Metastatic Breast Cancer
What is metastatic breast cancer?
Metastatic breast cancer — also called stage IV breast cancer — 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.
Although most people don’t have stage IV breast cancer when first diagnosed, up to 10% do. When the first diagnosis of breast cancer is metastatic, it is called de novo metastatic breast cancer. This means that the cancer 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 all these feelings. 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’s best for you and your situation.
Keep in mind that metastatic disease is not hopeless. Many 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 receiving treatment 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 is almost always 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 of metastatic breast cancer
Metastatic breast cancer symptoms can be very different depending on the cancer’s location, but signs of metastatic breast cancer 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
a constant dry cough
shortness of breath or difficulty breathing
chest pain
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
constant fatigue
Diagnosing metastatic breast cancer
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
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. Almost all people who develop stage IV breast cancer after a previous diagnosis of early-stage disease have a biopsy.
Where can metastatic breast cancer spread?
Breast cancer can metastasize, or spread to any area of the body, though some sites are more common than others. This is why it's important to tell your doctor about any new pain or discomfort you have, even if it's in a part of the body away from the breast. The symptoms of metastatic breast cancer will differ depending on where the cancer has spread in the body.
Bone metastasis: Breast cancer can spread to any bone, but most often spreads to the ribs, spine, pelvis, or the long bones in the arms and legs. The most common symptom of breast cancer that has spread to the bone is a sudden, noticeable new pain in these areas.
Brain metastasis: Symptoms of breast cancer that has spread to the brain can include headache, persistent nausea or vomiting, loss of balance, changes in speech or vision, and memory problems.
Lung metastasis: When breast cancer spreads into the lung, it often doesn’t cause symptoms. Sometimes it causes pain or discomfort in the lung, shortness of breath, and a persistent cough.
Liver metastasis: When breast cancer spreads to the liver, it often doesn’t cause symptoms. Sometimes it causes stomach pain, fatigue and weakness, weight loss or poor appetite, and fever.
Like metastatic ductal breast cancer, metastatic lobular breast cancer can spread to the bones, brain, liver, and lungs. But it can also spread to different areas:
Stomach, small intestine, or colon metastasis: Symptoms may include abdominal pain, difficulty eating, ascites (fluid build-up in the abdomen), and bloating.
Ovaries or uterus: Symptoms may include unusual pelvic bleeding or pain.
Bladder and ureter: Symptoms may include frequent urination or blood in the urine.
Tissues behind the eye: Symptoms may include eye pain or blurred vision.
Spinal cord fluid (leptomeningeal disease): People with triple-negative breast cancer or lobular breast cancer have a higher risk of developing leptomeningeal disease. Symptoms may include headache, nausea and vomiting, changes in your balance or how you walk, hearing loss, double vision, back or leg pain, or numbness or weakness in the legs or glute muscles.
Skin (cutaneous disease): Symptoms may include a reddening of the skin or other change in skin color, a persistent rash, or one or more firm lumps that don’t go away.
Oligometastatic breast cancer
Oligometastatic breast cancer means the cancer has spread to parts of the body away from the breast, but there are only a few, small metastatic lesions. Oligometastatic breast cancer is often found during testing for other things rather than because it’s causing symptoms. It’s estimated that up to 20% of people diagnosed with metastatic breast cancer have oligometastatic disease.
Treatment for metastatic breast cancer
There are a number of different approaches to treating metastatic breast cancer. Treatment decisions are based on where in the body the cancer has spread, the cancer’s characteristics (such as hormone receptor status and HER2 status), your symptoms, and any cancer treatments you’ve had in the past.
Doctors usually treat metastatic breast cancer in any part of the body with systemic medicines, which treat cancer throughout the entire body. Chemotherapy, hormonal therapy, targeted therapies, and immunotherapy are all systemic medicines. Local treatments that target a specific part of the body, such as surgery or radiation, are sometimes recommended.
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. By participating in a clinical trial, you can help researchers find better breast cancer treatments.
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, and figure out how to talk about the diagnosis with family and friends.
Learn more about life with metastatic breast cancer.
Sexuality and metastatic breast cancer
Many people with metastatic breast cancer experience physical and emotional changes that can affect sex and intimacy. It’s worth talking with your healthcare team about ways to address any sexual health concerns you may have.
Planning ahead for end of life
There are emotional, financial, legal, practical, and physical issues to consider when planning for the end of life. Some of these may include:
managing symptoms so you can stay comfortable
finding out about the support hospice care can offer
organizing your finances
Thinking about death can be sad and scary, and it’s completely understandable if you don’t feel ready to go there yet. It can also be hard to know where to start. Consider asking your doctor or a hospital social worker about resources to support you. Talking with a therapist, clergy, or a support group of people who’ve had or are considering these conversations, may also help.
More metastatic breast cancer resources
The Breastcancer.org Podcast features insights from medical experts and people living with breast cancer on topics such as sexual health and metastatic disease, talking to children about metastatic breast cancer, and more.
In this online forum, anyone managing the ups and downs of a metastatic breast cancer diagnosis can ask questions, share information and experiences, and give and receive support.
Breastcancer.org’s virtual community support group meetups are a safe place to share stories and connect with others with a similar diagnosis. There are meetups specifically for people with metastatic breast cancer.
Dozens of members of the Breastcancer.org community share their personal stories of living with metastatic disease.
These 20 key terms can help you better understand the diagnosis, treatments, and experience of living with metastatic breast cancer.
Read about common misconceptions about what metastatic breast cancer is and what it's like to live with it.
Recent research on metastatic disease has looked at how a vegetarian diet and exercise can help improve quality of life and the best type of radiation for painful spine metastases.
A vegetarian diet offers physical and mental benefits for women with metastatic breast cancer.
If you have metastatic disease and want better sex, exercise can help.
Stereotactic body radiation seems best for easing pain caused by spots of metastatic cancer in the spine.
— Last updated on July 2, 2025 at 5:52 PM