Metastatic or stage 4 breast cancer is cancer that has spread from the breast or nearby lymph nodes to other distant organs of the body such as the bones, liver, lungs or brain. You might hear it called advanced breast cancer or secondary breast cancer. Even though it has spread to other parts of the body the cancer is still known as breast cancer.
Staging and grade classifcation of breast cancer
Because of the complex nature of breast cancer, it is categorised by stages and grades to help make a more accurate diagnosis and determine the most effective treatment plan. It's important to note that different stages and grades of breast cancer can affect treatment options and prognosis, but early detection and treatment can improve outcomes.
Who will be apart of my healthcare team?
De novo cancer
What is de novo cancer?
De Novo breast cancer means you are diagnosed with stage four or metastatic cancer from the very beginning. At your first diagnosis, the cancer has already spread beyond its initial site (e.g. breast, ovary, prostate) and into more distant parts of the body (e.g lung, liver, bone).
Getting a cancer diagnosis can be scary, for those with a de novo diagnosis, it can be completely overwhelming and cause a lot of anxiety.
Andrea, diagnosed with de novo at 49
If you’ve been given a de novo or metastatic diagnosis, Andrea shares that there is still the possibility of finding moments of happiness and joy among it all and of learning how to live with this disease. With the right support and treatment, you can live well for longer. - Andrea
Understanding de novo cancer
What you might feel
It is absolutely normal to be anywhere on the spectrum of emotions when receiving a de novo diagnosis. From not being aware of what this diagnosis means, feeling hopeful, to being filled with anxiety and hopelessness. Having never been exposed to the cancer care system or experienced treatment before everything will be new to you. It can take some time to process what you have been told and understand the medical treatment plan.
It is important to be gentle with yourself and reach out for support when you need it and ask your medical team anything you are unsure about.
Where to get support
Once the initial shock has subsided it can help to connect with the right support to help you come to terms with your diagnosis, learn how to live well with metastatic disease and to understand what your future holds.
There are many places to find support:
- Your Medical Team: Can help you understand what is ahead on your treatment journey and the possible progression of your disease and symptoms. Keeping in contact with your medical team can help make informed decisions about your treatment and care.
- Cancer Care Nurse: can be an excellent point of contact for helping come to terms with your diagnosis, a place to be heard, someone to help you understand your treating team's decisions, show you that you can live with this diagnosis and support the complex emotions that inevitably follow a metastatic diagnosis.
- General Practitioner: If you have a good relationship with your general practitioner then you can be a very good support person and someone who is continuous throughout your journey.
- Family and Friends: An ear to listen, or arms to hug, or someone to dry tears can be worth their weight in gold. While you may not be comfortable sharing all aspects of your emotional world with these people, don't be afraid to reach out and ask for the practical support you need (rides to treatment, help caring for children, meal preparation).
- Support Groups: Finding an in-person or online support group can be really helpful connecting with others with a metastatic diagnosis provides you with a group of people who intrinsically understand what it is like to have metastatic cancer and the large psychological effect of your diagnosis.
Treatment for de novo cancer
One benefit of being new to the cancer health care system is that there might be more treatment options available to you as your cancer has not been exposed to any anti-cancer treatments before. The main goal of treatment for de novo cancer is to control the cancer.
Treatment options for de novo cancer can vary widely depending on the type and stage of cancer, as well as the patient's overall health and individual circumstances.
A treatment plan for your de novo cancer will be developed by your multi disciplinary team who will choose the most effective care based on your individual circumstance. Factors like the type and stage of cancer, your overall health, and your personal preferences will contribute to treatment decisions.
What can be confronting when it comes to treatment is that in order to help you live well, live longer and fulfil your goals it’s likely that treatment will be continuous. This means just as someone with a chronic disease needs lifelong treatment to manage this so too does someone with de novo metastatic cancer.
When one treatment is no longer working effectively your treatment team will switch to a new treatment and this will likely continue. With support from your treatment team, your cancer may never go away completely, but you can live well for longer with a de novo diagnosis.
Some of the possible treatments that might be suggested are:
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Radiation therapy: This uses high-energy external beams of radiation to destroy cancer cells. It breaks up abnormal cells, stopping them from growing and dividing.
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Endocrine or hormonal therapy: This type of systemic therapy works by blocking hormones that can activate the growth of certain types of cancer. This often involves taking one tablet daily for about 5-10 years. It may produce some menopausal side effects.
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Chemotherapy: This systemic treatment uses cytotoxic drugs with the aim to destroy cancer cells throughout the body. It is often given as an intravenous infusion every 3 weeks or weekly. It can be cytotoxic to healthy cells as well as cancer cells. Some of the common side effects include temporary hair loss, nail changes, mouth ulcers, nausea, and fatigue.
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Targeted therapy: Drugs that target specific cancer cell features to stop growth. This intravenous form of therapy is generally used for HER2-positive breast cancers and is delivered once every 3 weeks. It includes drugs known as Herceptin.
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Bone-directed therapy: To help prevent or treat bone fractures and other complications.
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Palliative care: To manage symptoms and improve quality of life during treatment for Stage 4 or metastatic breast cancer.
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Immunotherapy: Immunotherapy is a type of cancer treatment that assists the body's immune system to fight cancers.
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Surgery: Is not often the go-to treatment in De Novo cases it may be used in some cancers to remove solid tumours or alleviate symptoms caused by cancer such as pain, bone fracture or control bleeding.
