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My diagnosis

My diagnosis

When you understand your breast cancer diagnosis better you will be able to discuss with your oncologist about the treatment options.

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WHAT IS METASTATIC
BREAST CANCER?

Metastatic breast cancer is cancer that has spread from the breast to other parts of your body1,2. A tumor that has spread to another part of your body is called a metastasis (the plural is metastases)1,2.

Metastatic breast cancer is also referred to as Stage IV breast cancer or advanced breast cancer1.

WHAT DOES THE DIAGNOSIS OF METASTATIC BREAST CANCER MEAN TO ME?

When you are diagnosed with metastatic breast cancer it does not mean that your initial treatment was not effective or because of your lifestyle. Breast cancer can come back in another part of the body months or years after the original diagnosis and treatment. Nearly 30% of women diagnosed with early-stage breast cancer will develop metastatic disease1,2.

WHAT TESTS DO I NEED TO CONFIRM MY METASTATIC BREAST CANCER DIAGNOSIS AND CHECK MY PROGRESS?

How your metastatic breast cancer is diagnosed will depend entirely on your oncologist, the first thing your oncologist will want to do is find out as much as possible about your cancer - what type of metastatic breast cancer it is and where it has spread in the body. This will help your oncologist determine the best treatment plan for you1,2.

The types of tests you might have include:

laboratory_tests_1.png Laboratory tests – these are tests of the blood, urine of other body fluids.

imaging_procedures_0.png Imaging procedures – there are a variety of different imaging procedures that can help detect the location and size of tumors. Examples include CT scans and MRI scans.

biopsy.png Biopsy – this is when a sample of tissue is taken from your tumor to test for genetic markers on the tumor cells. Tests performed may vary from one person to another depending on your signs and symptoms and your oncologist’s recommendation.

Tests and scans used to diagnose your breast cancer may be repeated throughout your treatment duration. This will help to determine if you are responding to your treatment for example tumor shrinkage and stable disease (tumor neither growing or shrinking) and not responding when the tumor starts to grow again.

What are the different types of breast cancer?

The presence (or absence) of particular genetic markers on your breast cancer cells will define which type of breast cancer you have. The two main types of markers are human epidermal growth factor receptor 2 (HER2) and hormone receptors (HR). The two hormone receptors that are important in breast cancer are estrogen receptors (ER) and progesterone receptors (PR).

By knowing the combination of your genetic markers, it will help your oncologist in selecting the right treatment for you.

There are four main types of breast cancer1,2,3:

HR-positive, HER2-negative

This is the most common form of breast cancer found in approximately two-thirds of patients3.

HR-negative, HER2-positive

Human epidermal growth factor receptor 2 (HER2) is found within the cell membrane. When HER2 is activated, it causes breast cancer cells to grow and divide. When breast cancers have cells with more than 2 copies of the HER2 gene, this will generate too many HER2 receptors, and subsequently breast cancer cells grow and divide fast. This cancer is called HER2 positive.

HR-positive, HER2-positive

This is cancer that has both HER2 and hormone receptors.

HR-negative, HER2-negative (also called triple-negative)

This cancer does not have HER2 or the receptors for the hormones estrogen and progesterone. Between 10-20% of breast cancers are triple-negative.

Your oncologist may want to re-test your cancer cells for HER2 and hormone receptor status since these can often change when your breast cancer recurs.

What are the common sites of breast cancer metastases and symptoms?

An important part of breast cancer diagnosis is to find out where the cancer has spread – or where you may have metastases. This will allow your oncologist to give you treatment specifically aimed at minimizing the possible effects of your metastases. For example, treatment can help strengthen your bones if cancer has spread to your bones1,2.

The most common sites for breast cancer metastases are bones, liver, lungs and brain. The symptoms you experience will depend on the location of your metastases1,2.

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  • Brain
  • Lungs
  • Liver
  • Bones
  • BRAIN

    Symptoms will depend on which area of the brain is affected by the cancer. Possible symptoms include headache, nausea, fatigue, weakness, confusion, memory loss, speech problems and seizures1,2.

  • LUNGS

    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 appetite1,2,4.

  • LIVER

    If breast cancer has spread to the liver, you may experience pain, nausea, loss of appetite, hiccups, jaundice, exhaustion and itchy skin1.

  • BONES

    Bone metastases are the most common site of cancer-related pain and occur in approximately two-thirds of women with metastatic breast cancer.
    You may experience pain, bone fractures due to bone weakening, spinal cord compression, anemia and fatigue1.

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

Frequently Asked Questions

Where can I go get breast cancer screening tests?

Breast cancer is one of the most common types of cancer in Malaysia, and we recommend regular screening for early detection and diagnosis. You can get screened for breast cancer by scheduling an appointment at a clinic or a hospital.

Although breast cancer screening cannot prevent breast cancer, the general guidelines is that, frequently checking your breasts for cancer before there are any signs or symptoms can help you catch the disease early. And by seeking out the right oncologist and treatment will hopefully prevent the disease from progressing further.

How often should I do breast cancer self-checks?

Aim to give yourself once a month, ideally 7-10 days after each menstrual period, which is when breasts are the least tender and lumpy.

During your breast cancer self-checks make sure to follow proper guidelines and look for any changes in breast tissue, such as changes in size, any lumps, dimpling or puckering of the breast, inversion of the nipple, redness or scaliness of the skin or nipple area, or discharge from the nipple.

If you see any changes mentioned above, it is imperative that you consult with your physician immediately.

What is the prognosis of metastatic breast cancer?

Despite there being no cure for metastatic breast cancer after being diagnosed, many treatment options that can extend a patient’s life have been available in Malaysia since the 1990's. Consult with your oncologist to choose the right treatment course for you.

What kind of treatments are available for metastatic breast cancer?

Treatments for this type of stage IV cancer encompass many of the same treatments as other stages of breast cancer.

  • Chemotherapy
  • Radiation therapy
  • Hormone therapy
  • Biologic targeted therapy
  • Breast surgery
References
  1. National Breast Cancer Foundation Australia (2020). Stage 4 (Advanced or Metastatic) Breast Cancer. Retrieved from https://nbcf.org.au/about-breast-cancer/diagnosis/stage-4-advanced-or-metastatic-breast-cancer/. Accessed 18 August 2020.
  2. Australian Government Cancer Australia (August 2020) Metastatic Breast Cancer. Retrieved from https://breast-cancer.canceraustralia.gov.au/affected-cancer/cancer-types/breast-cancer/types/metastatic-breast-cancer. Accessed 18 August 2020
  3. Howlader, N et al. (2014) US Incidence of Breast Cancer Subtypes Defined by Joint Hormone Receptor and HER2 Status. JNCI 106 (5): 1-8.
  4. National Cancer Institute (2019). Breast Cancer Treatment Adult -Patient Version. Retrieved from https://www.cancer.gov/types/breast/patient/breast-treatment-pdq. Accessed 18 August 2020