MBC: Role of Surgery
There may be a potential role of surgery for patients with MBC. Patients whose breast cancer is metastatic at the time of their diagnosis may first be treated with systemic therapy (medication given by vein or pill which goes throughout the body, such as chemotherapy or hormone blocking medication). Providing systemic therapy will allow the physicians to see the response of their cancer to medications. Surgery may be considered down the road to decrease the tumor load and allow their bodies to better fight the cancer.
Surgery may be recommended to resect, i.e. surgically remove, isolated metastases. An example of this may be in a patient with a single area of breast cancer spread to the lung. Prior to surgery a specialized scan (such as a PET scan) may be ordered to make sure that there are no other metastases.
Another example would be spread to the liver where there is only one metastasis. Surgery is not effective in removing multiple areas of breast cancer spread and does not benefit a patient in terms of long term survival. For areas of spread that involve only a few metastases, some cancer centers may offer special clinical trials to see if treatment with cyroablation (freezing of the cancerous tumor) or in case of brain metastasis stereotactic radiation would be beneficial.
“First of all, do no harm” is the physician mantra, especially when it comes to treating patients with MBC.
In patients whose breast cancer recurs after their original breast cancer treatment, the site of metastasis will frequently require a biopsy. It is important to biopsy the metastasis to check the biology of the metastasis. Often the biology of the metastasis differs from the original cancer biology. For example, the initial breast cancer was estrogen receptor positive but the metastasis will be estrogen receptor negative. This information is critical for recommending effective treatment for the MBC and avoiding medications that will not work against the MBC.