Caitlin Whyte (Host): Today, we are answering all of your questions about metastatic breast cancer with oncologists Dr. Paige Ganem.

This is Flourish, a podcast brought to you by Prisma Health. I'm Caitlin Whyte. Well, doctor, today we are talking all about metastatic breast cancer. My first question for you is what does it mean to be diagnosed with metastatic breast cancer?

Dr. Paige Ganem: So, metastatic cancer in general, not specific just to breast, means that the cancer has spread from the site where it originated. So, for example, in breast cancer, the tumor starts in the breast. It typically spreads through the path of the lymph nodes. And then, it is found to be metastatic when it is in another organ. So, that can be really anywhere else in your body. But that's kind of the definition of metastatic cancer. It's also what we reference when we say stage IV cancer. So, they kind of go hand in hand, meaning the same thing.

Host: All right. Thank you for that. So, where does breast cancer then usually spread to if it does spread?

Dr. Paige Ganem: The most common locations that breast cancer spreads to tend to be lungs and liver as your solid organs. It can go to your bones. And then, breast cancer is a big term for multiple different types of disease. And sometimes the subtype has a propensity to go to a specific organ more than others. So, the brain, for example, some breast cancers are more likely to go there than others. But really, breast cancer can spread anywhere.

Host: Wow. All right. And are there any signs that breast cancer has spread?

Dr. Paige Ganem: They can be somewhat nonspecific and very dependent on the organ in which the cancer has spread to. So if it is in your lungs, you may have a cough or shortness of breath. If it is in your liver signs of kind of general malaise, feeling tired, your energy level being impacted. If it's impacting the function of your liver or blocking ducts in your liver, you can have what we call jaundice, which is yellowing of the skin and eyes. If it is in your bones, there can be pain. So, there's a variety of symptoms that can happen. And a lot of them mimic normal things that people's bodies can go through. You know, if you're having hip pain in your 60s, that may not at all be pathologic or bad. That can be something very common. And so, it kind of takes a full evaluation and picture to kind of really narrow in on a specific concern, because some of this stuff can be really nonspecific.

Host: Yeah, of course. Well, let's talk about treatment. Is metastatic breast cancer treatable, and what is the survival rate there?

Dr. Paige Ganem: It is absolutely treatable, though I hesitate to say that we can cure somebody that's metastatic. Our goal in this stage of treatment becomes controlling as best we can, shrinking the tumor away. There are times when these cancers that were metastatic are not present on scans when we check going through treatment, but we don't generally have a stop point in mind with metastatic cancer like we do with earlier stages. So generally, it involves a lifelong commitment to treatment, and it's really hard to tell you the statistics for survival in metastatic breast cancer, because in the last five to ten years, the amount of therapy options that we have has exploded. I mean, I don't have a better way to say it other than we have so many more options than we did.

But like I mentioned a little bit earlier, there are multiple forms of breast cancer, and what's really important in choosing our treatment is knowing the makeup of each individual's tumor. So, there's different receptors we look for. You may have heard of hormone receptors or HER2 receptors or even triple-negative, which means the breast cancer doesn't express any of the receptors that we have a targeted medicine to. So, treatment very much depends on the type of cancer you have, and we have women living, I mean, years, up to 10, 20 years with metastatic breast cancer if they respond to medication. So, it's very individualized, and it's very individual in terms of what a person's prognosis looks like.

Host: Of course. Well, how about if a person with metastatic breast cancer wants to continue to work? Do you have any advice on how to do that?

Dr. Paige Ganem: I advise you to continue to live your life as you're living it before cancer. Now, going through treatment, you may have side effects, you may have symptoms, you may be tired, and you may need to take a break, and I think that is perfectly okay. But I encourage all of my women and even men who have breast cancer to try to continue to live their life and work.

Now if you're work is significantly impacted, that's a conversation we have. However, there is no reason you cannot continue to work or live your life just because you have a diagnosis of metastatic breast cancer.

Host: And wrapping up here, what is your best advice for someone with metastatic breast cancer?

Dr. Paige Ganem: I think it's really important to keep in mind the goal that is most important to the patient. In addition to being aggressively treating a cancer that we know is there, we also need to be mindful of how is this treatment making them feel? How is it impacting their quality of life? Because since this is not a curable disease, there does need to be regular check-ins about, you know, is what we're doing still reaching the most important goal to you at that point in time?

And so over time, that can change for patients, and that can be very different for a 40-year-old woman compared to an 80-year-old woman. At some point, age is just a number. But in the same vein, you know, there's different priorities in life, and it's really important to me to make sure that I am not just continuing to treat a cancer, but I am treating a person, and there's a lot more going on in a person's life that's really important in addition to doing everything we can to treat a cancer. So, leaning on your community and your support system, whether that's family, community, church. Just using all of your resources to get through this really tough thing that you'll be going through, but also making sure that your doctor knows what's important to you.

Host: Absolutely. Well, some really important things to consider here. Thank you for all the work that you do, doctor. For more information and other podcasts like this one head on over to prismahealth.org/flourish. This has been Flourish, a podcast brought to you by Prisma health. Thanks for listening. I'm Caitlin Whyte.