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The information on this page was reviewed and approved by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on March 12, 2021.

Metastatic breast cancer

Metastatic breast cancer is essentially stage IV breast cancer. It’s also referred to as advanced breast cancer. The word “metastatic” refers to cancer that has spread beyond the part of the body where it started. In comparison, the term “localized” means the cancer is contained to its primary site.

Metastasis is the process by which cancer cells spread. In the case of metastatic breast cancer, the cancer originated in breast tissue, then spread to other parts of the body.

Metastatic cancer is further described as local, regional or distant, depending on the location of the cancer cells in relation to the original tumor.

  • Localized metastatic breast cancer often means the breast cancer has spread to nearby lymph nodes.
  • The more distant locations include the bones, lungs, skin, liver and brain, although it’s possible for other parts of the body to be affected.

It’s important to remember that every cancer is unique and that your experience may not necessarily be the same as that of another breast cancer patient. With a personalized treatment plan, metastatic breast cancer is typically treatable. A recent National Cancer Institute (NCI) study found that the number of U.S. women living longer with distant metastatic breast cancer is growing, thanks to advances in treatments.

It’s also important to prepare yourself with information about the disease, its symptoms and how it’s detected and treated.

Symptoms of metastatic breast cancer

The symptoms of metastatic breast cancer may be different than those of early-stage breast cancer, but not always. Sometimes, there are no symptoms at all.

You should always speak with your doctor if you experience any new signs or symptoms, but here are some of the most common signs that breast cancer has spread:

  • Bone pain or bone fractures due to tumor cells spreading to the bones or spinal cord
  • Headaches or dizziness when cancer has spread to the brain
  • Shortness of breath or chest pain, caused by lung cancer
  • Jaundice or stomach swelling

The symptoms of breast cancer metastasis may also vary depending on where in the body the cancer has spread. For example:

  • If the breast or chest wall is affected, symptoms may include pain, nipple discharge, or a lump or thickening in the breast or underarm.
  • If the cancer has spread to bones, symptoms may include pain, fractures or decreased alertness due to high calcium levels.
  • If the cancer has spread to the lungs, symptoms may include shortness of breath, difficulty breathing, coughing, chest pain or fatigue.
  • If the cancer has spread to the liver, symptoms may include nausea, fatigue, swelling of the feet and hands or yellowing skin.
  • If cancer has spread to the central nervous system, which includes the brain or spinal cord, symptoms may include pain, memory loss, headache, blurred or double vision, difficulty with and/or movement or seizures.

Diagnosing metastatic breast cancer

Getting a clear picture of where breast cancer has spread is essential for creating a personalized treatment plan. Your care team will likely use a combination of the following tests and tools to diagnose both localized and advanced breast cancer:

Ultrasound exam: With this imaging technique, sound waves (known as ultrasound waves) create a picture of internal areas of the body.

Magnetic resonance imaging (MRI): This procedure produces detailed images using magnetic fields and radio waves.

Blood chemistry studies: A blood sample is taken to measure the amounts of certain substances that are released by your organs and tissues. A higher or lower amount of a particular substance may be a sign of disease.

Biopsy: A biopsy is the removal of cells or tissues so a pathologist may view them through a microscope. Your original breast cancer diagnosis was likely confirmed with a biopsy.

Additional tools for diagnosing advanced breast cancer

The additional tools below are often used specifically for diagnosing advanced cancer:

Sentinel lymph node biopsy: This procedure removes sentinel lymph node cells during surgery for examination. When breast cancer spreads, it often heads first to the lymph nodes.

Chest X-ray: This detailed image of the chest may help doctors see whether cancer has spread to the bones.

Computed tomography (CT) scan: Also known as a CAT scan, this procedure takes detailed pictures of internal areas of the body using a computer linked to an X-ray machine. A dye may be used to help the organs show up more clearly in the images.

Bone scan: This procedure looks for bone metastasis, or cancer cells that have spread to the bone. A small amount of radioactive material is injected into the blood, then detected with a scanner.

Positron emission tomography (PET) scan: A PET scan is a detailed imaging tool that uses a radioactive drug, known as a tracer, to search for cancer cells within your body.

Treatment options for metastatic breast cancer

Treatment for metastatic breast cancer often is based on systemic therapies, which use drugs rather than surgery or radiation. Metastases treatments are designed to shrink tumors and slow their growth, help ease symptoms and improve quality of life. Treatment may change, such as when one therapy stops working, or the side effects become too uncomfortable. Rather than having only one treatment, most patients undergo several treatments combined to help fight the cancer.

The four broad categories of drug-based treatments are:

Hormone therapy

This therapy works by stopping hormones, such as estrogen and progesterone. Some types of breast cancers have receptors, or proteins, which attach to these hormones to help them grow. By blocking the hormones, you may help slow the cancer’s progression. This treatment works on hormone receptor-positive cancers. Side effects of hormone therapies may include hot flashes and vaginal dryness.

Chemotherapy

With so many chemotherapy drugs available, finding the right one for you would depend on your specific type of breast cancer. (It’s frequently used to treat triple-negative breast cancers.)

Chemotherapy is given intravenously, often in cycles throughout several weeks. Some patients tolerate it better than others. It’s possible to experience nausea, diarrhea, a loss of appetite leading to weight loss, fatigue, hair loss and mouth sores.

Targeted drugs

Targeted therapies are newer treatments that work to block specific types of proteins or gene mutations that fuel breast cancer. You may hear the terms “monoclonal antibodies,” “antibody-drug conjugates” or “inhibitors.” These drugs may stop or slow a process fueling cancer, and are sometimes combined with chemotherapy or hormone therapy. Side effects are possible and vary from one drug to another.

Immunotherapies

Immunotherapy drugs are designed to stimulate the immune system to destroy cancer cells in certain types of breast cancers. They’re known as immune checkpoint inhibitors. Side effects may include fatigue, coughing, nausea, rash, loss of appetite and autoimmune reactions.

Other treatment options

In some cases, surgery or radiation may be recommended.

Also, clinical trials may offer qualified patients the opportunity to receive state-of-the-art care and new treatments. Clinical trials, supported by organizations such as NCI, help doctors improve available treatments, comparing new methods and protocols with the current standard care.

Listing search services, such as NCI’s Steps to Find A Clinical Trial, are available online. Ask your cancer care team to help you find and evaluate clinical trial options.

No matter the treatment, ask your cancer care team to talk you through the process in advance, explaining how it would work, what you may feel and how your body may react.

Integrative therapies for metastatic breast cancer

You may find it beneficial to add integrative therapies to your treatment plan. There are many evidence-informed integrative modalities to boost the mind and body. Practices like gentle yoga, meditation, massage and music therapy may feel enjoyable and reduce stress and anxiety levels.

To help our patients maintain quality of life after a metastatic breast cancer diagnosis, our team of breast cancer experts may offer supportive care services to help manage side effects of the disease and its treatments. These may include:

Before starting any integrative therapies, however, ask your care team for advice on which ones are most suited to you and fit into your overall treatment plan, as well as how to do them safely.

Living with metastatic breast cancer

An advanced breast cancer diagnosis often elicits a flood of emotions: fear, confusion, sadness, anger and worry. You may wonder, “Why me?” You may think it’s unfair that this has happened to you. All of these emotions and feelings are normal, so take the time to process your thoughts, speak with your care team to understand your diagnosis, and connect with loved ones and close friends for support.

Over time, as the shock wears off, many patients find that they get on with their lives, adjusting to what some call their “new normal.” You may continue to work, enjoy life and spend time with family and friends, even if sometimes you have less energy than before.

Try to eat a nutritious diet to feel stronger and better tolerate treatments. Maintaining good nutrition may also help lower your risk of infection and provide you with more energy for enjoying life.

Light exercise may give your mind and body's boost, helping you feel energized, especially if you spend time in the fresh air. Always seek medical advice before making any changes to your diet or exercise routines.

Getting additional support

Many people do better when they get support, information and guidance after a diagnosis. Some of this will come from your care team, but now is also the time to rely on family and close friends and colleagues who want to help.

Peer support, either online, face-to-face or via telephone, lets you connect with others who are going through a similar experience. Support groups give patients, caregivers and family members a forum to discuss emotions, gain practical tips and feel more hopeful. Joining a group may be a good way to find emotional support and even find new friendships.

If dealing with a diagnosis of metastatic cancer is causing anxiety, depression and/or fear, working with a licensed cancer psychologist may help you find practical coping strategies.

If you’re unsure of all the different types of support available to you, ask your care team or contact a breast cancer nonprofit organization NCI also offers a searchable database to help you find support groups or services.