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According to the American Cancer Society, about 1 in 8 women are likely to develop invasive breast cancer during their lifetime. One of the common causes of cancer deaths worldwide, breast cancer can develop in the ducts that carry milk to the lobules. Under such circumstances, it is referred to as ductal cancer. It is referred to as lobular cancer, when it begins in the cells that line the lobules (glands that make milk). It commonly affects women in the age group of 45-55.

The American Cancer Society estimates that about 60,290 new cases of carcinoma in situ (CIS), i.e., non-invasive breast cancer, and 231,840 new cases of invasive breast cancer will be diagnosed in women in 2015. Though the number of cases has declined due to increased awareness about the risk factors and the availability of screening tests, there's a dire need to make consistent efforts to make women aware about the importance of early detection of this condition. This is to facilitate treatment in the early stages, wherein the life expectancy and survival rate is greater, in comparison to the final stage.

Staging and Metastatic Breast Cancer

Breast cancer is divided into four stages:

• The pre-cancer stage is referred to as Stage 0.
• The first stage is divided into Stage IA and Stage IB.
• The second stage is divided into Stage IIA and Stage IIB.
• The third stage is divided into Stage IIIA, Stage IIIB, and Stage IIIC.
• The fourth stage or Stage IV is the final stage.

Breast cancer is categorized as per the TNM classification. While T (followed by a number from 0 to 4) describes the size of the tumor and spread of the cancer to the skin or to the chest wall under the breast, N (followed by 0 to 3) indicates whether the cancer has spread to lymph nodes near the breast. M (followed by a 0 or 1) indicates whether the cancer has metastasized or spread to distant organs. M1 indicates that the cancer has spread to distant organs or to lymph nodes far from the breast. It is only in the fourth or final stage that the cancer spreads to distant organs.

So, the fourth stage is the most advanced stage. Metastasis is the condition in which the cancer cells spread from the original tumor site, i.e., from the breast to different regions of the body. These cells can travel through the lymphatic system and blood vessels, and take root in almost any part of the body. Regional metastases normally spread to the areas surrounding the breast, whereas the distant metastases may reach up to different organs like the bones, lungs, and the liver.

Bone Metastases

There are primarily two types of bone cancer that account for nearly 25% of the metastatic breast cancer: osteolytic and osteoblastic. Osteolytic cancer affects the bones, thereby causing holes to form, which in turn increases the risk of fractures. Osteoblastic cancer increases the density of the bones, but also makes them prone to fractures. It must be noted that both the forms of bone cancer cause severe pain.

Lung Metastases

It occurs when the cancer cells start growing within the lungs. This can lead to symptoms such as shortness of breath, chest pain, blood-tinged sputum, cough, weakness, and weight loss. The lung metastases account for 60-70% of deaths associated with this cancer.

Liver Metastases

It mainly occurs in two-thirds of metastatic breast cancers when the cancer cells starts to multiply within the liver tissues. In later stages, the liver could swell up. The patient is likely to experience symptoms such as nausea, jaundice, loss of appetite, dark-colored urine, abdominal swelling, pain in the upper right quadrant of the abdomen, etc.

Prognosis and Survival Rate for Breast Cancer

The prognosis for stage IV breast cancer mainly depends on the location of tumor, extent of metastasis, type of organ affected, the period between the relapse, i.e. (period between the initial treatment and the relapse), etc. The life expectancy of a breast cancer patient is dependent on the type of treatment received.

According to the National Cancer Institute's SEER database, the 5-year survival rate for the four stages is:

Stage 0: 100%
Stage I: 100%
Stage II: 93%
Stage III: 72%
Stage IV: 22%

The five-year survival rate of a patient diagnosed with stage IV breast cancer is nearly 22%, which is quite low in comparison to other stages. Studies suggest that the life expectancy for metastatic breast cancer in women is 2 to 3 years, but about 25-30% of these patients live for 5 years, and 10% do survive even after 10 years.

Research suggests that the 5-year survival rate for women detected with breast cancer is about 80%, and approximately 88% of women who have been diagnosed in the early stages survive longer (around 10 years).

According to American Cancer Society, women who are diagnosed with breast cancer before the age of 40 have slightly poorer prognoses than older women: Their five-year survival rate is about 82%, whereas women in the age group of 40-74 years have a survival rate of 85%.

Symptoms, Diagnosis, and TreatmentScaling or itching (called pruritus) on the nipple .Development of a breast lump and breast ulcer.Sudden increase in the mature breast size.Continuous itching in the skin of the breast.Change in color and texture of areola (dark pigmented area surrounding the nipple).Sudden discharge from the nipples.Bone fractures and bone pain.Regional pain and weight loss

Diagnosis and Treatment

The patient has to undergo a staging process which may include tests like clinical breast exams, biopsy, and imaging tests such as a chest X-ray, mammogram (X-ray film of the soft tissue of the breast), bone scan, CT scan, and MRI scan for determining the size and location of the cancer.

The treatment mainly focuses on providing relief and extending the life expectancy. However, in the fourth stage, it's impossible to destroy all of existing cancer cells. The treatment involves shrinking the existing tumors, or making attempts to slow down the growth of cancer cells in the breast and regions to which the cancer has metastasized.

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