Advanced breast cancer is cancer that has spread to other parts of the body. If you’ve been diagnosed with advanced breast cancer, it’s important to know what to expect. Fortunately, with new and developing treatments, living with advanced cancer is no longer uncommon.
People are living full and active lives while also managing advanced cancer, including advanced breast cancer. Learn more about the symptoms, treatments, and current outlook of advanced breast cancer.
Advanced breast cancer includes stage 3 and stage 4 breast cancer.
Metastatic or stage 4 breast cancer is cancer that has spread to other parts of the body. It’s still considered breast cancer. Even if the cancer cells are in your bones or lungs, they’re still breast cancer cells.
Locally advanced or stage 3 breast cancer has all the characteristics of advanced breast cancer. But locally advanced breast cancer doesn’t affect far-away organs like your bones or lungs. Instead, it may affect nearby lymph nodes and surrounding tissue or skin.
Not everyone with advanced breast cancer will have the same symptoms, but some symptoms are more common.
Symptoms of advanced breast cancer can include:
- breast lump that you can either see or feel
- skin changes, like dimpling or rash
- nipple discharge
- breast pain or discomfort
- unexplained weight loss
- loss of appetite
Other symptoms may depend on where the cancer has spread:
- Bone. If advanced breast cancer has spread to the bone, you may have bone pain or easily broken ribs.
- Brain. When advanced breast cancer spreads to the brain, you might have headaches or memory problems.
- Lungs. Advanced breast cancer in the lungs may cause a chronic cough or shortness of breath.
- Liver. Spread to the liver causes no symptoms at first, but may cause jaundice or a swollen abdomen when advanced.
Once you receive a breast cancer diagnosis, you’ll also get your cancer’s staging. Staging is important because it helps determine your treatment options and prognosis. Tests for staging include:
Other tests may include:
- blood tests, including tumor markers which look for signs of tumors in your blood
- whole-body bone scan, with or without X-rays of certain bones
- MRI of spine or brain
- biopsy of any specific tissue or area
- removal of fluid from symptomatic areas to check for cancer cells, like a pleural tap that removes fluid from between the lung and chest wall
If your doctor recommends surgery in your treatment plan, they may also order a sentinel lymph node biopsy, which is done during surgery. This test can tell the doctor where your cancer is likely to spread.
Metastatic breast cancer cannot be completely cured, but it can be treated. Systemic drug therapies are the main form of treatment for this form of breast cancer. This is because these medications can go through the bloodstream to cancer in other parts of your body outside the breast.
Treatments can include:
Surgery or radiation may also be used in some situations.
In about two-thirds of breast cancer cases, the cancer is hormone receptor-positive. This means the hormones estrogen and progesterone are stimulating cancer cell growth. Hormone therapy works in these cases by blocking or lowering estrogen production.
These drugs can include:
- toremifene (Fareston)
- fulvestrant (Faslodex)
- leuprolide (Lupron)
- aromatase inhibitors, including letrozole (Femara), anastrozole (Arimidex), and exemestane (Aromasin)
Chemotherapy travels through the bloodstream to reach cancer throughout the body. It’s often used for advanced breast cancer, particularly when cancer is hormone receptor-negative. Common chemotherapy drugs for advanced breast cancer include:
- taxanes (paclitaxel, docetaxel)
- anthracyclines (doxorubicin, pegylated liposomal doxorubicin, epirubicin)
- platinum agents (cisplatin, carboplatin)
- vinorelbine (Navelbine)
- capecitabine (Xeloda)
- gemcitabine (Gemzar)
- ixabepilone (Ixempra)
- eribulin (Halaven)
Targeted therapy drugs are like chemotherapy drugs because they also travel through the bloodstream. But these medications target and block the growth and spread of cancer by interfering with specific genes, proteins, or blood vessels. Targeted therapy can be used to treat:
- human epidermal growth factor receptor 2-positive breast cancer
- hormone receptor-positive breast cancer
- cancer with BRCA gene mutations
- triple-negative breast cancer
Targeted therapy for HER2-positive breast cancer
In human epidermal growth factor receptor 2 (HER2)-positive breast cancer, the cancer cells have too much of a growth protein called HER2. About 1 in 5 women with breast cancer have HER2-positive breast cancer. Targeted therapies focus on controlling the HER2 protein. Drugs like trastuzumab (Herceptin) help treat HER2-positive breast cancer.
Targeted therapy for hormone receptor-positive breast cancer
These drugs target certain proteins in the cells that help stop the cells from dividing. They can also be used with traditional hormone therapy for breast cancer. An example is palbociclib (Ibrance), which is used to treat advanced, hormone receptor-positive, HER2-negative breast cancer. You might get palbociclib in combination with a hormone therapy like an aromatase inhibitor or fulvestrant.
Targeted therapy for BRCA mutations and breast cancer
Poly ADP-ribose polymerase (PARP) inhibitors are used to treat breast cancer in those who have BRCA mutations. PARP proteins usually help to repair damaged DNA in cells, but mutations can stop this from happening. PARP inhibitors block the PARP proteins. Drugs include olaparib (Lynparza) and talazoparib (Talzenna).
Targeted therapy for triple-negative breast cancer
In triple-negative breast cancer, the cancer cells don’t have estrogen or progesterone receptors and are not HER2-positive. Targeted therapies are often antibody-drug conjugates, which are created by joining an antibody with a chemotherapy drug. Sacituzumab govitecan (Trodelvy) is in this category.
Immunotherapy drugs help to stimulate your own immune system to better recognize and kill cancer cells. They can be effective for some types of advanced breast cancer. Today’s immunotherapy drugs are called immune checkpoint inhibitors.
To keep your immune system from attacking your own body, your body has proteins that act as “checkpoints” on immune cells. These checkpoint proteins need to be turned on or off to start an immune response. Breast cancer cells can use these proteins to keep from being attacked.
Treatment for advanced breast cancer will generally continue for the rest of your life. This will keep the cancer under as much control as possible to relieve symptoms and can improve the quality and length of your life.
It’s important to find the treatments that work best for you to get relief from your symptoms with minimal side effects. Talk with your oncologist about your expectations for treatment and any future treatments that might become available.