Metastatic breast cancer

Note that breast cancer that has spread elsewhere can also be treated - 50% of patients with bone mets are alive 10 years later.

New chemotherapy regions and special laryet therapies have revolutionaised the management of patients whose breast cancer has spread elsewhere.

Metastatic breast cancer is a Stage IV cancer.

The choices of therapy for Stage IV breast cancer are shown in the following algorithm. DXT and surgery (toilet mastectomy) must be added where necessary (e.g. DXT for bone pain or impending paraplegia from a spinal secondary; toilet mastectomy for a foul smelling, fungating, breast tumour that makes life dreadful).

Watch out for these symptoms and contact your oncologist. The problems associated with disseminated breast cancer are:

	Neurological problems (confirmed with x-ray and MRI spine). Secondary deposits (metastatic spread) to the bony vertebral pedicles of the spinal column may result in spinal cord injury, with its attending paraplegia (paralysis), bladder and bowel problems. These are managed with steriods and urgent radiation.
	Hemiparesis (confirmed with MRI brain). Secondaries to the brain may result in paralysis of the opposite side of the body, sensory disturbances, loss of speech and visual disturbances, amongst many other symptoms.
	Liver secondaries (confirmed with sonar and CAT scan of the liver). Jaundice may occur very late in this situation. This is managed with chemotherapy.
	Lung secondaries (confirmed with an x-ray chest). Malignant pleural effusions may cause dyspnoea (breathlessness) and can be managed by taking off-time.
	Bone secondaries (confirmed with x-ray bones and bone scan). Bone pain and fractures occur. This can be managed with chemotherapy and radiation.

Hypercalcaemia (High calcium).Patients may become very ill (severe vomiting) and the serum calcium will need to be decreased with biphosphonates if it is too high.