Breast Cancer and Metastasis: What to Expect

Medically reviewed by Monica Bien, PA-C on November 28, 2016Written by Annette McDermott on February 3, 2016

Where can breast cancer spread to?

Metastatic cancer is cancer that’s spread to a different part of the body than where it originated. In some cases, the cancer may have already spread by the time of diagnosis. Other times, the cancer may spread after the initial treatment.

For example, a person who has been treated for early stage breast cancer may later be diagnosed with recurrent or metastatic breast cancer. Recurrent cancer is cancer that comes back after your initial treatment.

Metastasis and recurrence can occur with almost every type of cancer.

The most common metastasis locations for breast cancer are the:

  • bones
  • liver
  • lungs
  • brain

Metastatic breast cancer is considered advanced-stage cancer. Cancer metastasis or recurrence may occur months to years after initial breast cancer treatment.

Types of recurring breast cancer

Breast cancer may recur locally, regionally, or distantly:

Local recurring breast cancer occurs when a new tumor develops in the breast that was originally affected. If the breast has been removed, the tumor may grow in the chest wall or nearby skin.

Regional recurring breast cancer happens in the same region as the original cancer. In the case of breast cancer, this may be the lymph nodes above the collarbone or in the armpit.

Distant recurring breast cancer happens when cancer cells travel to a different part of the body. This new location is far away from the original cancer. When cancer recurs distantly, it’s considered metastatic cancer.

What are the symptoms of metastatic breast cancer?

Not everyone with metastatic breast cancer experiences symptoms. When symptoms do occur, they can vary. Symptoms depend on the location of the metastasis and its severity.

Metastasis to the bones may cause severe bone pain.

Metastasis to the liver may cause:

  • jaundice, or yellowing of the skin and the whites of the eyes
  • itchiness
  • abdominal pain
  • loss of appetite
  • nausea
  • vomiting

Metastasis to the lungs may cause:

  • chronic cough
  • chest pain
  • fatigue
  • shortness of breath

Metastasis to the brain may cause:

  • severe headaches or pressure to the head
  • visual disturbances
  • nausea
  • vomiting
  • slurred speech
  • changes in personality or behavior
  • seizures
  • weakness
  • numbness
  • paralysis
  • trouble with balance or walking

Nonspecific symptoms that may accompany any form of metastatic breast cancer include:

  • fatigue
  • loss of appetite
  • weight loss
  • fever

Some symptoms may not be caused by the cancer itself, but by the treatment that you may be undergoing. If you’re experiencing any of these symptoms, speak with your doctor. They may be able to recommend a therapy to alleviate some symptoms.

What causes metastatic breast cancer?

Breast cancer treatments are intended to eliminate any cancer cells that may remain after surgery. Potential treatments include radiation, hormone therapy, and chemotherapy.

In some cases, some cancer cells survive these treatments. These cancer cells may break away from the original tumor. These cells then make their way to other parts of the body via the circulatory or lymphatic systems. Once the cells settle somewhere in the body, they have the potential to form a new tumor. This can happen quickly or develop years after initial treatment.

Diagnosing metastatic breast cancer

Several tests are used to confirm a diagnosis of metastatic breast cancer. These include:

  • MRI
  • CT scan
  • X-rays
  • bone scan
  • tissue biopsy

Treating metastatic breast cancer

There isn’t a cure for metastatic breast cancer. There are treatments aimed at preventing further progression, reducing symptoms, and improving the quality and length of life. Treatments are individualized. They depend on the type and extent of recurrence, previous treatment received, and your overall health.

Treatment options may include:

  • hormone therapy for ER-positive breast cancer, which is the most common type of breast cancer
  • chemotherapy
  • medications that target specific proteins on cancer cells to stop growth, sometimes called targeted therapy
  • bone-building drugs to reduce bone pain and increase bone strength
  • radiation therapy
  • surgery

The U.S. Food and Drug Administration (FDA) approved the drug palbociclib (Ibrance) in 2015 by for use in conjunction with an aromatase inhibitor. This combination is used to treat ER-positive, HER2-negative metastatic breast cancer in postmenopausal women.

Other therapies used in hormone positive breast cancer include:

  • selective estrogen receptor modulators
  • fulvestrant (Faslodex)
  • everolimus (Afinitor)
  • ovarian suppression drugs
  • ovarian ablation to stop the ovaries from producing estrogen

In addition to chemotherapy, women with HER2-positive metastatic breast cancer may also benefit from a combination therapy including:

What’s the outlook?

Deciding which treatment option to move forward with requires both education and careful consideration. Although you should work with your doctor to understand your options, the choice is ultimately up to you. As you consider the possibilities, keep these tips in mind:

Don’t rush into anything. Take time to consider your choices, and get a second opinion if necessary.

Bring someone with you to your doctor appointments. Take notes or ask your doctor if you can record your visit. This can help ensure that you don’t forget anything that’s discussed.

Ask questions. Have your doctor explain all of the potential benefits, risks, and side effects associated with each treatment.

Consider a clinical trial. Find out if there are any clinical trials for which you may be eligible. There may be an experimental treatment option available for your specific cancer.

Although receiving a metastatic breast cancer diagnosis can be overwhelming, there are many treatment options that can help reduce symptoms and prolong life expectancy. Though there isn’t a current curative treatment, some women will live for many years with metastatic breast cancer.

Research on how to stop cancer cell growth, boost the immune system, and disrupt cancer metastasis is ongoing and new treatment options may be available in the future.

Check out: Stage 4 breast cancer: Stories of survivorship »

Can you prevent metastatic breast cancer?

There isn’t a definitive way to guarantee that your cancer won’t recur or metastasize after treatment, but there are steps you can take that may reduce your risk.

These steps include:

  • maintaining a healthy weight
  • quitting smoking
  • staying active
  • eating more fresh fruits and vegetables (at least 2 1/2 cups daily), legumes, whole grains, poultry, and fish
  • reducing your intake of red meat and only eating lean red meat in smaller portions
  • avoiding processed and sugar-laden foods
  • cutting back on alcohol to one drink per day for women

Keep reading: Metastatic breast cancer by the numbers: Facts and statistics »

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