Breast Cancer

Questions to Ask Your Doctor About Metastatic Breast Cancer

Metastatic breast cancer is cancer that began in the breasts but has spread to other areas of the body.

Hearing that you or a loved one has MBC is a difficult diagnosis to receive and a difficult topic to talk about. You are not alone; more than 150,000 people in the U.S. are currently living with MBC. Although there is no cure for MBC, there are effective treatments that can slow the progress of the cancer, minimize symptoms, improve quality of life and prolong a person’s life. Knowing what questions to ask at an appointment with your healthcare provider can help you make an informed decision about treatment.

Your healthcare provider may not have answers to all your questions just yet, and additional diagnostic tests may be required. In either case, the questions below can serve as a starting point to understanding what is known and what you’ll need to learn about the cancer in order to decide on the best treatment option.

What parts of the body has cancer spread to?

Breast cancer cells can spread to any part of the body, though the most common areas are the liver, lungs, bones and brain. To learn where cancer has spread, your healthcare providers will likely use an imaging test or a combination of imaging tests, such as CTs, MRIs, PET scans, bone scans or X-rays. These diagnostic tests will also help determine the location and size of the tumors.

Do the cancers need to be biopsied?

MBC can be present when you are initially diagnosed with breast cancer, but often occurs when the original cancer relapses. Your doctor may want to do a biopsy of the suspected metastasis for confirmation before a treatment plan is formulated. However, a biopsy may not be necessary, depending on your situation. In most cases the metastatic tumors will be similar in type to the original tumor. Occasionally, the tumor receptors will change over time or after the original treatment. As you probably remember, your original tumor was tested for various receptors:

  • ER/PR-positive: When a cancer is estrogen-receptor/progesterone-receptor-positive—or ER/PR-positive—it uses the hormone estrogen to fuel its growth. There are a number of treatments that prevent these cancer cells from getting the estrogen they need to grow.
  • HER2-positive: Human epidermal growth factor receptor 2, or HER2, is a protein that promotes the growth of normal cells. Some cancers produce an excess of this protein, which makes them more aggressive. Specific treatments are designed to target these cancer cells.

What treatment options are available?

Chemotherapy, hormonal therapy and biologic therapy are all used to treat MBC, but treatment depends on a number of important factors, including the biology of the cancer. Your treatment may change over time. If your cancer stops responding to one or more treatment types, it may respond to another. If you have side effects that are hard to control, another treatment may be recommended. Surgery and radiation therapy are not common treatments, but may be needed to remove or shrink specific tumors that are causing severe symptoms or are life threatening, such as tumors in the brain or the spinal column. Your treatment plan will include medications to help with pain management and side effects of therapy. Many patients prefer to get a second opinion before committing to a treatment plan.

Early on, ask your doctor about palliative care to help you address spiritual and emotional issues, get support for making decisions about treatments and other care, and access counseling. Care teams may include your traditional healthcare providers, counselors, dieticians, social workers and chaplains. Palliative care helps with managing symptoms and has been shown to improve quality of life. Palliative care is different than hospice or end-of-life care.

How will they know if the treatment is working?

Your doctor will monitor your symptoms and follow your scans periodically. Your blood work will also help to follow your blood counts and liver function tests. In some patients, there may be tumor markers present in the blood. Ask your doctor how often you should have various tests.

What is my prognosis?

Prognosis is different for every patient and depends on many factors. Your healthcare provider will explain what your prognosis is and what that prognosis means. Remember that there is still much to be learned about breast cancer, and researchers are constantly working to find new ways to treat this condition. Patients today have access to treatment options that did not exist even a few years ago and survival times are improving. In fact, more than a third of women live more than five years—and some live 10 or more years after being diagnosed with metastatic breast cancer.

Sourcing: UptoDate, National Institutes of Health, American Cancer Society, National Cancer Institute

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