Navigating an Advanced Stage Diagnosis
- Bachelorette alum Katie Thurston, 34, has given fans an update on her breast cancer stage, sharing that she found out the disease has now spread to her liver, though she is “very optimistic” about her upcoming treatment since her medical team caught the spread early.
- The reality star, who just got married in NYC on March 22 after moving to the east coast from Los Angeles, disclosed on February 15 that she has invasive ductal carcinoma, which is when cancer forms in the milk ducts of the breast. Katie had been waiting for her final staging results after numerous scans. Her specific type of breast cancer is triple positive, which is a HER2-positive cancer.
- Breast cancer classified as HER2-positive tends to exhibit faster growth, increased likelihood of spreading (metastasis), and a higher chance of recurrence. Despite its aggressive nature, HER2-positive cancer responds well to treatments that specifically target HER2 proteins.
- Though it can be scary to find that you have late-stage cancer, new treatments have significantly improved the outlook. These new treatments are increasing the lifespan of women with metastatic disease. For more information on this type of cancer, SurvivorNet has developed a guide called Living With HER2-positive Breast Cancer to help you navigate through this health challenge.
“After days of waiting, unfortunately, I did find out today that my breast cancer has spread to the liver,” Katie shared via Instagram video on Friday. “It is fairly small, however it does put me at stage four.”
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Triple-positive breast cancers is a type of breast cancer where the tumor cells have estrogen receptors, progesterone receptors and a larger than normal number of HER2 receptors on their surface. When faced with a breast cancer diagnosis, it’s important to know if you have any one of these receptors because it can alter your specific course of treatment.
Katie explained that after she was first diagnosed, she went through several scans, including a mammogram, ultrasound, CT scan, MRI, and most recently, a PET scan, and had been waiting to find out the official stage of her disease, which she initially identified as invasive ductal carcinoma, a type of breast cancer that forms in the milk ducts of the breast.
“Went to the doc thinking it was going to be nothing. I was wrong,” the Renton, Washington native wrote in a Q&A last month on her Instagram Stories, which she highlighted in a series titled “Breast Cancer.”
Katie, who said she once had a benign (non-cancerous) cyst removed from the same breast, noted that the pain “probably led to more doubt and delay in getting it checked out, as lots of sites will say ‘most breast cancers don’t hurt.’”
The marketing manager by trade previously mentioned in February that she tested negative for a BRCA1 or BRCA2 gene mutation, and shared that she has no family history of breast cancer — all common misconceptions for some women assuming they are “in the clear” from ever having to receive a diagnosis, but unfortunately that is not the case.
Describing the “range of emotions” she felt after first finding out she had cancer, Katie said she experienced “Despair. Anger. Sadness. Denial. And then strength.”
“Purposeful. Ready,” she added on her Instagram share. “I cried a lot. I tried to even make a video instead of this post and couldn’t.”
Handling Fear When You Get the Diagnosis
Cancer is said to be one of the most challenging experiences for a human to go through. It would be very out of the ordinary if you weren’t scared. Anxiety and fear are totally normal reactions to the news that you have breast cancer. Acknowledging these emotions can be therapeutic and important to the healing process.
So how do you confront your fears without letting them take over entirely?
1. Let your family and close friends know and let them help. So many cancer survivors tell us they want and need support but are often too preoccupied to make specific requests. Urge those close to you to jump in with whatever practical help they can offer.
2. Keep a journal. It can be extremely cathartic to let those feelings loose on paper. Grab a pen and a nice journal and chronical your different thoughts throughout the day.
3. Join a cancer support group. There are groups in nearly every community offering opportunities to connect with others going through a similar journey. You’ll learn incredibly helpful insight from others who can tell you about what to expect and how to stay strong on tough days.
4. Consider seeing a therapist. Ask your doctor to refer you to a therapist so you can discuss your fears and concerns in a safe space. Often, vocalizing your thoughts and feelings rather than internalizing them can provide relief. Above all, just know that there are countless resources and support here for you to turn to at any time.
Feel the Fear, and Let it Go — Meditation for Cancer Survivors
What Is ‘HER2-Positive’ Breast Cancer?
The human epidermal growth factor receptor 2 (HER2) is a receptor on the surface of almost all the cells in our body, and it is one of the many receptors responsible for the communication between the cells to promote their growth, division, repair, and survival. In other words, HER2 is one of the many receptors that help cells grow and divide when the timing is right.
Breast cancer classified as HER2-positive tends to exhibit faster growth, increased likelihood of spreading (metastasis), and a higher chance of recurrence. Despite its aggressive nature, HER2-positive cancer responds well to treatments that specifically target HER2 proteins.
All breast cells are examined for an abundance of this protein (HER2). HER2 proteins act as receptors that regulate the growth and division of cells. If there is an excess of HER2 receptors in breast tissue (known as overexpression), it can lead to rapid multiplication of breast cells. This uncontrolled growth may result in the formation of a tumor.
There are no distinct symptoms or specific risk factors associated with HER2-positive breast cancer, although research indicates that this type of cancer may be more prevalent among younger women.
For more information on this type of cancer, SurvivorNet has developed a guide called Living With HER2-positive Breast Cancer to help you you through.
Testing for Your Breast Cancer Type
If a mammogram detects something suspicious, as in Katie’s case, you will then get a biopsy, which is when your doctor will remove tissue from the tumor and inspect it further. If it is malignant, or cancerous, your doctor will also do IHC (immunohistochemistry) tests to find out if the cancer is being fueled by progesterone receptors, estrogen receptors and/or HER2.
Testing for genetic mutations and other factors are also significant, helping your medical team determine how aggressive your treatment plan should be, and whether or not preventative measures, such as a mastectomy (removal of breast tissue) or hysterectomy (removal of the uterus), should be taken.
Genetic testing and a family history of cancer
Breast Cancer Types
The first order of business for doctors is determining their patients’ breast cancer types and subtypes so they can effectively start treating the disease with the least amount of side effects.
According to Cleveland Clinic, the most common types of breast cancer include:
- Invasive (infiltrating) ductal carcinoma (IDC), which starts in your milk ducts and spreads to nearby breast tissue. It’s the most common type of breast cancer in the United States.
- Lobular breast cancer, which is the second most common breast cancer in the U.S., starts in the lobules, the milk-producing glands in your breast and spreads to nearby breast tissue.
- Ductal carcinoma in situ (DCIS), which starts in your milk ducts like IDC. The difference between the two is DCIS doesn’t spread beyond your milk ducts.
Less common breast cancer types include:
- Triple-negative breast cancer (TNBC): This invasive cancer is aggressive and spreads more quickly than other breast cancers.
- Inflammatory breast cancer (IBC) is rare, fast-growing and looks like a rash on your breast.
- Paget’s disease of the breast is another rare cancer affecting the skin of your nipple and may look like a rash. Less than 4% of all breast cancers are Paget’s disease of the breast.
Breast Cancer Subtypes
Estrogen and progesterone help cancerous cells grow, so healthcare providers must immediately find out if the cancer is fueled by either — or both, or neither. Here is an overview of subtypes:
- ER-positive (ER+) breast cancers have estrogen receptors.
- PR-positive (PR+) breast cancers have progesterone receptors.
- HR-positive (HR+) breast cancers have estrogen and progesterone receptors.
- HR-negative (HR-) breast cancers don’t have estrogen or progesterone receptors.
- HER2-positive (HER2+) breast cancers, which have higher than normal levels of the HER2 protein. This protein helps cancer cells to grow. About 15% to 20% of all breast cancers are HER2-positive.
Learning About Metastatic Breast Cancer
Metastatic breast cancer occurs when cancer cells have spread from the breast to other parts of the body. It may affect the bones, liver, lungs, brain, and other parts of the body. It is also classified as stage four breast cancer.
Metastasis simply refers to the spreading of a disease from one part of the body to another part. It can occur in any form of cancer, although some types are more likely to metastasize. This includes HER-2 positive and triple-negative breast cancers, which tend to be more aggressive.
While it’s not curable, there are several treatment options that can extend your life. With metastatic breast cancer, the primary goal of treatment is to control its spread.
Breast cancer is sometimes classified as either local, regional, or distant.
- Local: Cancer is located in the breast and has not spread
- Regional: Cancer spreads from the breast to nearby lymph nodes
- Distant: Cancer spreads to distant parts of the body including bones, liver, lungs, and/or brain
How Common is Metastatic Breast Cancer?
In a previous interview with SurvivorNet, Dr. Kenneth D. Miller, medical oncologist at the Alvin & Lois Lapidus Cancer Institute at Sinai Hospital of Baltimore, discussed metastatic breast cancer.
“Among women who are seeking medical attention for breast cancer for the first time, approximately 6 to 8% have evidence of metastatic breast cancer,” Dr. Miller said.
“For women who present initially with earlier stage breast cancer, about 20% will later develop metastatic disease.” According to the American Cancer Society, more than 150,000 women were living with metastatic breast cancer as of early 2019. Of those, three-quarters were originally diagnosed with stage 1, stage 2, or stage 3 disease.
How Does Breast Cancer Spread?
Breast cancer spreads through the bloodstream or lymphatic system. The blood carries cancer cells to different parts of the body where they begin to grow as new tumors. Once breast cancer spreads, the cancer cells may continue to grow slowly or they can stop growing and stay at equilibrium. It’s not known what makes them either grow or stop growing.
Breast cancer may metastasize after initial breast cancer treatment is finished.
Options for treating advanced breast cancer
If any cancer cells are left behind after treatment, they may grow and spread to other parts of the body. This can happen years after successful treatment of the original breast cancer.
Symptoms of Metastatic Breast Cancer
Metastatic breast cancer is also called stage four breast cancer because it occurs outside the breast. This type of breast cancer can be more difficult to diagnose and treat. Some women with this disease may experience no symptoms at all.
“Symptoms of recurrent breast cancer can vary significantly because they are related to where in the body the cancer metastases to,” Dr. Miller continued. “Women who have bone metastases may complain of bone pain. Metastases to the lung may cause shortness of breath. Sometimes a cancer recurrence is detected on a physical exam or with blood tests.”
The most common breast cancer symptoms include:
- A new lump in the breast
- Swelling or redness
- Changes in the breast or nipples appearance (puckering of the skin, inverted nipples)
- Pain in the breast
- Nipple discharge
As the disease spreads to other areas of the body (metastasis), it may cause additional symptoms depending on the area the cancer has spread:
- Bones: Severe bone pain or fractures
- Lungs: Difficulty breathing, chest pain, new cough
- Liver: Yellowing of the skin (jaundice), abdominal pain, nausea, and/or vomiting
- Brain: Headaches, memory loss, changes in vision, seizures
Liver Metastasis
Around 50% of people diagnosed with metastatic breast cancer develop liver metastases, according to Breastcancer.org, and 5-12% of these people “develop liver metastases as the main site of breast cancer recurrence.”
Doctors use imaging tests such as a CT scan, MRI, ultrasound or PET scan to diagnose liver metastasis.
While this advanced stage metastasis can’t be cured, it is possible for the disease to be managed with chemotherapy, targeted therapy and immunotherapy (which helps your immune system work harder to fight cancer cells), and in some cases, surgery, to improve quality of life.
Treatment Options
Treatment for metastatic breast cancer focuses on decreasing the spread of cancer cells, as well as relieving symptoms and improving quality of life. Individual treatment options depend on the stage, type of primary breast cancer, and whether hormone receptors are positive. There is no one size fits all treatment.
Treatment can include a combination of:
- Chemotherapy: Oral or IV medications that are toxic to tumor cells
- Hormonal therapies: Drugs that lower estrogen levels or block estrogen receptors from allowing the cancer cells to grow
- Targeted therapies: Drugs that target your tumor’s specific gene mutations
- Immunotherapy: Medications that stimulate your immune system to recognize and attack cancer cells
- Radiation: The use of high-energy rays to kill tumor cells and shrink tumors
- Surgery: To remove a cancerous tumor or lymph nodes (uncommon with stage IV; more common in stages I, II, and III)
- Clinical trials: Studies of new medications, treatments, and other therapies offer hope for better outcomes
Though it can be scary to find that you have late-stage cancer, new treatments have significantly improved the outlook. These new treatments are increasing the lifespan of women with metastatic disease.
Therapies that Target the HER2 Receptor
Targeted therapy is a treatment that targets specific genes, proteins, or the tissue environment that contribute to the cancer’s development and growth. There are specific targeted therapies meant to treat HER2 positive cancers, that are used in metastatic breast cancer.
Treatment for HER2-Positive Breast Cancer
The drugs trastuzumab (Herceptin) and pertuzumab (Perjeta) have transformed the outlook for some women with late-stage breast cancers. These therapies, which are often combined with chemotherapy, are very effective at controlling breast cancer once it has spread.
Potential side effects
Side effects from chemotherapy and targeted therapies can be different in every individual. The most common reactions in patients receiving Herceptin, for example, can include fever, nausea, increased cough, headache, fatigue and anemia. It’s important to note any and all reactions and report them to your medical team.
Questions to Ask Your Doctor After a Diagnosis
If you have been diagnosed with breast cancer, it’s a good idea to make a list of questions for your doctor. Here are a few questions to help you begin the conversation:
- What type of breast cancer do I have? What subtype?
- What is my stage? How likely is it for the stage to change?
- What treatment will I be receiving and for how long?
- What side effects are associated with this treatment?
- Are there steps I can take daily to help minimize these side effects?
- What physical activity routine do you recommend for me during treatment?
- Do I need to have a mastectomy?
- What does my genetic testing show about my cancer risk?
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