MY MBC IN DEPTH

It is incredibly important that you find a doctor and care team whom you trust and feel comfortable with, to ensure that you are getting the best care possible every step of the way. This section provides more in depth information about your diagnosis and treatment, and aims to address some of the more complex questions you may have on:

  • How metastatic breast cancer (MBC) is diagnosed
  • The di erent types of MBC
  • Di erent tests and procedures that will be part of your diagnosis

What is MBC?

MBC is cancer that has spread from the breast to di erent parts of your body. The tumours in these di erent parts are called metastases.

What are the different types of MBC?

Once you are diagnosed with MBC, your doctor will need to find out which type of cancer it is. This will help your doctor know which treatments may be best for you.

Breast cancer can have the genetic markers of HER2 and hormone receptors (HR) on your breast cancer cells. These markers can help guide e ective treatment.

Chemo Therapy

Antihormonal Therapy

Targeted Therapy

Radiation

Surgery

Chemotherapy, anti-hormonal therapy, targeted therapy, radiation and surgery are all treatment options.
There are four main types of MBC

  • Hormone receptor-positive, her2-negative

    This is the most common form of breast cancer found in approximately two-thirds of the population.

  • HORMONE RECEPTOR-NEGATIVE, HER2-POSITIVE

    When breast cancer cells make too much HER2 protein, they grow faster than normal cells - and faster than other cancer cells. This is called HER2-positive breast cancer. Between 15–20% of breast cancers are HER2-positive.

  • HORMONE RECEPTOR-POSITIVE, HER2-POSITIVE

    This is cancer that has both HER2 and hormone receptors. It has “tested positive” for both types.

  • HORMONE RECEPTOR-NEGATIVE, HER2-NEGATIVE, ALSO CALLED TRIPLE-NEGATIVE

    This cancer does not have HER2 or the hormone receptors oestrogen and progesterone. Between 10–20% of breast cancers are triple-negative.

! If your breast cancer recurs, your cancer cells should be retested
for HER2 and hormone receptor status, since these can often change from the original cancer

WHY IS MY CANCER REFERRED TO AS ‘STAGE IV’ BREAST CANCER?

Breast cancer is often classified into different stages from 0 to IV based on how large the tumour is and whether it has spread to surrounding lymph nodes and other parts of the body.

MBC is stage IV breast cancer. This means that the cancer has spread (metastasised) to other organs in the body

Some doctors may also use another staging system known as the TNM classification (T for tumour, N for nodes, M for metastases) to assess the stage of your breast cancer. However, the TNM staging system is less common than the numerical staging system (stages -0IV).

HOW IS MBC DIFFERENT FROM EARLY BREAST CANCER?

Early breast cancer includes stages 0, I or II. It refers to cancer that is still in the breast or which has only spread to lymph nodes near the breast. Treatment for early breast cancer usually happens for a limited period of time.

Metastatic breast cancer, otherwise known as stage IV breast cancer, is when the cancer has spread (metastasised) from the breast to other organs in the body. This is the most advanced stage of breast cancer.

Advanced breast cancer (stage III) only occurs in the same breast as the primary tumour and has not spread to other organs.

WHERE HAS THE CANCER SPREAD?

An important part of your diagnosis will be to fi nd out where the cancer has spread – or where you may have metastases or “mets.” This will allow your doctor to give you treatment specifi cally aimed at minimising the possible eects of those metastases. For example, treatment can help strengthen your bones if cancer has spread to your bones.

WHAT ARE THE SITES AND SYMPTOMS
OF DIFFERENT METASTASES?

The most common sites for breast cancer metastases are the bones, the liver, the lungs, and the brain. However, there is no set pattern for where breast cancer cells spread – every case is different.

Each of these types of metastases may lead to particular symptoms, which are listed in the fi gure.

! It’s important to talk to your doctor if you experience any unusual symptoms - don’t wait too long.

ABOUT METASTATIC SYMPTOMS

Brain

Symptoms will very much depend on which areas of your Brain are affected by the cancer. Possible symptoms include: Headache, nausea, exhaustion (fatigue), weakness, confusion, memory loss, difficulties with speech, and seizures.

Liver

If your breast cancer has spread to the liver, you may experience: Pain, nausea, loss of appetite, hiccups, jaundice, exhaustion, and itchy skin.

Bone

Sometimes breast cancer cells spread to one or both lungs through the blood or lymph system. Symptoms can include: Breathlessness, cough, pain, and loss of appetite.

Lung

Bone metastases are the most common site of cancer-related pain and occur in approximately twothirds of women with MBC. You may experience: Pain, bone fractures as a result of bone weakening, spinal cord compression, anaemia, and exhaustion.

MY PERSONAL GUIDE TO CANCER TESTING

The tests and scans you have to diagnose your cancer will likely be repeated throughout your treatment at regular check-ups. These tests help determine if your treatment is eective and the tumour has shrunk (remission) or stopped growing (stable disease), or if treatment has to be changed because the tumour is growing again (progression).

LAB TESTS

These are blood tests. They may be done at your doctor’s surgery or at a blood testing centre. If you have had cancer before, you were likely getting your white blood cell or T-cell count checked regularly.

High or low levels of certain substances in your body can be a sign of cancer. So, lab tests of the blood, urine, or other bodily fluids that measure these substances can help doctors make a diagnosis. However, abnormal lab results are not a sure sign of cancer.

IMAGING PROCEDURES

Imaging procedures create pictures of areas inside your body that help the doctor see whether a tumour is present. These pictures can be made in several ways:

Ct Or Cat Scan

Nuclear Or Radionuclide Scan

Ultrasound

CT or CAT SCAN

An x-ray machine linked to a computer takes a series of detailed pictures of your organs. You may receive an injection of a dye or other contrast material to highlight areas inside the body. This helps to make the pictures easier to read. This is usually a visit lasting a few hours and takes place at an imaging centre or at a hospital.

NUCLEAR (OR RADIONUCLIDE) SCAN

For this scan, you receive an injection of a small amount of radioactive material, which can be called a tracer. It flows through your bloodstream and collects in certain bones or organs. A machine called a scanner detects and measures the radioactivity. The scanner creates pictures of bones or organs on a computer screen or on film. Your body gets rid of the radioactive substance quickly. This type of scan may also be called radionuclide scan. This procedure must be done at a nuclear medicine facility or radiation centre, or at your hospital.

ULTRASOUND

An ultrasound device sends out sound waves that people cannot hear. The waves bounce o tissues inside your body. This picture is called a sonogram. This is the same test given to pregnant women to check on the growth of a baby. It may be done in your doctor’s surgery.

MRI

Pet Scan

X-Rays

Biopsy

MRI

A strong magnet linked to a computer is used to make detailed pictures of areas in your body. Your doctor can view these pictures on a monitor and print them on film. This appointment can take a few hours and is usually done at an imaging centre or at a hospital.

PET SCAN

For this scan, you receive an injection of a tracer. Then, a machine creates 3-D pictures that show where the tracer collects in the body. These scans show how organs and tissues are working. This appointment can take a few hours and is usually done at an imaging centre or at a hospital.

X-RAYS

X-rays use low doses of radiation to create images of the inside of your body. This test may be done at your doctor’s surgery.

BIOPSY

In most cases, doctors need to do a biopsy to make a diagnosis of cancer, even if you have already had a biopsy. A biopsy is a procedure in which the doctor removes a sample of tissue. A pathologist looks at the tissue under a microscope to see if it is cancerous. The sample may be removed in several ways:

With a needle

The doctor uses a needle to withdraw tissue or fluid.

With an endoscope

The doctor looks at areas inside the body using a thin, lighted tube called an endoscope. The scope is inserted through a natural opening, such as the mouth. Then, the doctor uses a special tool to remove tissue or cells through the tube.

With surgery

Surgery may be excisional or incisional. In an excisional biopsy, the surgeon removes the entire tumour. Often some of the normal tissue around the tumour also is removed. In an incisional biopsy, the surgeon removes just part of the tumour.