My mom has Stage IIIB lung cancer, and one of the first places I learned to look for good cancer information is the government's cancer information site, www.cancer.gov. The site is a great place to go to learn about treatment protocols.
Here's what the site says about Stage IV (metastatic) breast cancer:
Systemic disease
Treatment for systemic disease is palliative in intent. Goals of treatment include improving quality of life and prolongation of life. Although median survival has been reported to be 18 to 24 months,[15] some patients experience long-term survival. Among patients treated with systemic chemotherapy at a single institution between 1973 and 1982, 263 patients (16.6%) achieved complete responses. Of those, 49 patients (3.1% of the total group) remained in complete remission for more than 5 years, and 26 patients (1.5%) were still in complete remission at 16 years.[16] [Level of evidence: 3iiDii]
Translation: Only a few people with metastatic breast cancer live longer than 5 years. The goal of treatment is to make the patient's remaining time on earth more comfortable, and to avoid spreading of the cancer to places like the bone and the brain. Cancer bone pain is excruciating, and brain mets cause neurological decay really quickly.
Treatment of metastatic breast cancer will usually involve hormone therapy and/or chemotherapy with or without trastuzumab (Herceptin). Radiation therapy and/or surgery may be indicated for patients with limited symptomatic metastases. All patients with metastatic or recurrent breast cancer should be considered candidates for an ongoing clinical trial.
Patients with metastatic cancer can join clinical trials. The goal of a clinical trial is not just for the patient to perhaps "luck out" with a new drug, but also for the patient to help future patients by refining treatment protocols.
Surgery
Surgery may be indicated for selected patients. Examples include patients who need mastectomies for fungating/painful breast lesions, parenchymal brain or vertebral metastases with spinal cord compression, isolated lung metastases, pathologic (or impending) fractures, or pleural or pericardial effusions.
Radiation therapy
Radiation therapy has a major role in the palliation of localized symptomatic metastases. Indications include painful bony metastases, unresectable central nervous system metastases (i.e., brain, meningeal, and spinal cord), bronchial obstruction, and fungating/painful breast or chest wall lesions. Radiation therapy should also be given following surgery for decompression of intracranial or spinal cord metastases and following fixation of pathologic fractures. Clinical trials are exploring the optimal radiation fractionation schedule.[17] Strontium-89, a systemically administered radionuclide, can be administered for palliation of diffuse bony metastases.[18,19]<b</p>
I am hoping that Elizabeth Edwards gets the most prolonged period possible of feeling well, and being able to accompany her husband and really enjoy her life and her children for as long as she has left. The Edwardses are remarkable in their optimism and willingness to persevere, but for those of us who may know little about Stage IV breast cancer, here is what they are actually facing.