ABC of Breast Diseases: Metastatic breast cancer

Few other cancers when they metastasise have such a variable natural Xt $ course and effect on survival as breast cancer.Patients with hormone sensitive cancers may live for several years without any intervention 19 other than various sequential hormonal manipulations.In contrast, 15 patients with disease that is not hormone sensitive have a much shorter interval free of disease and shorter survival, reflecting the more 10 o aggressive biology of hormone independent cancers.The average 8 period of survival after diagnosis of metastatic disease is 18-24 months, but this varies widely between patients.Clinical patterns of relapse predict future behaviour.Patients with a long interval without disease (more than two years) after primary ~~~~d iagnosis and favourable sites of recurrence (such as local lymph nodes i. a0, '~.~~.,..~and chest wall) survive longer than patients with either a short interval .~~~~~~~~without disease or recurrence at other sites.Patients with visceral Median time of survival associated with sites of disease have the poorest outlook; these patients tend to have a short metastasis in patients with breast cancer.interval without disease and have cancers that are biologically more aggressive. Treatment of metastatic diseaseHormonal treatment of metastatic breast cancer Premenopausal women A patient may present with metastatic * Oophorectomy breast carcinoma or develop a systemic * Radiation menopause recurrence after treatment for an apparently * Gonadotrophin releasing hormone analogues localised breast cancer.The aim of treatment * Other treatments as for postmenopausal women is to produce effective control of symptoms with minimal side effects.In terms of drug Postmenopausal women treatment this ideal is only achieved by * Tamoxifen (or pure antioestrogen when available) hormonal treaunent in the 30% of patients * Aromatase inhibitors (such as aminoglutethimide and whose cancers respond to such drugs.There 4-hydroxyandrostenedione is no evidence that treating patients with * New oral aromatase inhibitors (currently in clinical trials) asymptomatic metastases improves overall * Progestogens (such as medroxyprogesterone acetate and megestrol survival, and chemotherapy should be given acetate) routinely only to symptomatic patients.Antioestrogens, aromatase inhibitors, and progestogens may be used in virtually any sequence in responsive patients.Radiographs showing metastatic lesions in humerus (left) and changes after course of hormonal treatment with consequent reduction in bone pain (right).