Women who have been diagnosed with metastatic breast cancer (MBC) often have many questions and concerns as they try to understand their condition and how it will impact their life.
MBC is the most advanced form of breast cancer which means it has spread from your breast to another part of your body. MBC is most often diagnosed as a recurrence of breast cancer that was treated earlier in your life. In some cases, MBC can be diagnosed when you first learn that you have breast cancer.
Before you meet with your cancer treatment team, it can be helpful to make a list of questions to discuss including:
1. What is the connection between hormones and metastatic breast cancer?
There is a strong connection between hormones and breast cancer. Normal breast cells and some breast cancer cells contain receptors that attach to hormones. Certain tumor cells have proteins, or receptors, on which certain substances found in the blood can attach. With MBC tumors, the tumor’s hormone receptors may stimulate an excess of certain hormones such as estrogen or progesterone, which can help to fuel the tumor’s growth. This is known as a hormone receptor-positive breast cancer, which may be designated as estrogen-receptorpositive (ER+) or progesterone-receptor-positive (PR+).
Tumors that do not test positive for estrogen or progesterone receptors are called estrogenreceptor-negative (- ER-) and progesterone-receptor-negative (PR-.)
2. What should I do if my tumor’s hormone receptor status changes?
The tumor’s hormone receptor status may change over time, which means it is important to consider re-biopsying the tumor. If the hormone receptor status of your metastatic breast cancer tumor changes, you should talk to your doctor about the best options for your care based on this new information. You may be able to remain on your current course of treatment, or your doctor may recommend alternate therapies that can treat your cancer more effectively.
3. What is HER2 and how does it affect my cancer?
HER2 stands for human epidermal growth factor 2, which is a protein produced by cells. Some cancer cells produce too much of the HER2 protein, which can fuel the cancer and cause it to grow or spread more aggressively.
Similar to the hormone receptor status, your tumor may have a HER2 status of positive (HER2+) or negative (HER2-).
4. What tests will I need?
Your doctor may want to order different tests throughout your treatment. Some tests help to determine the HER2 and hormone receptor status of your tumor. There are a variety of tests available, including imaging tests, bone and organ scans, blood tests and biopsy to understand the tumor’s progression. Some tests may need to be repeated as you go through treatment, to make sure the treatment is working, and to make sure the status of the tumor has not changed.
5. Where is my cancer located?
By definition, MBC is breast cancer that has traveled from your breast to another part of your body. The location of your cancer will be an important factor in determining the best treatments.
6. What treatments should I consider?
Choosing a course of treatment on your MBC journey is a very personal decision, and will be different for everyone. You should talk to your doctor about what treatment options may be right for you, which may include surgery, radiation and traditional chemotherapy, hormonal therapy for hormone sensitive cancers or targeted therapy for HER2+ cancer.
7. Should I think about hormonal or targeted therapy?
Approximately half of all people with hormone receptor positive breast cancer respond to hormonal therapy treatments. Different types of hormonal therapy may be recommended, depending on whether you are in menopause or not, as well as other health factors your doctor will consider.
Chemotherapy may be used in patients who test negative to hormone receptor or HER2- cancers. It is also used to treat positive receptor patients when hormone or targeted therapy is not controlling the cancer’s growth.
8. What are the possible side effects of my cancer treatments?
Treatment for cancer works by killing cancer cells or blocking the function of cancer cells in the body. Treatments often also affect other cells in the body, which can cause different side effects, depending on the type of treatment.
You should consider the possible side effects of each treatment option, and work closely with your medical team to identify the best options for your MBC journey.
As you prepare for your doctor’s appointment, consider taking a family member or friend to help you as you talk through these difficult questions. It can be very helpful to have someone with you to listen, take notes, and help you remember what you and your treatment team discussed.
Reviewed November 12, 2015
by Michele Blacksberg RN
Edited by Jody Smith