries from making hormones.
• Medicines that block or destroy hormone receptors. These medicines are called selective estrogen receptor modulators.

For metastatic breast cancer that is hormone receptor positive, estrogen blocker therapy often starts with an aromatase inhibitor medicine. If you haven't been through menopause, you also may need treatment to stop the ovaries from making hormones. Estrogen blocker therapy often is combined with targeted therapy.

Chemotherapy

Chemotherapy treats cancer with strong medicines. Many chemotherapy medicines exist. Chemotherapy for breast cancer often involves giving the medicine through a vein. Some medicines are available in pill form.

For metastatic breast cancer, chemotherapy may be used when estrogen blocker therapy isn't an option or is no longer working. Chemotherapy also may be used if the cancer is causing serious complications, such as if it's hurting the liver or lungs. Chemotherapy may help shrink the cancer more quickly than other treatments.

Targeted therapy

Targeted therapy uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die.

Many targeted therapy medicines exist for metastatic breast cancer. Your cancer cells may be tested to see which medicines are most likely to work against the cancer. Examples of targeted therapy medicines include:

• Anti-HER2 medicines. These medicines target cancer cells that are making extra HER2 protein. The medicines treat cancers that are HER2 positive.
• CDK4/6 inhibitors. These medicines target proteins on the cancer cells called cyclin-dependent kinases (CDK) 4 and 6. CDK4/6 inhibitors help make estrogen blocker therapy more effective for cancer that is hormone receptor positive.
• PARP inhibitors. Poly-(ADP-ribose) polymerase (PARP) inhibitors block the action of enzymes in the cancer cells that help repair breaks in the DNA. If the cancer cells can't repair themselves, they may die. These medicines treat cancer in people with certain changes in their DNA, such as BRCA1 and BRCA2.

Targeted therapy may be used alone or with other cancer treatments.

Antibody-drug conjugates

Antibody-drug conjugates are medicines that combine targeted therapy with chemotherapy. These medicines use targeted therapy to identify the cancer cells and deliver chemotherapy directly to those cells.

Antibody-drug conjugates are often used to treat metastatic breast cancer that is triple negative or HER2 positive. These medicines also may treat other types of breast cancer when other treatments don't help.

Immunotherapy

Immunotherapy is a treatment with medicine that helps the body's immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells.

Immunotherapy may help treat triple-negative breast cancer. Immunotherapy is typically used with chemotherapy or antibody-drug conjugates. Other types of breast cancer are sometimes treated with immunotherapy if tests on the cancer cells show this medicine might help.

Bone-building medicines

If cancer has spread to your bones, your healthcare professional may recommend a bone-building medicine to lower your risk of broken bones or reduce bone pain. These medicines don't treat the cancer. They may be used along with other treatments, such as estrogen blocker therapy and chemotherapy.

Radiation therapy

Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons or other sources.

Radiation therapy for breast cancer often uses external beam radiation. During this type of radiation therapy, you lie on a table while a machine moves around you. The machine directs radiation to precise points on your body.

Radiation therapy might help relieve symptoms such as pain for people with metastatic breast cancer. Radiation also may be used to treat cancer that spreads to the brain.

Surgery

Surgery isn't a common treatment for metastatic breast cancer. It might be used to remove an area of cancer that's causing symptoms or complications. It may be an option when other treatments haven't helped.

If your cancer is metastatic when it's first diagnosed, it's not clear whether removing the cancer in the breast may help. Studies have found different results. If surgery is part of your care plan, treatment usually starts with medicines. Then surgeons may remove the cancer in the breast with a mastectomy or lumpectomy procedure.

Clinical trials

Clinical trials are studies of new treatments. These studies provide a chance to try the latest treatments. The risk of side effects might not be known. Ask your healthcare team if you might be able to be in a clinical trial.

Palliative care

Palliative care is a special type of healthcare that helps you feel better when you have a serious illness. If you have cancer, palliative care can help relieve pain and other symptoms. A team of healthcare professionals gives palliative care. This team can include doctors, nurses and other specially trained health professionals. Their goal is to improve the quality of life for you and the people who care about you.

Palliative care specialists work with you, your family and your healthcare team to help you feel better. They provide added support while you have cancer treatment. You can have palliative care at the same time as treatment for cancer, such as surgery, chemotherapy or radiation therapy.

When palliative care is used with all of the other appropriate treatments, people with cancer may feel better and live longer.

临床试验

探索 Mayo Clinic 的研究 测试新的治疗、干预与检查方法，旨在预防、检测、治疗或控制这种疾病。

Prognosis

The prognosis for metastatic breast cancer, also called stage 4 breast cancer, is improving. But the cancer usually can't be cured. Most people with this diagnosis will die from their cancer.

One study that tracked metastatic breast cancer survival over time found that it has improved greatly as more medicines have become available. In that study, the most recent median survival time was more than three years. This means half of the people studied lived longer than three years, and half lived less than three years.

If you want to know more about your personal outlook, talk about it with your healthcare team. Your care team knows the details of your cancer and treatment. Care team members can give you a sense of your prognosis and help you make sense of what it means for you.

Your healthcare team can't know exactly how long you will live. But they may be able to give you a general range based on what is known about people in similar situations. This range is only an estimate, but it may help you plan for the future.

When thinking about your prognosis, your healthcare team might consider:

• The amount of time since your first diagnosis.
• The treatments you had previously.
• The places where the cancer has spread.
• The symptoms caused by the cancer.
• The hormone receptor status.
• The HER2 status.
• The DNA changes present in the cancer cells.
• Your overall health.

Some people want to know as much as possible about prognosis and life expectancy, while others choose to focus on treatment and day-to-day life. The amount of information that feels helpful is different for everyone.

妥善处理与支持

A diagnosis of metastatic breast cancer can bring shock, fear, anger, sadness and many other emotions. You may feel overwhelmed, want to withdraw or find that your feelings change from one day to the next. There's no right way to react. Over time, many people find ways to adjust to the uncertainty and may continue living meaningful, fulfilling lives. Here are some strategies that may help you cope.

Give yourself time to adjust

Once the initial emotions settle after a metastatic breast cancer diagnosis, many people reach a point of acceptance. Accepting a diagnosis of metastatic breast cancer doesn't mean that you're OK with it or that difficult feelings go away. You may still have days when you feel angry, afraid or sad. Acceptance can simply mean beginning to understand your circumstances and finding ways to live with this new reality.

As you adjust, you may gain a clearer sense of what matters most to you. You may find it easier to make decisions about the future, spend more time with people you care about or let go of things that feel less important. This process takes time, and it may not follow a straight path.

Connect with family and friends

Choosing to tell family and friends that the breast cancer has spread can be one of the hardest parts of the diagnosis. There's no single right way to have these conversations. It may help to choose a time when you won't be interrupted and to tell one trusted person first. Someone who listens, cares and is there for you can help you feel supported as you talk with others. If you wish, that person also can help share medical updates or coordinate practical help.

People may react in different ways or need time to understand what metastatic breast cancer means. When you feel ready, let people know what kind of support would help most. Examples include listening, driving you to treatment, or helping with meals, children or household tasks.

Talking with a spouse, partner or children may take more than one conversation. Be as open as you can. For young children, use words they can understand. Honest conversations can ease fear, help the people close to you prepare, and create opportunities for closeness and support.

Reach out for support resources

Find a good listener who you can talk to about your hopes and fears. This may be a friend or family member. You also may find it helpful to talk with a counselor, medical social worker or clergy member. Or join a cancer support group for understanding and guidance.

Ask your healthcare team about local support groups, or contact the American Cancer Society or another cancer organization in your area to find resources. Find support online through Mayo Clinic Connect, a community where you can connect with others for support, practical information and answers to everyday questions.

Find sources of meaning and connection

A diagnosis of metastatic breast cancer may lead you to look for meaning, comfort or a connection to something beyond yourself. For some people, that connection comes through faith or religion. For others, it may come through nature, relationships, service, music, meditation or art.

You also may find meaning in thinking about the mark you want to leave. This could mean sharing stories, writing letters, creating a scrapbook, recording memories, volunteering or supporting a cause that matters to you. Reflecting on your life, relationships and contributions can bring a sense of purpose, pride and connection.

Seek financial assistance

Cancer care can be costly. Along with medical bills, you may have other expenses, such as travel, lodging, childcare or time away from work. These costs can affect more than your budget. They also can add to the mental health burden that may come with having cancer.

If you're facing financial difficulties because of your cancer care, it's important to get help. Tell someone on your cancer care team as soon as possible. Your team will want to know if you're having trouble paying for things like nonmedical expenses, copays for office visits or medicines, which can affect whether you continue with your treatment plan.

Most cancer clinics have staff who can talk with you about finances related to cancer treatment. This may include social workers, case managers, financial counselors and patient navigators. These professionals may:

• Guide you through billing questions. You may be able to address outstanding bills with payment plans and reduced rates.
• Assist you in finding alternative financial resources, including from government, nonprofit and charitable institutions. Programs sponsored by these organizations may help pay for bills, including other expenses such as rent, utility bills and living expenses.
• Help you assess your current insurance and whether you're eligible for other programs, such as Medicare and Medicaid in the United States. If you're uninsured, a patient navigator could help you find insurance.
• Work with you to save on medicines.

Handling finances can often feel overwhelming. Consider asking a trusted family member or friend who is capable in this area for help keeping track of bills, insurance claims and key contacts.

准备您的预约

If you have any signs or symptoms that worry you, make an appointment with your healthcare professional.

Your healthcare professional can recommend the necessary tests and procedures to confirm a diagnosis of metastatic breast cancer. Then you'll likely be referred to an oncologist. This is a doctor who specializes in diagnosing and treating cancer.

What you can do

• Be prepared to discuss your new symptoms and any other health concerns that seem relevant.
• If you're seeing a new healthcare professional, request your medical records from your previous healthcare professional. If you already have these, bring your medical records and any imaging tests you have with you. Otherwise, you'll need to sign an information release form so that your new healthcare professional's office can get the records.
• Make a list of all medicines, vitamins or supplements that you're taking. Let your healthcare professional know if you have tried any alternative treatments for your cancer.
• Consider asking a family member or friend to come with you. It may be hard to remember all the information you hear during an appointment. Someone who goes with you may remember something that you missed or forgot.
• Write down questions to ask your healthcare professional.

Some basic questions to ask your healthcare professional include:

• Has my cancer spread?
• Are there other possible causes for my symptoms?
• What kinds of tests do I need? Do these tests require any special preparation?
• What are the hormone receptor status and the HER2 status of the cancer?
• What treatments are available to me, and which do you recommend?
• What types of side effects can I expect from treatment?
• Are there any alternatives to the approach that you're suggesting?
• Are there any clinical trials open to me?
• What's my outlook?

What to expect from your doctor

Your healthcare professional is likely to ask you several questions. Being ready to answer them may allow time to go over points you want to discuss in more detail. Your healthcare professional may ask:

• When did you first notice symptoms again?
• Has there been a change in the symptoms over time?
• How do you feel overall?
• Have you had any unexpected weight loss? Have you lost your appetite?
• Are you having any pain?