Advanced breast cancer cancer has spread beyond the breast to other parts of the body. Most women are diagnosed before this stage. Locally advanced breast cancer: Cancer has spread into the surrounding area such as lymph nodes, skin or the chest muscles but not spread to other distant parts of the body. Secondary breast cancer: Also called: Metastatic breast cancer Advanced breast cancer Stage 4 breast cancer Cancer has spread to distant parts of the body such as liver, brain or bones. Clinical features of advanced/metastatic breast cancer: Vary depending on the affected body part. Bone metastasis: Dull, persistent ache or pain in the bone. May get worse during movement. May make it hard to sleep at night. Though can spread to any bone, common sites: Ribs Spine Pelvis Upper bones of the arms. Legs Liver metastasis Loss of appetite Weight loss Tiredness Pain in the URQ Bloating Swelling in the abdomen Lung metastasis Shortness of breath Dry cough Chest pain Feeling of heaviness in the chest Brain metastasis Persistent headache Change in the part of the body controlled by a specific part of the brain such as: Weakness in a particular limb Blurred vision Nausea Vomiting Seizures Important to note that the above may not to related to breast cancer and my be related to something else such as bone pain due to arthritis, cough as a sign of cold or flu etc. Management of advanced breast cancer: Chemotherapy Can be neoadjuvant to shrink to tumor before surgery or adjuvant after the surgery to reduce recurrence. E.g. anthracyclines -> interfere with DNA replication and cell division. Taxanes -> stabilise microtubules-> disturb cell division 5-flurouracil Radiotherapy Adjuvant Locally advanced/inoperable tumours Palliative setting Hormonal therapy E.g. tamoxifen -> selective estrogen receptor modulator (SERM) -> blocks estrogen from binding to estrogen receptors. Aromatase inhibitors -> blocks aromatase -> prevents conversion of androgens into estrogens. Goserelin -> this is a LHRH agonist -> suppression of ovarian function -> decreased estrogen production. Targeted therapy such as: Targeting specific proteins such as HER2 protein e.g. Trastuzumab -> HER2 inhibitor. Surgery Palliative surgery Relieved symptoms Local control surgery Chest wall resection Skin resection Axillary lymph node dissection Breast reconstruction Management of metastatic breast cancer SYSTEMATIC THERAPY Hormonal replacement therapy Chemotherapy Targeted therapy Immunotherapy LOCAL THERAPY Radiation Surgery PALLIATIVE CARE Addressing pain, fatigue, shortness of breath Psychological support Emotional and psychological support for patients and their families. Quality of life enhancement