America received a shocking piece of news in March 2007. John Edward's wife, Elizabeth, had been diagnosed with metastatic breast cancer. She spoke calmly, with inner strength, about how she had asked her husband to continue his presidential campaign, and how she wanted to campaign by his side. She did not want to be best known by her illness; she wanted, in fact, needed, to carry on as normally as she could.



Her diagnosis gave a face to this illness. Americans began to discuss Elizabeth and John Edward's decisions. Globally, people talked about how deeply cancer affects families. Breast cancer is something that affects many, and almost everyone has known someone who has died from it. Her announcement gave a face to it and it made people think. It brought the topic out in the open.

What is metastatic breast cancer? Also called Stage IV breast cancer, it is cancer that has spread from the original (primary) site to other organs or tissues in the body, such as bone, liver, lungs or brain.

Sometimes, like Mrs. Edwards, it is a recurrence of the original cancer. However, in one out of ten diagnosed, the first diagnosis that a woman hears is metastatic breast cancer.

In it, cells break away from the breast, circulating through the blood and lymphatic system. The body's immune system attacks these circulating cancer cells. Most do not survive, but if the immune system malfunctions or is weak, or for another, unknown reason, will usually spread to the bone, then lung and liver next. The cells that have metastasized are still breast cancer cells, no matter where they are found in the body.

Treatment is palliative, improving quality of life, relieving symptoms and aimed at extending a woman's lifetime. But there are new treatments coming that are giving more hope to those patients with this cancer. Many women with this illness choose to become part of a clinical trial in order to access treatments that are not yet approved by the FDA.

If it is "estrogen-receptive," hormonal therapies such as the drug Herceptin can be lifesaving. Chemotherapy is indicated in bone, lung and liver metastases. For bone metastases, radiation and the drug bisphosphonate are often used. For liver and lung metastases, occasionally surgery is used. For cancer that has spread to the brain, radiation and surgery are used.

Palliative care to relieve symptoms from both the cancer and treatment involves drug and non-drug treatments such as relaxation therapy, acupuncture, and dietary management. Besides physical symptoms, palliative care for patients who are being treated or who cannot be cured focuses on spiritual and emotional needs, as well as physical needs.

As far as anyone knows today, metastatic cancer can't be cured. Sometimes, treatments can actually stop the cancer from growing for months or years. When Elizabeth Edwards asserted that she thought her own might be treatable, people listened. She gave a face to this illness - a loving, brave, wise, face - that no one will forget.