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Breast Cancer-13


Welcome to part 13 of educational series on breast cancer. In part 12, we learned about most advances in breast cancer therapy such as in hormonal therapies and radiotherapy.

Question: Thank you Dr. Chiragbhai. I am happy to inform you that many of our doctors have been reading this series regularly and have improved their understanding of this common disease. You have covered a lot of issues. What about very advanced cases i.e. stage 4 breast cancer? Can we cure any of them?

Answer: Important issue. As you know, many of our patients are still diagnosed in stage 4, and many relapse after initial treatment and go on to stage 4. First of all, however, I would like to clarify that stage 4 does not mean end of road.

This is a very heterogenous group of people. Technically anyone with a cancer that has spread outside of breast and regional nodes has stage 4 disease. But a patient with only a few bone metastases may live for several years, whereas one with many brain metastases may not survive few months.

With available treatment options, there are rare patients who are completely free of disease or live for over 5 years even after diagnosis of stage 4 disease.

Que: Oh! I always thought that stage 4 means few months survival and nothing will work. And that there are subsets of stage 4?

Ans:.Yes. This is true for every cancer to some extent, but the variation is extreme in case of breast cancer.

Que: So how do you treat stage 4 breast cancer patients?

Ans: Goal setting here is very important. Since this is rarely a curative treatment, goal is to provide symptom free period mainly, and extend survival to some extent. Therefore, hormonal therapy when ER/PR test is positive is the treatment of choice, and as we have seen earlier, now there are many options.

In fact, patients with few metastases and no symptoms are frequently left alone without treatment and only close observation, that too mainly clinical observation. Remember the goal is to make patient symptom free and if there are no symptoms, there is often no reason to treat for many months!!

Next group of drugs is targeted therapies like Herceptin, Avastin, Lapatinib etc, however they are very expensive. But when feasible, they are useful and well tolerated.

Last option is chemotherapy, where more than 10 drugs are available which can be used in many different ways, from weekly to 4 weekly, alone or in many different combinations. In general, single drug should be given rather than a combination of chemotherapy drugs. Oral medicines are also available. Duration of therapy is generally 4-6 months at a time with chemotherapy, and then there is a break period, until relapse of significant symptoms or impending risk of serious symptoms.

Once again I would like to stress that metastatic or stage 4 cancer is largely incurable and we can provide some reasonable quality of life. But early diagnosis, and good postoperative therapy to prevent stage 4 cases is the best strategy. That is why we stress so much on proper evaluation by all related specialities at first diagnosis of breast cancer, to decide right strategy for each and every patient.


Dr. Chirag A. Shah; M.D. Oncology/Hematology (USA),
Diplomate American Board of Oncology and Hematology.
Shyam Hem-Onc Clinic. 402 Galaxy, Near Shivranjani, Opp Jhansi ki Rani BRTS, Ahmedabad. 079 26754001