Metastatic breast cancer occurs when cancer that started in the breast spreads to another part of the body. It’s also known as Stage 4 breast cancer. There isn’t a cure for metastatic breast cancer, but it can be treated for a certain length of time.

The length of time between a stage 4 diagnosis and the onset of end-of-life symptoms varies among people with this form of cancer. Research suggests that about 15 percent of women diagnosed with metastatic breast cancer live at least five years after their diagnosis. There are those who live much longer. Newer treatments are helping to extend lives and improve the quality of life for people with metastatic breast cancer.

Stage 4 Breast Cancer: Stories of Survivorship

Regardless of what stage of cancer you have, it’s important to be informed. This will give you a better idea of what’s ahead.

What Is Metastatic Breast Cancer?

Metastasis occurs when cancer or another disease spreads from the location where it originated to another part of the body. If breast cancer spreads beyond the breast, it tends to appear in one or more of the following areas:

  • bones
  • brain
  • lung
  • liver

If the cancer is confined to the breast, it usually isn’t life-threatening. If it has spread to nearby lymph nodes, it’s possible it can be cured. That’s why early diagnosis and treatment of breast cancer is so important. It’s when the cancer spreads to a vital organ that the disease becomes terminal.

Successful breast cancer treatment can often eliminate cancer completely from the body. Unfortunately, even early and effective treatment can’t guarantee that cancer won’t reappear somewhere else. This can happen months to years later.

What Are the Symptoms?

At its earliest stage, there are usually no obvious symptoms of breast cancer. Once symptoms do appear, they can include a lump that can be felt in the breast or under the armpit. Inflammatory breast cancer may present with redness and swelling. The skin may also be dimpled, warm to the touch, or both.

At stage 4, symptoms in the breast usually include a lump, as well as:

  • skin changes like dimpling or ulceration
  • nipple discharge
  • swelling of the breast or arm
  • large, hard palpable lymph nodes under your arm or in your neck
  • pain or discomfort

You may also see noticeable differences in the shape of the affected breast.

Advanced stage 4 symptoms may also include:

  • fatigue
  • difficulty sleeping
  • difficulty digesting
  • shortness of breath
  • pain
  • anxiety
  • depression

Signs of Metastasis

Difficulty catching your breath may signal that your breast cancer may have spread to your lungs. The same is true for symptoms such as chest pain and a chronic cough.

Breast cancer that has spread to the bones may make the bones weaker and more likely to fracture. Pain is common.

If your breast cancer has spread to your liver, you may experience:

  • yellowing of the skin, which is called jaundice
  • abnormal liver function
  • abdominal pain
  • itchy skin

Breast cancer that metastasizes to the brain can be especially troubling. In addition to severe headaches and possible seizures, the symptoms may include:

  • personality changes
  • behavior changes
  • vision problems
  • nausea
  • difficulty walking
  • difficulty balancing

What Symptoms Are Present During the Final Months of Life?

During the final months of life, many people with cancer chose to transfer to hospice or palliative care. This usually happens when you and your doctor decide to stop cancer-directed treatment and switch the focus of your care to symptom management, comfort, and quality of life. At this point, a hospice team will provide your care. This team often can include:

  • doctors
  • nurses
  • social workers
  • chaplain services


Fatigue will continue to affect anyone with metastatic breast cancer. When you’re healthy, tired feelings come and go, and good rest can make you feel better. The fatigue that occurs in people with cancer, especially toward the end of life, can seem never-ending. It may feel as though no amount of sleep can restore your energy.


Pain is also a common complaint among people with metastatic breast cancer. Pay close attention to your pain. The better you’re able to describe it to your doctor, the easier they can help find the most effective treatment.

Loss of Appetite and Weight Loss

You may also experience a loss of appetite and weight loss. As your body slows down, it demands less food. You may develop difficulty swallowing, which can make it difficult to eat and drink.

Fear and Anxiety

Dying is unchartered territory for all of us. This can be a time of great anxiety and fear of the unknown. Many people will find comfort in spiritual guidance at this time. Meditation, chaplain services, and prayer can be helpful depending on your spiritual or religious beliefs.

Other Symptoms

Trouble swallowing can also lead to breathing troubles at the end of life. Shortness of breath can also develop from mucus buildup in the lungs or other respiratory problems related to breast cancer.

Symptom Management

Lifestyle Changes

In many cases, breathing difficulties can be managed. Propping up pillows so you can sleep with your head slightly elevated can make a big difference. Making sure your room is cool and not stuffy may also help. Talk with your doctor, or perhaps a respiratory specialist, about breathing techniques that might help you breathe more easily and help you relax. If you have a severe case, supplemental oxygen may be required.

You may also need to adjust your eating habits. A reduced appetite is common near the end of life, though your loved ones may urge you to eat even when you’re not hungry. Changes in your smell and taste senses may also make you less interested in food. Try to experiment with different foods or supplement your diet with protein drinks that are high in calories. This can help you strike a balance between a smaller appetite and maintaining enough strength and energy to get through the day.

Relaxation is key to managing all your symptoms. As you get closer to dying, you may develop increased feelings of fear and anxiety. Learning relaxation techniques can help with the psychological aspects of dying as well as help manage your pain. Some people will also need pain medications at this time. Your doctor may prescribe increasingly powerful drugs as your pain increases and as your body builds up a tolerance to certain medications. It’s also common for doctors to prescribe anti-anxiety medications at this time.


Opiod medications are often provided if untreated pain becomes too much to bear. You can get these painkilling drugs in a variety of ways:

  • by mouth
  • by using a skin patch
  • by using a rectal suppository
  • intravenously

A pain medicine pump may be required near the end of life to administer appropriate levels of medication.

Opioids can cause considerable drowsiness. This may interfere with an already compromised sleep schedule. If fatigue and sleeping problems are affecting your quality of life, simple solutions such as adjusting your sleep schedule or even where you sleep might help.

Speaking with Your Doctor

Part of symptom management means following your doctor’s advice. It also means reporting your symptoms and your concerns to your healthcare providers. The doctors and other members of your healthcare team can better manage your end-of-life care if you speak up about what is and isn’t working.