Metastatic Recurrence

Metastatic (advanced) disease means that the breast cancer cells have found their way into the bloodstream and traveled to other parts of the body. Here are the most common places breast cancer spreads to:

• lymph nodes beyond the armpit area
• in or under the skin beyond the breast area
• the bones
• the lungs
• the space between the lung and the inside surface of the chest wall (causing a buildup of fluid, called "pleural effusion")
• the liver
• the brain

If you've had breast cancer, see your doctor if you get symptoms that might signal the cancer has spread to these areas.

Symptoms of cancer in the bones may include:

• back, bone, or joint pain lasting more than two to three weeks that seems to be getting worse
• numbness or weakness in a particular part of the body
• a change in bowel or bladder activity, such as problems with incontinence or not being able to urinate or have a bowel movement. This may be a sign that the nerves in your backbone are getting pinched by the cancer

Symptoms of cancer in the brain may include:

• headaches
• weakness in your arms or legs
• changes in vision (blurry, double, or loss of vision)
• personality change
• confusion
• loss of balance, possibly with episodes of falling
• nausea
• seizure

Symptoms of cancer in or around the lungs may include:

• a cough that doesn't go away and gets worse over time (either a dry cough or one that brings up mucus or even blood)
• shortness of breath
• chest pain with no obvious cause
• loss of appetite and possibly weight loss

Symptoms of cancer in the liver may include:

• pain in your belly (abdomen) that lasts a long time, gets worse over time, and has no other obvious cause
• fullness and bloating in your belly
• jaundice (a yellow tinge to the skin and whites of your eyes that results from a backup of bile, a dark green substance that's made in your liver and helps you digest fat)
• blood tests that show abnormalities in how your liver is functioning
• loss of appetite and possible weight loss

If you have any of these symptoms, your doctor will do some tests to see if they are caused by cancer coming back or spreading. What tests you get depend on your symptoms. These tests might include:

• blood tests
• a whole-body bone scan, with or without X-rays of specific bones
• an MRI of the spine or brain
• a CAT scan of the chest, belly, pelvis, and/or brain
• a PET scan
• X-ray or ultrasound of the belly or chest
• bronchoscopy if you have a bloody cough or a sign that something is blocking your breathing
• a biopsy of the area in question
• removal of fluid from the affected area, called a "tap." A pleural tap removes fluid trapped between the lung and the chest wall. A spinal tap removes fluid from around the spinal cord, through the back area

Sometimes your doctor will find possible signs of metastatic disease by doing blood tests in a regular checkup, even if you have no symptoms. Routine blood tests might show something wrong with your liver. Blood tests can also reveal a buildup of calcium or other compounds that suggest the cancer might be in the bones. This might also show up in a routine bone scan.

Some oncologists also order blood tests to look for tumor markers—special proteins in the blood. Common markers for breast cancer include

• CEA (carcino-embryonic antigen)
• CA (cancer antigen) 15-3
• CA 27-29

An increase in the amounts of these tumor markers can suggest the cancer is growing. But sometimes the levels of the markers go up even though the cancer hasn't spread.

Most experts do not recommend getting these blood tests or other tests routinely unless you have symptoms. That is because these tests have never been shown to improve how long or how well people live.

Symptoms of metastatic breast cancer at first presentation include any of those mentioned above. "Metastatic at presentation" means breast cancer has spread beyond the breast and nearby lymph nodes when it is first diagnosed. Somehow, breast cancer cells moved out of the breast and spread to other parts of the body silently, without producing signs or symptoms until now. Even though early-stage breast cancer was never diagnosed, this is now considered advanced disease.