comscoreMetastatic Breast Cancer

Metastatic Breast Cancer

Metastatic breast cancer — also called stage IV — is breast cancer that has spread to another part of the body, most commonly the bones, lungs, brain, or liver.
 

What is metastatic breast cancer?

Metastatic breast cancer — also called stage IV — is breast cancer that has spread to
another part of the body, most commonly the bones, lungs, brain, or liver.

The process of cancer spreading is called metastasis. Metastasis happens when cancer cells break away from the original tumor in the breast and travel to other parts of the body. These cancer cells travel through the bloodstream or the lymphatic system (the network of lymph nodes and vessels that removes bacteria, viruses, and cell waste).

Breast cancer can come back in another part of the body months or years after the original diagnosis and treatment. This is called metastatic recurrence or distant recurrence. Nearly 30% of women diagnosed with early-stage breast cancer develop metastatic disease. Because there are so few cases of male breast cancer, it's not clear how many of these breast cancers metastasize, but men are also diagnosed with metastatic breast cancer.

When the first diagnosis of breast cancer is metastatic, it is called de novo metastatic breast cancer. This means that by the time the breast cancer is first detected, it has already spread to another part of the body.

Metastatic breast cancer is made up of cells from the original tumor that developed in the breast. So if breast cancer spreads to the bone, the metastatic tumor in the bone is made up of breast cancer cells, not bone cancer cells.

Being diagnosed with metastatic breast cancer can be overwhelming. You may feel angry, scared, stressed, or sad. Some people may question the cancer treatments they had or be mad at their doctors or themselves for not being able to cure the disease. Others may deal with a diagnosis of metastatic breast cancer in a matter-of-fact way. There is no right or wrong way to come to terms with the diagnosis. You need to do and feel what is best for you and your situation.

 
 

Keep in mind that metastatic disease is not hopeless. Some people live long, productive lives with stage IV breast cancer. There are a variety of treatment options for metastatic breast cancer, and new medicines are being tested every day. More and more people are living life to the fullest while being treated for metastatic breast cancer.

While there is no cure for metastatic breast cancer, treatment may control it for a number of years. If one treatment stops working, there may be another you can try. The cancer can be active sometimes and then go into remission at other times. Many different treatments — alone, in combination, or in sequence — are often used. Depending on the situation, your doctor may recommend taking a break in treatment when the disease is under control and you are feeling good.

 

Symptoms and diagnosis of metastatic breast cancer

The most common parts of the body where breast cancer tends to spread (metastasize) are the bones, lungs, brain, and liver. But metastatic breast cancer can affect other parts of the body, as well.

Metastatic breast cancer symptoms can be very different depending on the cancer’s location, but may include:

  • back, bone, or joint pain that does not go away

  • difficulty urinating (either incontinence or not being able to go), which can be a sign that the cancer is pinching nerves in your back

  • numbness or weakness anywhere in your body

  • a constant dry cough

  • shortness of breath or difficulty breathing

  • chest pain

  • loss of appetite

  • abdominal bloating, pain, or tenderness

  • constant nausea, vomiting, or weight loss

  • jaundice (a yellow tinge to the skin and whites of your eyes)

  • severe headaches

  • vision problems (blurry vision, double vision, loss of vision)

  • seizures

  • loss of balance

  • confusion

If you have a history of breast cancer and develop any symptoms of metastatic breast cancer, your doctor may recommend one or more of the following tests to see if the cancer has returned:

  • blood tests (including tumor markers in some patients)

  • whole-body bone scan, with or without X-rays of specific bones

  • MRI (magnetic resonance imaging) of the spine or brain

  • CT (computed tomography) scan of the chest, abdomen, pelvis, or brain

  • PET (positron emission tomography) scan

  • X-ray or ultrasound of the abdomen or chest

  • bronchoscopy, if you have a constant cough or trouble breathing

  • biopsy of any suspicious area

  • a tap, removal of fluid from the area with symptoms to check for cancer cells; a pleural tap (also called a thoracentesis) removes fluid between the lung and chest wall; a spinal tap removes fluid from around the spinal cord; and a tap of fluid in the abdomen (called a paracentesis) removes fluid in the abdominal cavity

These tests may also be used if you have no history of breast cancer and your doctor is having trouble determining the cause of your symptoms.

When breast cancer spreads to other parts of the body, it’s important to confirm whether the cancer has certain characteristics that may influence your treatment options, such as HER2 status and hormone receptor status. If you have been diagnosed with metastatic breast cancer years after an early-stage breast cancer diagnosis, it may seem logical to assume that the hormone receptor status and HER2 status are the same. But research has shown that the hormone receptor status and HER2 status of early-stage breast cancer can be different than that of a metastatic recurrence.

A biopsy may be done to determine these factors that can influence your treatment, which will be listed in your pathology report.

 
 
 

Common metastatic sites

The symptoms and diagnosis of metastatic breast cancer will differ depending on where the cancer has spread in the body, as will your treatment options.

 

Treatment for metastatic breast cancer

There are a number of different approaches to treating metastatic breast cancer. Every cancer is unique and treatment can be tailored to your specific circumstances.

Doctors usually treat metastatic breast cancer in any part of the body with systemic medications, which treat cancer throughout the entire body. Chemotherapy, hormonal therapy, targeted therapies, and immunotherapy are all systemic medications. Local treatments that target a specific part of the body, such as surgery or radiation, are sometimes recommended.

Most treatment decisions depend on where in the body the cancer has spread, the cancer’s characteristics (such as hormone receptor status and HER2 status), and any cancer treatments you’ve had in the past.

Learn more
Clinical trials for metastatic breast cancer

If you’re being treated for metastatic breast cancer, you may want to talk to your doctor about whether participating in a clinical trial makes sense for you. It’s important to know that researchers conducting clinical trials carefully consider your specific situation before approving you as a study participant. By participating in a clinical trial, you can help researchers find better breast cancer treatments that may help extend lives in the future. But you also may benefit from the treatment the researchers are studying.

Learn more
 

Living with metastatic breast cancer

It can be upsetting for you, your family, and other loved ones to learn that breast cancer has spread to other areas of the body. But there are ways to manage your feelings, get support, figure out how to talk about the diagnosis with family and friends, and work after being diagnosed.

Learn more
Sexuality and metastatic breast cancer

It’s not always easy to balance your sexual needs with the physical and emotional challenges of a metastatic breast cancer diagnosis. You can manage the sexual issues that can often come up with a metastatic breast cancer diagnosis.

Learn more
 

Planning ahead for end of life

There are emotional, financial, legal, practical, and physical issues to consider when you decide you don’t want to continue treatment for metastatic breast cancer. Some of these may include:

  • managing symptoms so you can stay comfortable

  • finding out about the support hospice care can offer

  • organizing your finances

It’s completely understandable if you don’t feel ready to read some of this material. But it’s a good idea to talk with your loved ones or a counselor if you have any fears or concerns.

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Myths and misconceptions about metastatic breast cancer

Metastatic breast cancer is very different from early-stage breast cancer. There are a number of common misconceptions about what metastatic breast cancer is and what it's like to live with it.

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20 terms you should know about metastatic breast cancer

If you have been diagnosed with metastatic breast cancer, you may encounter a lot of unfamiliar terminology when trying to learn about the disease. These 20 key terms can help you better understand the diagnosis, treatments, and experience of living with metastatic breast cancer.

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— Last updated on August 15, 2022, 4:10 PM

Reviewed by 4 medical advisers
 
Jenni Sheng, MD
Johns Hopkins University School of Medicine, Baltimore, MD
Marisa C. Weiss, MD
Lankenau Medical Center, Wynnewood, PA
Brian Wojciechowski, MD
Crozer Health System, Philadelphia area, PA
Sameer Gupta, MD, MPH
Bryn Mawr Hospital, Bryn Mawr, PA
Learn more about our advisory board
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