How Do I Know If My Advanced Breast Cancer Therapy Is Working?

In In The News by Barbara Jacoby


Knowing if your current therapy treatment is truly doing everything it can to beat your breast cancer is, well, difficult to say the least. Here are some things to think about or consider.

What are the symptoms of metastatic cancer?

It’s not always easy to tell if cancer is progressing, despite treatment. That’s because it doesn’t always cause new symptoms right away.

Some very general symptoms of breast cancer metastasis are:

  • fatigue
  • loss of appetite
  • numbness
  • weakness
  • weight loss

What complicates matters is that some of those same symptoms could be bad side effects of treatments such as:

  • chemotherapy
  • hormone therapy
  • targeted treatments
  • radiation

Breast cancer can spread anywhere in the body. The most common sites are bones, brain, liver, and lungs. The symptoms you have will depend on where the cancer has spread and how large the tumors are.

If you have trouble urinating, for example, it could mean that a tumor is pinching the nerves in your back. Here are some other symptoms of new metastasis by site:

  • Bone: You might have progressive sharp or dull pain in your bones and joints. There could also be some swelling. Bone fractures and compression of the spine are also signs of bone metastasis.

When bones are damaged by cancer, they can release calcium into your blood. This is known as hypercalcemia. Some symptoms of hypercalcemia are nausea, constipation, thirst, irritability, sleepiness, and confusion.

  • Brain: Symptoms may include headaches, dizziness, vision problems, loss of balance, nausea, or vomiting. There could also be changes in personality or behavior, confusion, or even seizures.
  • Liver: Abdominal pain, especially on your right side, could mean that cancer has reached your liver. Other indicators are abdominal bloating, loss of appetite, nausea, vomiting, itchy skin, rash, and jaundice, which causes yellowing of your skin or eyes.
  • Lungs: Shortness of breath, chronic cough, coughing up blood, chest pain, or chronic chest infections could be due to tumors in your lungs.

Report these and other new symptoms to your doctor right away.

How will we keep tabs on treatment?

With some treatments, you know fairly quickly that they’re failing. It can take months to evaluate others. In advanced breast cancer, a treatment that has worked well for some time can suddenly become ineffective.

That’s why you and your oncology team both play a vital role in assessing the effectiveness of your treatment.

Your role is to follow treatment guidelines and keep your doctor up to date on new or worsening symptoms. If you have any concerns at all — even if you think they’re minor — don’t dismiss them. Good communication is key.

While in treatment, your doctor will monitor signs and symptoms, perform physical exams, and run a few tests. How often you’re seen and tested will depend on areas of known metastasis and the type of treatment you’re getting.

If a new metastasis is suspected, there are a number of tests to help determine if that’s the case. Among them are:

Blood tests

Blood tests are commonly used to monitor treatment. Tumor markers in your blood can indicate disease progression and help make treatment decisions.

Blood chemistry tests can give your doctor an idea if certain organs are functioning well, and can measure:

  • liver enzyme levels, including bilirubin, to assess liver function
  • potassium, chloride, and urea nitrogen levels to evaluate liver and kidney function
  • calcium levels to test bone and kidney health

If blood chemistry results are questionable, imaging tests can help determine if cancer has spread to a new area.

Imaging tests

  • CT scan or MRI scan: Scans of your head, chest, abdomen, or pelvis can be helpful in spotting cancer that has spread to your brain, lungs, or liver. They can also detect cancer in your spine.
  • X-ray: This simple imaging test can give your doctor a closer look at specific bones, your chest, or your abdomen.
  • Bone scan: If you’re experiencing bone pain in multiple areas, a full-body bone scan is a good way to see if cancer has spread to bone anywhere in your body.
  • PET scan: This test is good at finding cancer that has spread to lymph nodes and other parts of your body.

Other tests

  • Bronchoscopy: This is a procedure in which a thin instrument called a bronchoscope is inserted down your throat and into your lungs. The instrument has a tiny camera on the end so your doctor can check for signs of cancer.
  • Biopsy: A sample of suspicious tissue can be analyzed under a microscope to determine if it’s cancerous.

Deciding on the next steps

The main goals of advanced breast cancer treatment are to prolong life and keep symptoms managed. If your current treatment is working, you can continue with it indefinitely.

If your current treatment isn’t working, there’s no reason to continue. Talk to your doctor about what other treatments might be appropriate. Keep these points in mind:

  • your treatment goals
  • how another treatment could be expected to work
  • how treatment will be administered and monitored — and how all that fits into your life
  • the balance of potential benefits to potential side effects
  • if and how side effects can be effectively managed
  • your overall quality of life

You might also want to discuss the possibility of entering a clinical trial for advanced breast cancer. If you meet the eligibility requirements, you may have access to new and experimental treatments your doctor can’t offer.

Ask questions and let your wishes be known.

When you’ve tried all treatment options and your cancer is still progressing, you may decide to stop treating the cancer.

If that’s your choice, you can still receive palliative care. That would include pain management, as well as help with other symptoms. Your doctor can provide further information on home health care and hospice programs to help you and your family cope.