Whether you have just recently been diagnosed with stage IV breast cancer, or you are just now recovering from the shock, you are certainly filled with bewilderment and confusion with all of the information that has been thrown at you in such a short period of time. The moment you first heard those words was a huge turning point, and perhaps a defining moment that cut your life into half: the half before cancer and the now. Nobody can tell you they know exactly how you feel, but the fact that you found this article says that you certainly do not feel like giving up. It may even be possible that it is not you who has the cancer, but someone who you care deeply about. Regardless of your reason for stopping here, the following information is intended to try to clear up a bit of your confusion and offer you hope, in a very straight-forward and unflowered sort of manner.
What Does Stage IV Breast Cancer Mean?
Cancer is staged using a series of seemingly foreign codes of numbers and letters that come from your pathology reports. To you, this code may seem random and very confusing, but to your cancer care team, the code has a very specific meaning that results in your particular stage.
The TNM system (which stands for Tumor, lymph Nodes, and Metastasis) is the classification system that helps your cancer care team define the tumor size, determine how the cancer is affecting your lymph nodes, and describe whether the cancer has spread beyond.
A tumor is designated with a code of T1, T2, T3, or T4. T1 through T3 designate the tumor size, while a T4 tumor is any cancer that has metastasized into your chest wall or skin. T1 measures up to two centimeters; T2 refers to any cancer that is more than two centimeters, but less than five centimeters; and T3 is any cancer that is more than five centimeters.
The classification for lymph node ranges from N0 through N3 and describes how many lymph nodes are affected. N0 means that no lymph nodes are affected; N1 means that the cancer has spread to anywhere from one to three lymph nodes; N2 means that more than three but less than ten lymph nodes are affected; and N3 means that the cancer has spread to more than 10 lymph nodes.
Metastasis (or "M" in the TNM system) is rated with either M0 (meaning that the cancer has not spread to any other organs) or M1 (meaning that the cancer has spread to lungs, liver, bones, or other locations in the body.
If you have stage IV cancer, it means that you have any number in the tumor group, any number in the lymph nodes group, and you have the only stage in which metastasis (spreading) has occurred.
It is almost impossible to research breast cancer and not eventually come across some survival rate statistics. I'm sure that by now you have seen several different types of statistics and may be concerned about the numbers or confused about the terms and variations. It is important that you get a little bit of an idea of how these statistics are gathered and what the results mean.
Survival rates are statistics that tell you how many or what portion of people with the same type and stage of breast cancer are still alive after a certain amount of time (usually 5 - 10 years) after their initial diagnosis. It is important to note that statistics are not a definite guide for prognosis, but merely a record of past or current survival. They do not always take the same factors into account when they are compiled. For example, age, other health issues, and lifestyle choices can severely affect these numbers.
The American Cancer Society lists a very basic statistic for people with any type of cancer. Their 5-year survival rate is based on the percentage of people who survived at least 5 years after diagnosis. Their general statistics state the following:
- Women who were diagnosed with stage 0 or stage I breast cancer had a 5-year survival rate of 100%;
- Women who were diagnosed with stage II breast cancer had a 5-year survival rate of about 93%;
- For the women who were diagnosed with stage III breast cancer, the 5-year survival rate is about 72%;
- Stage IV (or metastatic) breast cancer had a 5-year survival rate of about 22%.
Please remember that these statistics are only estimates and do not definitively predict what will happen to all women with late stage breast cancer. This survey was presented in 2016 and many advances may have improved this rate since then. This statistic is not to tell you that you are doomed to the remaining 78%, but more of a benchmark that tells you and your health care providers how aggressive you all must be so that you can prepare for this long and hard fight.
Should You Get a Second Opinion?
There are many valid reasons why you might want to get a second opinion. Maybe you are a patient in a small-town hospital and you have concerns about the skill-level in the pathology lab. Perhaps your private physician seemed a little skeptical or concerned about the conclusions he drew from one of your tests. Sometimes, a pathology report can raise more questions than it provides answers for. If your physician seems as confused as you are, or indicates that the result seems inconclusive, then you may want to seek a more thorough oncologist or higher-trained pathologist.
Highly trained and specialized pathologists are acutely aware of the many complexities that are involved in breast cancer pathology. Many people are surprised to learn that breast cancer can manifest in a vast number of variation and is not as simple as a yes or no answer. Someone who has spent a large majority of their medical profession reading, researching, studying, and interpreting breast cancer pathology reports may be better skilled at reading “between the lines” than your private physician who is limited to only a few initial cases each year.
If you have a close connection with your physician, it may be natural to feel a little reserved about asking them for a second opinion. It is important to remember that at the end of the day, you and your family are the ones who have to live with your medical decisions. Don’t feel bad about asking your physician to recommend a cancer specialist. You have a very long and hard fight ahead of you and you need the strongest and best-suited allies that you can find. Chances are if your physician is anywhere worth his or her oats, they will recommend a second opinion, anyway.
National Cancer Institute www.cancernet.nci.nih.gov
The National Cancer Institute web site has some of the most recent cancer information and news from the National Cancer Institute. This agency is headed by the U.S. Department of Health and Human Services.
American Cancer Society www.cancer.org
With over 2 million volunteers and over 3,000 local chapters, the ACS works endlessly to end cancer through prevention, saving lives, education, and advocacy.
Cancer Care, Inc. www.cancercare.org
This nonprofit organization began in 1994 to offer emotional support, information, practical help, and additional support to help people with all types of cancer and their loved ones find hope and live full lives after a diagnosis.
Ricks, D. (2005). Breast Cancer Basics and Beyond. [Book]. Hunter House, Inc., Alameda: California.