Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatmentPrognosisCopingA Word From Verywell
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Prognosis
Coping
A Word From Verywell
De novo metastatic breast cancer (also known asStage 4breast cancer) is a relatively rare breast cancer. It is generally considered incurable as it has already spread to other parts of the body at the time of diagnosis. However, advances in treatment options can improve and prolong the lives of patients.
According to the American Cancer Society, de novo metastatic breast cancer (MBC) accounts for approximately 6% of cases of U.S. women diagnosed with breast cancer.
What Is De Novo?“De novo” indicates that the cancer is the first diagnosis, not arecurringcancer.
What Is De Novo?
“De novo” indicates that the cancer is the first diagnosis, not arecurringcancer.
Where Breast Cancer Can Spread
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Symptoms of De Novo Metastatic Breast Cancer
If you have had these symptoms for some time, speak with your doctor so they can help you figure out the cause of your symptoms and make a diagnosis.
The signs and symptoms may depend on which areas the cancer has spread to. The most common site of metastasis (where the cancer has spread) for de novo MBC is the bones (40%–75% of patients), while the least common site is the brain (less than 5%). Over time, 75% of patients will develop metastases to other organs in addition to when they are first diagnosed.
Here is a chart describing the associated symptoms with each possible site of metastasis:
What Are the Symptoms of Metastatic Breast Cancer?
Other reasons that patients may be diagnosed with de novo MBC is if they delay seeking medical care despite experiencing symptoms of breast cancer. A 2019 study showed that the top reasons that women delayed seeking treatment include:
Why People Are Noncompliant with Treatment
While the exact cause of de novo MBC is unknown, potential risk factors for breast cancer in general include:
Further tests may be conducted to determine where the cancer has spread. Screening and tests may differ based on what symptoms are present and the likely site the cancer has metastasized to. Paying close attention to any symptoms and changes in symptoms can help your doctor determine the appropriate screening tools to confirm a diagnosis.
The fact that de novo MBC can be spread to any organ and body system means that a systemic treatment approach is needed.Treatment will be tailored according to the specific metastatic location. For example, Xgeva (denosumab) may be added to the treatment scheme for bone metastases.
As always, method of treatment depends on the goals of the patient and family. The goals of care must balance potential control of cancer while managing symptoms and maintaining the highest quality of life.
Cancer Control
There is some controversy over whether patients should have surgery for de novo MBC. In one study, surgery significantly improved the overall five-year survival rate for patients. However, it is unclear if the surgery provided the benefit.
Unless the tumor is causing the patient a great deal of physical discomfort, surgery is generally not recommended for patients with de novo MBC since the cancer cells have already spread to other parts of the body.Generally, surgery for patients with de novo MBC has declined over the years.
Depending on where the cancer has spread to, systemic treatments may be recommended, includinghormone therapy,chemotherapy,targeted therapies, andimmunotherapy. While some families may desire the continuation of anticancer treatment, it’s important to continue communicating with the patient and assessing the situation.
Treatment Options for Metastatic Breast Cancer
Despite the number of patients who continue to receive anticancer therapy toward the end of life, there is often no benefit to survival of continuing systemic treatments two weeks before the end of life. Sadly, many patients who continue receiving chemotherapy (cancer-fighting drugs) toward the end of life generally delaypalliative care(symptom relief) andhospice(end-of-life care) and are only admitted within three days of death.
The Difference Between Hospice and Palliative Care
Symptom Management
There are many strategies for managing symptoms. It’s important to accurately describe the symptoms to your doctor so that you can be treated accordingly. This includes describing the type of symptoms, the location and duration of pain or other symptoms, and how they interfere with your daily life. Managing symptoms can help a patient prolong the best quality of life throughout the duration of treatment and when treatment is discontinued.
Here is a chart describing some of the most commonly reported symptoms and management strategies:
SymptomTreatmentPainOpioids, adjuvant (after initial treatment) analgesics such as antidepressants and anticonvulsants, topical anesthetics, glucocorticoids for pain related to inflammation, nonsteroidal anti-inflammatory drugs and acetaminophen, radiation therapyFatigueRegular physical activity, cognitive behavioral therapy, psychostimulants and antidepressants, energy conservation strategies, distractions such as music, games, or socializing, adequate sleep, massageDepression and anxietyAntidepressants, anxiolytics, psychosocial support such as group counseling and cognitive behavioral therapyDifficulty sleepingCognitive behavioral therapy, complementary and alternative medicine (CAM) therapies such as aromatherapy, expressive therapy, expressive writing, healing, massage, muscle relaxation, mindfulness-based stress reduction, and yogaLymphedemaManual lymph drainage, compression garments, remedial exercises, and skin care, laser therapyLocal recurrenceSurgery and/or radiation, systemic therapyDifficulty breathingOpioids, oxygenBone metastasisOpioids, corticosteroids, bone conserving drugs, nonsteroidal anti-inflammatory drugs (NSAIDs), surgery, or radiation therapyGastrointestinal symptomsNausea, vomiting, and anti-inflammatory medication, stool softener or bulking agents, nutrition counseling, appetite stimulants, or diureticsPrognosisWhile de novo metastatic breast cancer is generally considered incurable, the prognosis has improved significantly with advances in treatment options. Unfortunately, it is unclear which treatment patterns or factors, independently or combined, has the best prognosis.Generally, the goal of treatment for de no novo MBC is to improve and prolong quality of life.While the prognosis continues to be poor, over the past few decades, the overall five-year survival rate has increased from 20% to 40%.Many studies researching what may impact prognosis are conflicting and inconclusive. Possible factors that may contribute to impact overall survival rate (OS) include:Presence of hormone receptor positive and HER2+ tumors improve OSSurgical removal of the primary tumor improves prognosis for some womenHigher socioeconomic status improves OSEthnicity (Asian women have higher OS, African American women have lowest OS)Older age decreases OSLack of insurance decreases OSMore research is needed to understand the best treatments and factors that may influence prognosis for de novo MBC.Metastatic Breast Cancer PrognosisCopingPatients diagnosed with de novo metastatic breast cancer may experience many concerns that require social, psychological support, support groups, and counseling. These normal and common concerns include:Fear of dyingDeclining quality of lifeDistressing side effects of treatmentDecreasing physical ability and the ability to care for familyInability to maintain relationshipsDisagreement with family about care at the end of lifeIt is critical to have ongoing conversations with the patient and patient’s family to ensure these social and psychological supports are met and to help families navigate through a very difficult time.Your healthcare team can help connect you and your family with social and psychological support systems to help you through your diagnosis, treatment, and any end-of-life decisions.End of Life Concerns With Metastatic Breast CancerA Word From VerywellReceiving any cancer diagnosis can be surprising, distressing, and devastating, especially an advanced stage cancer.If you’ve been diagnosed with de novo metastatic breast cancer, speak with your healthcare provider to discuss your options moving forward. You may also want to discuss your plan with family, therapists, or other professionals before making decisions. You should continue to monitor your symptoms and update your healthcare team on any changes you experience.
While de novo metastatic breast cancer is generally considered incurable, the prognosis has improved significantly with advances in treatment options. Unfortunately, it is unclear which treatment patterns or factors, independently or combined, has the best prognosis.Generally, the goal of treatment for de no novo MBC is to improve and prolong quality of life.
While the prognosis continues to be poor, over the past few decades, the overall five-year survival rate has increased from 20% to 40%.
Many studies researching what may impact prognosis are conflicting and inconclusive. Possible factors that may contribute to impact overall survival rate (OS) include:
More research is needed to understand the best treatments and factors that may influence prognosis for de novo MBC.
Metastatic Breast Cancer Prognosis
Patients diagnosed with de novo metastatic breast cancer may experience many concerns that require social, psychological support, support groups, and counseling. These normal and common concerns include:
It is critical to have ongoing conversations with the patient and patient’s family to ensure these social and psychological supports are met and to help families navigate through a very difficult time.
Your healthcare team can help connect you and your family with social and psychological support systems to help you through your diagnosis, treatment, and any end-of-life decisions.
End of Life Concerns With Metastatic Breast Cancer
Receiving any cancer diagnosis can be surprising, distressing, and devastating, especially an advanced stage cancer.
If you’ve been diagnosed with de novo metastatic breast cancer, speak with your healthcare provider to discuss your options moving forward. You may also want to discuss your plan with family, therapists, or other professionals before making decisions. You should continue to monitor your symptoms and update your healthcare team on any changes you experience.
13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
American Cancer Society.Cancer Facts and Figures.
National Cancer Institute.NCI Dictionary of Cancer Terms.
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