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 create a picture of internal areas of the body.
Magnetic resonance imaging : 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.
Breast 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.
Why Werent These Escaping Cells Identified The First Time The Cancer Was Treated
Although scans of the body can detect if there is obvious spread to these other organs, for women with early stage breast cancer there rarely is anything that shows up on a scan. There is a limit to what scans can tell us: they wont show extremely tiny spots of cancer, and they definitely cant show us if there are individual cells circulating in the body. Neither will any blood test, or any other test for that matter. So the first time around we perform our surgery and give our treatmentschemotherapy, hormonal therapy, radiationwith the hope that if microscopic spread has already taken place, the treatments will scavenge those cells and kill them before they take up residence someplace in the body.
Unfortunately, these treatments dont work 100 percent of the time. So if cells have spread, and if the treatments we give dont affect them, the cancer cells can persist and take hold someplace, developing into metastases, or spread. This is why and how recurrence happens.
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Living With Secondary Breast Cancer
You will see your cancer doctor or specialist nurse regularly during and after treatment. This means that any symptoms or problems can be managed early on. You may have regular scans to check how the cancer has responded to treatment.
You may need treatment at different times or have ongoing treatment with hormone therapy. There may be long periods when the cancer is controlled and you are getting on with day-to-day life.
We have more about well-being and coping in our information about living with secondary breast cancer.
You may get anxious between appointments. This is natural. It may help to get support from family, friends or a support organisation. Macmillan is also here to support you. If you would like to talk, you can:
Ten Lifestyle Changes That May Help
All breast cancer survivors live with the concern about a recurrence or a new cancer. This fear is usually the biggest worry of all. Many women feel that their body has betrayed them and therefore it takes time to trust it again.
Learning how to cope with fears of recurrence is important. Though your body has gone through many changes as a result of a cancer diagnosis and treatment, most women become healthy, strong and optimistic once again.
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How Can I Take Care Of Myself While Living With Metastatic Breast Cancer
Living with metastatic breast cancer can be challenging. Your care team can help provide physical and emotional support. Talk to them about how you can:
- Eat the most nutritious diet for your needs.
- Exercise regularly.
- Get emotional support, including finding support groups.
- Reach out for help from friends, family and loved ones.
- Find mental health services.
- Find complementary therapies.
Can I Lower My Risk Of Breast Cancer Progressing Or Coming Back
If you have breast cancer, you probably want to know if there are things you can do that might lower your risk of the cancer growing or coming back, such as exercising, eating a certain type of diet, or taking nutritional supplements. Fortunately, breast cancer is one of the best studied types of cancer in this regard, and research has shown there are some things you can do that might be helpful.
Staying as healthy as possible is more important than ever after breast cancer treatment. Controlling your weight, keeping physically active, and eating right may help you lower your risk of your breast cancer coming back, as well as help protect you from other health problems.
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Diagnosis Of Secondary Breast Cancer
You may be diagnosed with secondary breast cancer after having tests to check a new symptom. This could be through your GP or at a breast cancer follow-up clinic. Sometimes there may be no obvious symptoms and the diagnosis is made after routine follow-up tests.
Some women who have just been diagnosed with primary breast cancer have tests that show the cancer has already spread to other parts of the body. Sometimes the secondary breast cancer is diagnosed first and tests show that it first started in the breast.
Your cancer doctor or nurse will ask you about your symptoms and general health. You may need some of the following tests:
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Support For Living With Secondary Breast Cancer In The Lung
Everyones experience of being diagnosed with secondary breast cancer is different, and people cope in their own way.
For many people, uncertainty can be the hardest part of living with secondary breast cancer.
You may find it helpful to talk to someone else whos had a diagnosis of secondary breast cancer.
- Chat to other people living with secondary breast cancer on our online Forum
- Meet other women with a secondary diagnosis and get information and support at a Living with Secondary Breast Cancer meet-up
- Live Chat is a weekly private chat room where you can talk about whatevers on your mind
You can also call Breast Cancer Nows Helpline free on 0808 800 6000.
What Is Secondary Breast Cancer
Secondary breast cancer is when cancer cells from a cancer that started in the breast spread to other parts of the body. The cancer that started in the breast is called primary breast cancer.Secondary breast cancer is also called advanced breast cancer or metastatic breast cancer. The most common places for breast cancer to spread to are the:
Rarely, breast cancer may spread to other parts of the body, such as the bone marrow, ovaries or lining of the tummy which is called the peritoneum.
Breast cancer can spread to different parts of the body. This does not mean it will go to all these places.
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How Is Metastatic Breast Cancer Treated
The main treatment for metastatic breast cancer is systemic therapy. These therapies treat the entire body. Systemic treatments may include a combination of:
Your care team will plan your treatment based on:
- Body parts cancer has reached.
- Past breast cancer treatments.
- Tumor biology, or how the cancer cells look and behave.
Can You Tell When Exactly My Breast Cancer Started
Often times, one of the most frequently asked questions I get when someone is diagnosed with breast cancer is when did it begin? says Roesch. And the general rule is that we really cant tell for sure when the cancer popped up. We can look at the subtype of breast cancer to perhaps get a better understanding if it was weeks vs. months for example, but theres no way to tell for sure.
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How Is A Local Recurrence After Lumpectomy Diagnosed
After a diagnosis of early stage breast cancer, any remaining breast tissue should be evaluated annually with scans .
Most local recurrences within the breast after lumpectomy are detected on routine annual breast imaging, which usually takes the form of mammography and ultrasound, and on occasions MRI.
If you have a local recurrence or new primary breast cancer, you may find symptoms similar to an initial breast cancer. This includes:
- A new lump in the breast, armpit area or around the collarbone
- A change in breast size or shape
- Changes to the nipple, such as sores or crusting, an ulcer or inverted nipple
- Clear or bloody nipple discharge
- Changes to the skin including redness, puckering or dimpling
- Breast tenderness or pain
Once a local recurrence has been diagnosed, we do tests to see whether there are signs of cancer elsewhere in the body. These may include a chest X-ray, CT scan, bone scan or PET scan, and blood tests , then we have to figure out how best to treat the tumour in the breast. Usually in these cases we do a mastectomy, as the prior less drastic surgery and radiation didnt take care of it.
The Types Of Radiotherapy
The type of radiotherapy you have will depend on the type of breast cancer and the type of surgery you have. Some women may not need to have radiotherapy at all.
Types of radiotherapy include:
- breast radiotherapy after breast-conserving surgery, radiation is applied to the whole of the remaining breast tissue
- chest-wall radiotherapy after a mastectomy, radiotherapy is applied to the chest wall
- breast boost some women may be offered a boost of high-dose radiotherapy in the area where the cancer was removed however, this may affect the appearance of your breast, particularly if you have large breasts, and can sometimes have other side effects, including hardening of breast tissue
- radiotherapy to the lymph nodes where radiotherapy is aimed at the armpit and the surrounding area to kill any cancer that may be in the lymph nodes
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Take Care Of Your Emotional Needs
A breast cancer diagnosis can take quite a toll on your body, both physically and mentally. The treatments can affect each person differently. And the uncertainty that comes along with breast cancer may also affect your self-worth, identity, and your confidence.
After treatment, managing your new normal and coming to terms with all that has happened may feel challenging. Itâs important to take the time to heal and prioritize your overall emotional and mental health, in addition to your physical health.
- Make some time for self-care and put your needs first.
- Talk to a professional counselor or therapist if fears of breast cancer coming back start to interfere with your daily life.
- Connect with other people whoâve had breast cancer to gain a sense of community.
- Follow news on new treatments or findings.
- Practice mindfulness to reduce stress. Yoga, meditation, and other relaxation techniques can help you center yourself.
- Pick up a hobby that youâve enjoyed before, or explore new ones.
- Journal your feelings.
Keep in mind that if breast cancer does come back, it is not your fault and it can often be treated.
Johns Hopkins Medicine: âReducing Risk of Recurrence,â âEndocrine Therapy for Premenopausal Women,â âEndocrine Therapy for Postmenopausal Women,â âBreast Cancer Recurrence.â
Cleveland Clinic: â3 Reasons to Quit Smoking After a Cancer Diagnosis.â
American Lung Association: âTop Tips for Quitting Smoking.â
Am I Still At Risk Of Local Recurrence If I Have Had A Mastectomy
Yes. Local recurrence can also happen after a mastectomy, although the likelihood is usually low.
Some of the signs of local recurrence after mastectomy include
- A lump or raised bump in or under the skin, especially near the previous mastectomy scar
- Changes to the skin, including redness or thickening
After reconstruction a local recurrence can appear at the suture line of the flap or in front of the implant. When its in the skin itself, it is red and raised. Reconstruction rarely if ever hides a recurrence. With implants, the recurrences are in front of the implant. With a flap, the recurrences are not in the flap itself but along the edge of the breast skin.
Local recurrence after mastectomy is often described as a chest wall recurrence, which isnt entirely accurate because it implies that the cancer is in the muscle or bone. But usually such a recurrence appears in the skin and fat where the breast was before, and only rarely does it include the muscle.
Ninety percent of local recurrences following mastectomy happen within the first five years after the mastectomy. Approximately 20 to 30 percent of women with local recurrences after mastectomy have already been diagnosed with metastatic disease, and another 20 to 30 percent will develop it within a few months of diagnosis. Therefore, just as with local recurrences after breast conservation, tests should be done to look for distant disease.
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Why Does Metastatic Breast Cancer Happen
Most often, metastatic cancer occurs because treatment didnt destroy all the cancer cells. Sometimes, a few cells remain dormant, or are hidden and undetectable. Then, for reasons providers dont fully understand, the cells begin to grow and spread again.
De novo metastatic breast cancer means that at the time of initial diagnosis, the breast cancer has already spread to other parts of the body. In the absence of treatment, the cancer spreads.
There is nothing you can do to keep breast cancer from metastasizing. And metastatic breast cancer doesnt happen because of something you did.
The Nonlinear Path To Metastasis
Cancer doesnât just spread because a primary tumor has reached a certain size or stage. Disseminated tumor cells, or DTCs, can break off before a tumor has even formed and travel to distant sites in the body where they lie dormant until something âwakes them upâ and they start the deadly process of metastasis, or cancer spread/colonization.
One common hideout for these sleepy creeps is the bone marrow. Dormant tumor cells have been found in the bone marrow of breast cancer patients at the very earliest stage of the disease â DCIS or stage 0 â and Ghajar said theyâre mostly likely present in other patients with early-stage disease, as well.
Past research has shown an association between DTCs in the bone marrow of cancer patients and metastatic recurrence â and not necessarily just bone metastasis.
âPatients with breast cancer cells in the marrow recur more often than patients who donât have cells in the bone marrow,â said Ghajar, who collaborated with a cadre of Fred Hutch researchers as well as scientists from the University of Colorado Anschutz Medical Campus and the University of California, San Diego. âAnd tumor cells in the bone marrow predict metastasis in a variety of different sites. They even predict metastasis in cancers that never get bone mets.â
But Ghajar said thereâs scientific evidence that âif you can successfully remove disseminated tumor cells, you can prevent those patients from having mets.â
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Treatment Of Local Recurrence After Previous Mastectomy
Most commonly the lesion is removed surgically and followed by radiation to the chest wall if the woman has not previously had radiation Treatment of local recurrence after mastectomy can involve a variety of different approaches, including surgery to remove the recurrence if it is confined to a limited area. Other options for treatment include radiation, chemotherapy, and endocrine therapy, or a combination of these.
Despite aggressive local treatment, many women with an isolated local recurrence following mastectomy eventually develop distant metastases. This is not because the local recurrence spreads, but rather because it is a sign that things have changed and dormant cells in other organs may also be waking up.