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 initial 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 local or regional breast cancer or metastatic breast cancer. Recurrent cancer is cancer that comes back after your initial treatment.
Metastasis and local or regional recurrence can occur with almost every type of cancer.
The most common metastasis locations for breast cancer are the:
Metastatic breast cancer is considered advanced-stage cancer. Cancer metastasis or local or regional recurrence may occur months to years after initial breast cancer treatment.
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.
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
- abdominal pain
- loss of appetite
Metastasis to the lungs may cause:
- chronic cough
- chest pain
- shortness of breath
Metastasis to the brain may cause:
- severe headaches or pressure to the head
- visual disturbances
- slurred speech
- changes in personality or behavior
- trouble with balance or walking
Nonspecific symptoms that may accompany any form of metastatic breast cancer include:
- loss of appetite
- weight loss
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.
Breast cancer treatments are intended to eliminate any cancer cells that may remain after surgery. Potential treatments include radiation, hormone therapy, chemotherapy, and targeted therapy.
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.
Several tests are used to confirm a diagnosis of metastatic breast cancer. These include:
- CT scan
- bone scan
- tissue biopsy
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, the type of cancer, previous treatment received, and your overall health. Treatment options may include:
- hormone therapy for estrogen receptor-positive (ER-positive) breast cancer, which is the most common type of breast cancer
- 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
The US Food and Drug Administration (FDA) approved the drug palbociclib (Ibrance) in 2015 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)
- PARP inhibitor, such as olaparib (Lynparza)
- ovarian suppression drugs
- ovarian ablation to stop the ovaries from producing estrogen
In addition to chemotherapy, treatment for HER2-positive metastatic breast cancer usually includes a HER2 targeted therapy such as:
- pertuzumab (Perjeta)
- trastuzumab (Herceptin)
- ado-trastuzumab emtansine (Kadcyla)
- lapatinib (Tykerb)
Deciding which treatment option to move forward with requires both information 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.
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