Skin Metastasis in Breast Cancer: Treatment Options and Prognosis

Q: Skin Metastasis in Breast Cancer: Treatment Options and Prognosis

Dear Miss Len：<br>1. <br>Should we try to coexist with it? -- Actually, your current situation seems to be one of coexistence. <br>Although there are skin and bone metastases or recurrences, other internal organs are still relatively stable. <br>You might want to reconsider your

It has relapsed again?

Dear Dr.
Wu,
I have just completed my sixth round of chemotherapy and have found a hard lump.
It has now been confirmed that the cancer has metastasized to my skin (mostly around the scar on my chest).
After three rounds of chemotherapy, it spread to my bones, and after six rounds, it has now spread to my skin.
Does this mean that chemotherapy is ineffective for me? Since my diagnosis in 2005, I have had metastasis to the lymph nodes on the other side of my neck this January, March, June, and October.
I have tried almost all available medications, including targeted therapies like Herceptin and Avastin.
The recent biopsy report indicates that my hormone receptors have turned positive (originally negative), so I have started hormone therapy and arranged for radiation therapy.
I asked my doctor whether I should consider using Lapatinib, but he advised against using all my options too soon.

1.
Should I try to coexist with the cancer? Should I stop focusing on trying to eliminate the cancer cells? However, the rapid growth over the past year makes me very afraid it will spread to my organs.
2.
I have heard in a lecture that Avastin is targeted for HER2-negative patients (I am HER2-positive).
Is this true? And does it only extend survival by two months (is paying out-of-pocket just to live two more months worth it)? If the perspective is that survival rates indicate a few extra months rather than years, is there a need to pay for Lapatinib?
3.
I found limited information online about skin metastasis.
I came across (1) "The Application of Arsenic Trioxide Emulsion in Patients with Skin Metastatic Breast Cancer—A Case Report on Drug Absorption Study." Is this being used clinically? What are the effects? (2) "When cancer metastasizes to the skin, there is a high likelihood it will spread to organs." Is this probability significant? (3) "According to some studies, the average lifespan of breast cancer patients with local skin metastasis is about 12 to 13 months." With advancements in medicine, can we expect a longer survival?
4.
Currently, I experience numbness, itching, and pain.
I have a fellow patient whose skin has ulcerated.
Will it eventually ulcerate for everyone, or does it vary by individual? Why does it hurt? Isn't pain typically associated with advanced stages of cancer? Does this indicate that my condition has worsened?
5.
When doctors encounter terminal patients, do they choose to remain silent and not disclose too much information? I have many questions, and I ask Dr.
Wu to answer honestly without fear that I cannot handle the truth.
I am grateful, and I remain grateful.
Thank you.

len, 40~49 year old female. Ask Date: 2008/10/28

Dr. Wu Jingtang reply Breast and Thyroid

Dear Miss Len:
1.
Should we try to coexist with it? -- Actually, your current situation seems to be one of coexistence.
Although there are skin and bone metastases or recurrences, other internal organs are still relatively stable.
You might want to reconsider your medication regimen.
Sometimes, after trying these advanced (newly developed) drugs, it may be worth attempting the original chemotherapy combinations (such as CMF) again, as you might experience unexpected benefits!
2.
Is it true that Avastin is only for HER2-negative patients (I am HER2-positive) and that it only extends survival by 2 months (is the out-of-pocket cost just for an additional 2 months)? -- In fact, Avastin is not exclusively for HER2-negative patients; what matters is that it must be used in combination with other chemotherapy agents! I am not aware of your previous experience with Avastin, but it is worth considering.
As for the question of how long it extends survival, that depends on individual perspectives.
Two months can feel long or short depending on the person, but I believe it is more important to focus on living each day to the fullest!
3.
Using "arsenic trioxide emulsion" for skin metastasis -- I do not have clinical experience with this! Sorry!
4.
[Typically, when metastasis occurs in the skin, there is a high likelihood of organ metastasis, with an average lifespan of about 12 to 13 months.] Is this a significant probability? -- It depends on individual circumstances!
5.
Currently experiencing numbness, itching, and pain.
Some patients have skin ulcerations.
Will it eventually lead to ulceration for everyone, or does it vary by individual? -- It depends on the severity of the disease.
If cancer cells invade nerves or bones, pain is usually present, and the severity depends on the extent of the invasion!
6.
When doctors encounter terminal patients, do they choose to remain silent and not tell the patients too much? -- They should not! In fact, if patients have a deep understanding of their condition, they will naturally have some insights and preparations, which can enhance their cooperation with treatment.
7.
If hormone receptors are positive, hormone therapy medications can be used.
There are now AI (Aromatase Inhibitors like Femara and Aromasin) that have shown good results!
8.
Should I use Lapatinib? Should I exhaust all options? -- This is subjective; those who use it first can gain treatment benefits but may worry about having no options left later (some believe new drugs will be available in the future!).
Those who wait can preserve this drug for later use (fearing there may be no new drugs?).
However, the immediate issues are more challenging to resolve! Currently, it is important to reassess your medication regimen, whether to revert to older treatments or to use a combination of old and new approaches.
Additionally, if local excision can resolve skin recurrence, that should also be considered!
Lastly, I want to encourage you to keep pushing forward!
Sincerely,
Dr.
Ching-Tang Wu
Attending Surgeon, Taoyuan Hospital, Department of Health
November 10, 1997

Reply Date: 2008/10/28

More Info

Understanding skin metastasis in breast cancer is crucial for patients facing advanced stages of the disease. Skin metastasis, particularly in breast cancer, indicates a progression of the disease and can significantly impact treatment options and prognosis.
1. Coexisting with Cancer: The idea of coexisting with cancer rather than aggressively trying to eradicate it can be a valid approach, especially in cases where the cancer has shown resistance to multiple treatments. The rapid growth of lesions can be alarming, and while it is natural to fear further organ involvement, it is essential to focus on quality of life and symptom management. Palliative care can be integrated into your treatment plan to help manage symptoms and maintain comfort.

2. Avastin and Hormonal Therapy: Avastin (bevacizumab) is not exclusively for HER2-negative breast cancer; it can be used in combination with chemotherapy for HER2-positive cases as well. The claim that it only extends life by a few months can be disheartening, but every additional month can be significant for patients and their families. The decision to use Lapatinib, especially given your recent receptor status change to positive, should be discussed with your oncologist. They may recommend reserving certain treatments for later stages of the disease, depending on your overall health and treatment response.

3. Treatment Options for Skin Metastasis: The use of arsenic trioxide in treating skin metastasis is still being explored, and while some case reports suggest potential benefits, it is not widely adopted in clinical practice. The likelihood of skin metastasis leading to organ involvement varies by individual and depends on the aggressiveness of the cancer. Regular monitoring and imaging can help assess any changes in disease status.

4. Symptoms and Pain Management: The symptoms you are experiencing, such as numbness, itching, and pain, can be associated with skin metastasis. Pain does not always correlate with the severity of cancer; it can arise from nerve involvement or skin irritation. Some patients may experience ulceration, while others may not, as this varies greatly among individuals. Effective pain management strategies should be discussed with your healthcare team to improve your quality of life.

5. Communication with Healthcare Providers: It is essential for healthcare providers to communicate openly with patients about their prognosis and treatment options. While some may choose to withhold information to protect patients from distress, many believe that informed patients can make better decisions regarding their care. Your desire for honesty is valid and reflects a need for clarity in navigating your treatment journey.

In conclusion, managing skin metastasis in breast cancer involves a multifaceted approach that includes considering the patient's overall health, treatment history, and personal preferences. Engaging in open discussions with your healthcare team about treatment options, symptom management, and quality of life is crucial. Each patient's journey is unique, and finding a balance between aggressive treatment and maintaining comfort is key.

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