Surgeon offers answers on metastatic breast cancer

By Shahreen Abedin
CNN

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(CNN) -- In light of Elizabeth Edwards' recurrent breast cancer, CNN Medical News producer Shahreen Abedin spoke with Dr. Rache Simmons, breast surgeon at the New York-Presbyterian Weill-Cornell Medical Center's Breast Cancer Center. Dr. Simmons has never treated Elizabeth Edwards, so the answers she gives are mainly about metastatic breast cancer in general, unless otherwise specified.

CNN: What are survival rates for Stage IV metastatic breast cancer?

Dr. Rache Simmons: It depends on where the cancer is located. Patients can do very well for years if it's isolated just to the bone. If there is a speck on the lungs or other organ that turns out to be cancer, that could mean a much worse prognosis, a much shorter life expectancy.

The bone is often the first place to spread to with breast cancer. Most breast cancer systemic recurrences (meaning the kinds that spread to the rest of the body) happen in the next two years after the first time the cancer is diagnosed. The next plateau is within five years. After that, it's very rare to have recurrences. However, recurrences do still happen, even as late as 10 years later. But that's very unusual.

For patients with small cancers and negative lymph nodes with no evidence of disease spread at the time of diagnosis, still about five to 10 percent of women end up developing metastatic disease.

If the recurrence happens later in the five-year period after diagnosis, rather than earlier, that's a good sign; the patient will probably have a better response to the treatments. If the recurrence happens very soon after diagnosis, like six months, a year, or 18 months, then patients tend to do worse.

CNN: What would the standard treatment be once recurrence is diagnosed?

Simmons: Probably hormonal therapy. Mainly anti-estrogen types of treatments -- like Tamoxifen or aromatase inhibitors. Sometimes chemo is an option, either in addition to or instead of hormone therapy.

Sometimes radiation therapy to localized area, especially if the patient is in pain.

To find it accidentally, when the person is having no pain, is a very lucky thing. Usually what happens is a patient develops a pain and then gets X-rays -- and then they find it.

CNN: What does it mean when it's "low-volume" amounts of cancer in the bone?

Simmons: It means the patient probably will respond to treatment better. If it's found at the stage where it's spread throughout the body, it's less optimistic.

CNN: How does this affect quality of life?

Simmons: Usually people respond to medications with bone cancer. They can have a very decent quality of life for years.

CNN: Why is surgery usually not an option in metastatic breast cancer?

Simmons: There wouldn't be any benefit in going in and taking out that area. Many cells with cancer are probably located throughout her system. If you remove cells from one area, chances are, another cell will grow elsewhere. It's much more effective to treat systemically. Plus, it's hard to go in and remove cells from the bone.

CNN: Why is metastatic breast cancer considered incurable?

Simmons: With patients with Stage IV disease, they will always have breast cancer. But you could live 10 years with it. And if the treatment medications improve, the outcomes may be even better.

CNN: What is the likelihood of the metastatic cancer spreading to the lungs or other organs?

Simmons: Typically it spreads to bone, lungs, liver, and brain. If it's contained within the bone -- which is the case with the majority of patients -- they can do very well. When it goes to other organs, patients usually don't do as well for long, generally speaking. But the likelihood of spreading is very individualized, so we can't say what the likelihood of it spreading for Elizabeth Edwards would be.

CNN: What other tests are usually done to decide which treatment to try?

Simmons: Doctors will probably want test to see whether the cancer cells in the bone are estrogen-receptor positive, to see whether anti-estrogen medications would work much better. And they will probably test for other tumor markers to let them know what medications would be beneficial.

CNN: Elizabeth Edwards had a pain in her left side -- a fracture -- could that have something to do with the cancer?

Simmons: The two could be totally unrelated. Or it could be that there's a cancer that they can't yet see there.

CNN: What is the likelihood that some of the medications she takes will make her tired?

Simmons: It depends on what meds. If a patient takes mainly hormonal drugs -- patients usually feel good with those drugs. If they are taking chemo drugs -- that depends on how it's tolerated.

CNN: Does late-life pregnancy increase risk of this type of cancer?

Simmons: No.

CNN: How much can Elizabeth Edwards be expected to campaign while receiving treatment?

Simmons: For patients who become metastatic, the prognosis depends on where it presents. Eventually, most likely, they will die from the breast cancer. So it's a matter of how long they live, and how good is their quality of life.

Shahreen Abedin is a producer with CNN Medical News.