How Is Metastatic Breast Cancer Treated?
Metastatic breast cancer, also known as stage 4 breast cancer, is diagnosed when the cancer has spread outside the breast to other organs, most commonly the bones, brain, liver, and lungs, according to the American Society of Clinical Oncology (ASCO).e60dc2a1-f33c-4a05-9b50-8e3e8e5976295e33d180-d44b-4e48-a257-ea9c6fbdcfc7 “While [metastatic breast cancer] is not traditionally considered to be curable — meaning that we make it go away and it never comes back again — it is very treatable,” says Tiffany Troso-Sandoval, MD , a breast oncologist at Memorial Sloan Kettering Cancer Center in New York City. “Patients can live with certain types of metastatic breast cancer for many, many years.” While someone with metastatic breast cancer can’t currently be cured of the disease, many treatments can help slow the spread of the cancer, manage pain and other symptoms and side effects, and improve quality of life, according to the American Cancer Society (ACS).e60dc2a1-f33c-4a05-9b50-8e3e8e597629b2e5fc0c-975f-4550-8933-abe3b13d6976 Metastatic breast cancer is most typically treated using hormone therapy, chemotherapy, immunotherapy, targeted drugs, or a combination of these treatments, per the ACS.e60dc2a1-f33c-4a05-9b50-8e3e8e5976297dbcb28c-ce5d-4f42-8955-34378a770f07 Radiation therapy and surgery are not as commonly used to treat breast cancer that has metastasized, though radiation may be used as part of palliative care to help relieve pain.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292858cc94-e39c-4234-965e-9873c0faf80f The treatment you receive will largely depend on where and how much the cancer has spread and the disease type.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f4356c2c-0306-4822-90c9-b94fb13fcb6b
Breast Cancer Types and Subtypes The overwhelming majority (75 to 80 percent) of breast cancers arise from the milk ducts and are referred to as invasive ductal carcinoma.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294d5390b2-2058-4d86-8cc8-daf161e807fe The second most common type of breast cancer is invasive lobular carcinoma (up to 15 percent), which arises from the milk lobules.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e5fb0a62-0e36-4457-adad-af90b47b4935 There are other less common types of breast cancer, too.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b49581d2-9ddd-4e66-94c4-41090fb1a349 Beyond where the cancer originated, breast cancer is further classified into subtypes based on the receptors that appear on the surface of the cells. Knowing a cancer’s subtypes helps doctors select the treatments that each subtype is sensitive to.e60dc2a1-f33c-4a05-9b50-8e3e8e59762965cf2be0-0008-433a-a19b-7bbca5e9a60a Common breast cancer subtypes include these varieties: Hormone Receptor-Positive Many breast tumors — up to 75 percent — contain receptors for estrogen and progesterone, the female hormones, on their surface. If a tumor is hormone-positive, it means that it carries these receptors and will grow in the presence of these hormones. Many treatments for this subtype are designed to block the hormones or interfere with their production. It’s very common for breast cancers to be positive for these hormones. HER2-Positive HER2 is a common receptor found in many areas of the body. But in some cancers, including breast cancer, the HER2 receptor can be present to an abnormal degree. About 20 percent of breast tumors are positive for HER2 receptors, known as being HER2-positive. There are drugs that target this receptor. Triple-Negative These breast cancers don’t carry receptors for progesterone, estrogen, or HER2. They are considered more complicated to treat because, without these receptors, they are more difficult to target with treatments.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b541f9b5-890e-4c66-8cc7-1a155303c34d
Treating Metastatic Hormone-Positive, HER2-Negative Breast Cancer Hormone Therapy Because hormone receptor-positive breast cancers grow in response to estrogen and progesterone, treating this type of cancer is most commonly done using drugs that block the hormone pathways, says Kelly McCann, MD , a breast oncologist at UCLA Health in Beverly Hills, California. In postmenopausal women, oral medications called aromatase inhibitors, which decrease hormone levels, are used, says Dr. McCann, most typically: anastrozole (Arimidex) exemestane (Aromasin) letrozole (Femara) Estrogen helps the body maintain bone density, so one complication that can arise from blocking it is a decrease in bone density, says McCann. Other side effects of these drugs may include arthralgia, or aching of the bones and joints, and menopausal symptoms, such as hot flashes or vaginal dryness, says McCann. Your doctor may combine your prescription with a class of drugs called CDK 4/6 inhibitors. CDK 4/6 Inhibitors CDK 4/6 inhibitors stop cancer cells from multiplying by targeting the CDK 4/6 protein found on the surface of breast cancer cells. Some research suggests that using a combination of CDK 4/6 inhibitors with aromatase inhibitors may be better at slowing the spread of cancer than if the therapies are used individually. The most commonly used CDK 4/6 inhibitors, says McCann, are: palbociclib (Ibrance) ribociclib (Kisqali) abemaciclib (Verzenio) Though CDK 4/6 inhibitors are tolerable for most people, side effects may include fatigue, low blood counts, and a decrease in appetite, says Dr. Troso-Sandoval. Estrogen Receptor Modulators Those with metastatic breast cancer who are premenopausal might be treated with an estrogen receptor modulator, most commonly tamoxifen (Nolvadex, Soltamox) , which blocks the effect of estrogen in the breast but mimics estrogen in the uterus and bone. “However, in the metastatic setting it would not be uncommon to give aromatase inhibitors instead,” says Lisa Curcio, MD , of Nuvance Health in upstate New York, who is also part of Everyday Health’s Health Expert Network. Chemotherapy Targeted therapies like aromatase inhibitors and CDK 4/6 inhibitors are often the go-tos when treating metastatic hormone receptor-positive breast cancer because they tend to be more effective and have fewer side effects than older options like chemotherapy, says McCann. But chemotherapy may still be used, particularly if a patient has widespread disease that’s progressing despite the other therapies or they’re experiencing intolerable side effects from them. The most commonly used chemotherapy drugs include: capecitabine (Xeloda) carboplatin (Paraplatin) eribulin (Halaven) gemcitabine (Gemzar) paclitaxel (Taxol) vinorelbine (Navelbine) Side effects of chemotherapy include an increased risk of infection, anemia, bruising and bleeding, blood clots, and nausea. Many of these side effects can be managed with the help of palliative care, a change in diet, and additional medication.e60dc2a1-f33c-4a05-9b50-8e3e8e597629aa9ec188-fa9e-4d04-bc08-0f54d9032085
Treating Metastatic HER2-Positive Breast Cancer Targeted Therapy Metastatic HER2-positive breast cancer may also be hormone-positive, also known as triple positive, so these patients may receive hormone therapy as well as therapy targeted for the HER2 receptor. This treatment may be combined with the same type of chemotherapy used for hormone-positive metastatic breast cancers, McCann says. The most common medications to treat metastatic HER2-positive breast cancer, according to Troso-Sandoval, include: trastuzumab (Herceptin, Herzuma, Ontruzant) pertuzumab (Perjeta) trastuzumab emtansine (Kadcyla) Side effects may include diarrhea, hair loss, nausea, fatigue, and a rash on your skin. If you experience these symptoms, tell your provider. They may be able to prescribe additional medications or suggest lifestyle changes to help.e60dc2a1-f33c-4a05-9b50-8e3e8e59762932495a80-9322-4323-aa88-8db8219241d2 Chemotherapy Chemotherapy treatment for HER2-positive cancer is very similar to other breast cancer chemotherapies. See above for more information. New Drug Treatments Advancements in research on metastatic HER2-positive breast cancer have led to the development of new drugs: Fam-trastuzumab deruxtecan nxki (Enhertu) is now approved by the U.S. Food and Drug Administration (FDA) for metastatic breast cancer that is positive for HER2 receptors. The agent consists of a drug linked to an antibody that delivers the drug to cancer cells using HER2 receptors as a target. It is also approved for metastatic breast cancer that has borderline HER2 levels, also called HER2-low breast cancer. Side effects may include nausea, fatigue, and low blood cell counts.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f22f41a0-d637-40a6-9fd6-27e4ddc11954 Tucatinib (Tukysa) is a small molecule–inhibitor of HER2, meaning it slows the progression of cancers that carry the HER2 receptor. It has been approved by the FDA when combined with trastuzumab and capecitabine.e60dc2a1-f33c-4a05-9b50-8e3e8e59762954e8d08c-94c6-403a-bff0-b340f68c8094 Side effects may include nerve damage, nausea, and fatigue. Providers can address these issues with palliative care, including medication and lifestyle changes.e60dc2a1-f33c-4a05-9b50-8e3e8e5976299db2e149-c324-4a2c-aa30-e331b3088e08
Treating Metastatic Triple-Negative Breast Cancer Triple-negative breast cancer (TNBC), which makes up about 15 percent of all breast cancers, is defined by the absence of estrogen, progesterone, and HER2 proteins, McCann says. It’s more difficult to treat because it lacks receptors to target. TNBC is less common than the other subtypes and is more often seen in Black women. It is associated with the BRCA1 genetic mutation, known to increase the risk for breast cancer, but most people with TNBC will not have a genetic mutation, says McCann. Chemotherapy Because this form of breast cancer lacks hormone and HER2 receptors, therapies that target them are not used. Instead, McCann says, metastatic triple-negative breast cancer is usually treated with chemotherapy, which is similar to the chemotherapy treatment addressed above. Immunotherapy Your provider may opt to treat you with immunotherapy. Before trying this, doctors will usually examine tissue from the tumor to check it for a biomarker called PD-L1, McCann says. Tumors with this biomarker tend to be more responsive to a class of immunotherapy drugs known as PD-L1 inhibitors. The most common immunotherapy drug used to treat triple negative breast cancer is pembrolizumab (Keytruda) . In one clinical trial, patients with triple negative breast cancer whose tumors were PDL-1 positive, and received pembrolizumab with chemotherapy experienced shrinkage of their tumors and survived longer with less spread of their cancer than those who received chemotherapy alone.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294a4fc139-12db-4bab-addf-d7c5df029593 Because tumors can grow and mutate quickly, one complication with immunotherapy treatment may be developing resistance, says McCann. Side effects of pembrolizumab can include fatigue, pain, rash, diarrhea and fever.e60dc2a1-f33c-4a05-9b50-8e3e8e597629650f7913-2fdd-44ec-98b9-a54b175ff84d
Questions to Ask Your Doctor What kind of breast cancer do I have?What subtype of breast cancer do I have?What organs has it spread to?How will we track my response to treatment? How will we know when to change treatments?
Are you and your partner neglecting sex play? Learn how to add it back into your routine to boost your bond in and out of the bedroom. While “quickies” can be fun and spontaneous, skipping foreplay means missing out on a great way to connect emotionally and physically. According to Pepper Schwartz, PhD, a sexual health expert and researcher at the University of Minnesota in Minneapolis, foreplay is critical, elemental, and necessary.
Foreplay, also known as “outercourse,” is any sexual activity that occurs before intercourse. There is no single way to engage in foreplay, as it can mean different things to different people. It can involve kissing, caressing, cuddling, flirty texting or talking, massage, and oral sex. If you like it a little rough, biting, pinching, scratching, and spanking can be a turn-on. The goal is to increase sexual excitement, which can help prepare the body for intercourse. Foreplay is sometimes thought of as a warm-up for sex, but it doesn’t necessarily have to lead to intercourse. Some couples find foreplay itself to be sexually fulfilling as a main event.
The benefits of foreplay include lubrication of the vagina, an extended erection, and the prevention of premature ejaculation for people with penises. The female body pulls the uterus up when aroused, lengthening the vagina. This process, called uterine tenting, creates a pool area for semen, which is part of the reproductive sophistication of our machinery, according to Dr. Schwartz. As those muscles relax, the nerve endings start to get stimulated, paving the way for a more pleasurable experience. Research involving married couples has found that 1 to 10 minutes of foreplay was associated with 40% of women achieving orgasm during sex. That percentage rose to 50 with 12 to 20 minutes of foreplay and 60 with more than 20 minutes of foreplay.
If you want more action in bed, you have to let your partner know what you want. But talking about sex can be easier said than done for some. Dr. Lyndsey Harper, a clinical assistant professor of obstetrics and gynecology at Texas A&M School of Medicine in Bryan, Texas, recommends two sentence starters to try when expressing sexual desire to your partner: “I want you to…” and “It feels so good when you…”. If it makes you more comfortable, you can bring up your sexual needs outside of the bedroom. If you don’t know how to bring it up, she suggests starting the conversation with something like, “Our sex life is really important, and I’d love for us to feel open talking about things. Would it be okay for me to share with you some things I like?”
Communication comfort is closely linked to trust. To experience true intimacy and fun foreplay, trusting each other is essential, especially since our needs constantly change. Couples who find it difficult to communicate about their desires should consider seeing a couple’s counselor or sex therapist who can help them navigate these discussions.
- Foreplay is just play. Couples can engage in it however they want. According to Dr. Harper, it generally takes about 20 minutes of arousal for women to become fully lubricated and ready for penetrative sex. However, it is best to abolish the idea of “foreplay” and the “main event” of penetrative sex and work together with your partner to create a fun and intimate sexual life where everyone’s needs are met.
https://www.everydayhealth.com/sexual-health/sexual-foreplay.aspx
The post How Is Metastatic Breast Cancer Treated? appeared first on Secretly Sexy.
Are you and your partner neglecting sex play? Learn how to add it back into your routine to boost your bond in and out of the bedroom. While "quickies" can be fun and spontaneous, skipping foreplay means missing out on a great way to connect emotionally and physically. According to Pepper Schwartz, PhD, a sexual health expert and researcher at the University of Minnesota in Minneapolis, foreplay is critical, elemental, and necessary. Foreplay, also known as "outercourse," is any sexual activity that occurs before intercourse. There is no single way to engage in foreplay, as it can mean different things to different people. It can involve kissing, caressing, cuddling, flirty texting or talking, massage, and oral sex. If you like it a little rough, biting, pinching, scratching, and spanking can be a turn-on. The goal is to increase sexual excitement, which can help prepare the body for intercourse. Foreplay is sometimes thought of as a warm-up for sex, but it doesn't necessarily have to lead to intercourse. Some couples find foreplay itself to be sexually fulfilling as a main event. The benefits of foreplay include lubrication of the vagina, an extended erection, and the prevention of premature ejaculation for people with penises. The female body pulls the uterus up when aroused, lengthening the vagina. This process, called uterine tenting, creates a pool area for semen, which is part of the reproductive sophistication of our machinery, according to Dr. Schwartz. As those muscles relax, the nerve endings start to get stimulated, paving the way for a more pleasurable experience. Research involving married couples has found that 1 to 10 minutes of foreplay was associated with 40% of women achieving orgasm during sex. That percentage rose to 50 with 12 to 20 minutes of foreplay and 60 with more than 20 minutes of foreplay. If you want more action in bed, you have to let your partner know what you want. But talking about sex can be easier said than done for some. Dr. Lyndsey Harper, a clinical assistant professor of obstetrics and gynecology at Texas A&M School of Medicine in Bryan, Texas, recommends two sentence starters to try when expressing sexual desire to your partner: "I want you to..." and "It feels so good when you...". If it makes you more comfortable, you can bring up your sexual needs outside of the bedroom. If you don't know how to bring it up, she suggests starting the conversation with something like, "Our sex life is really important, and I'd love for us to feel open talking about things. Would it be okay for me to share with you some things I like?" Communication comfort is closely linked to trust. To experience true intimacy and fun foreplay, trusting each other is essential, especially since our needs constantly change. Couples who find it difficult to communicate about their desires should consider seeing a couple's counselor or sex therapist who can help them navigate these discussions.- Foreplay is just play. Couples can engage in it however they want. According to Dr. Harper, it generally takes about 20 minutes of arousal for women to become fully lubricated and ready for penetrative sex. However, it is best to abolish the idea of "foreplay" and the "main event" of penetrative sex and work together with your partner to create a fun and intimate sexual life where everyone's needs are met.
https://www.everydayhealth.com/sexual-health/sexual-foreplay.aspx
