A 58-year-old woman with breast cancer is found on staging CT and bone scan to have multiple liver and bone metastases. What is the most appropriate overall treatment goal?

Answer: A. Palliative treatment, as metastatic breast cancer is considered incurable

Metastatic breast cancer

Breast cancer with distant metastases (e.g. liver, lung, bone) is considered incurable, and treatment is palliative - aimed at controlling symptoms, maintaining quality of life and prolonging survival, not cure.

Key principles

• Treatment is palliative (systemic therapy guided by receptor status, plus supportive care).
• Surgery to the breast is generally not performed except for palliation - for example, if there is fungation or a risk of fungation of the primary.
• Prognosis is worse for visceral metastases (liver, lung) than for bone metastases.

Why not the curative options

Radical or conserving surgery, curative neoadjuvant chemotherapy and sentinel node biopsy all aim at cure or locoregional control, which is not the goal once distant metastases are present.

Treatment by category (recap)

Early - primary surgery + adjuvant therapy; locally advanced - neoadjuvant chemotherapy then surgery; metastatic - palliative care.