What Are The Symptoms Of Metastatic Breast Cancer

Metastatic Breast Cancer Blood Tests

Different blood tests may be used to detect breast cancer:

• The CA 27.29 blood test measures the level of a protein called the CA 27.29 antigen. In theory, the level rises as there is more breast cancer in the body. This test can, in some patients, help determine if cancer is growing in the body, or whether treatments are working. Similar tests include the CA-15-3 and CEA.
• Circulating tumor cells may also be measured through a blood test. CTCs are extremely rare in healthy individuals and patients with nonmalignant diseases but are often present in people with metastatic cancer. Some clinical studies indicate the assessment of CTCs can assist doctors in monitoring and predicting cancer progression and in evaluating a patients response to therapy. CTC testing and use is still in the experimental stage.

For more detailed information on MBC treatment and resources, download or order a free copy of our Metastatic Navigator.

What Is The Prognosis For Those With Metastatic Cancer

While there is no cure for metastatic breast cancer, there are treatments that slow the cancer, extending the patients life while also improving the quality of life, Henry says. Many patients now live 10 years or more after a metastatic diagnosis.

“We are seeing improvements in how long people are living. The new types of medicines that are being approved treat the cancer and help with other symptoms. People are not only living longer, but they are also feeling better longer for the most part, which is very encouraging.”

Other Symptoms And Signs Of Metastasis

• Loss of appetite

• Vomiting

• Fatigue

If you are concerned about any changes you experience, please talk with your doctor. Your doctor will ask how long and how often you have been experiencing the symptom, in addition to other questions. This is to help figure out the cause of the problem, called a diagnosis.

If the doctor diagnoses metastatic breast cancer, relieving symptoms remains an important part of care and treatment. This may be called palliative care or supportive care. It is often started soon after diagnosis and continued throughout treatment. Be sure to talk with your health care team about the symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. Use the menu to choose a different section to read in this guide.

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Treatment For Physical Symptoms

The American Cancer Society urge that a person should not have to endure pain in the final months and days of life.

Many people find relief with opioid medications, but these can cause side effects such as fatigue and constipation. A person may use opioids in combination with other pain relief medications, such as acetaminophen or ibuprofen.

Other drugs, such as antidepressants and antiseizure medications, can also treat certain types of pain.

Doctors can also prescribe medications for nausea and vomiting. Some drugs for treating nausea can make a person drowsy. However, these drugs may help people eat and drink more or simply make it easier for them to function and interact with other people.

Metastatic Breast Cancer: Diagnosis And Treatment

Metastatic breast cancer is cancer that originated in the breast and has spread to other organ systems in the body. Women may have metastatic disease at the time of their initial diagnosis or in the months or years following a diagnosis of localized breast cancer. As is true with localized breast cancer, metastasis and its meaning to your health depend on many factors.

The following factors are important for making decisions on treatment:

• Where the metastasis is
• What symptoms you are experiencing
• What prior treatments you have had
• All of the information about your breast cancer’s biology

The most common sites of spread beyond local breast cancer are bone, lung, liver and brain.

Learning of a diagnosis of metastatic disease is often accompanied by fear, uncertainty and difficulty with treatment decision making. While we have no treatments guaranteed to cure metastatic breast cancer, many women live many years with courage, tenacity and hope, treating breast cancer as a chronic illness and responding variably to systemic therapies.

The team of doctors and health care providers at the UCSF Carol Franc Buck Breast Care Center will work with you individually to address your personal medical concerns and to determine a treatment plan that meets your medical needs. In addition, the Breast Care Center and the UCSF Patient and Family Cancer Support Center offer support and wellness services to help you manage the emotional and lifestyle challenges that you may face.

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Metastatic Breast Cancer Symptoms In The Liver:

This can be a bit trickier to identify because the symptoms can be similar to other stomach and gastrointestinal issues, says Dr. Taiwo. Often a person will have abdominal pain, nausea, and vomiting, or even jaundice , depending on how much the cancer has spread in the liver. By the time that a patient tends to present with symptoms, they already have a fairly significant burden of disease, she saysmeaning that their cancer has already progressed to make them very sick.

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:

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How Is Metastatic Breast Cancer In Bones Treated

Metastatic breast cancer in the bones is typically not curable. Instead, Dr. Taiwo says that doctors prioritize slowing the cancer’s growth and managing related symptoms. “The focus really is trying to extend life and maintain quality of life,” she says.

Metastatic breast cancer patients often receive traditional medications like chemotherapy, immunotherapy, and targeted treatments for their specific cancer type , says Dr. Tsarwhas. But there are also many bone-strengthening medications used to help people with bone metastases. Bone-targeted agents like denosumab, for example, are used to help slow bone degradation and reduce the risk of fractures, he says.

Localized radiation treatment can also help shrink bone cancer cells and reduce pain, adds Dr. Taiwo. This can hugely improve a patient’s quality of life, she says, as bone lesions can be incredibly painful.

“We also look for any bones that might have the potential to cause a problem in terms of a fracture,” says Dr. Lin. In those cases, she says doctors often send people to orthopedic surgeons for preventative surgeries to help stabilize bones. For example, surgeons can use medical-grade bone cement to seal and support existing fractures, or recommend joint-replacement surgery to ensure a person has pain-free mobility.

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.

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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 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 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.

What Are Metastatic Breast Cancer Symptoms And How Is It Diagnosed

When breast cancer metastasizes outside the breast, it causes a secondary cancer in a new area of the body. Symptoms of metastatic breast cancer vary depending on where the secondary cancer develops. Your doctor will order appropriate diagnostic tests to confirm secondary cancer based on your symptoms.

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What Are The Signs Of Metastatic Breast Cancer

Metastatic breast cancer is stage IV cancer, which has spread to other parts of the body. Cancers are a group of diseases in which some types of cells turn abnormal and proliferate without control. Cancer can start anywhere and spread to any part of the body, but is named by the organ in which it first develops. Men can also develop breast cancer, although it is rare.

If breast cancer spreads to the bone, it is still considered metastatic breast cancer that has spread to the bone it is not considered to be bone cancer. In metastatic breast cancer, breast cancer cells break from the primary tumor, travel through blood or lymph fluid, settle into other parts of the body and start growing into new metastatic breast tumors.

What Are The Symptoms Of Bone Metastasis In Breast Cancer

All three doctors say that new, progressive pain in your bones or joints is the most common symptom of metastatic breast cancer in bones. “I always tell patients to inform me if there’s pain that’s not getting better,” says Dr. Tsarwhas. This can sometimes be confused with arthritis or other pre-existing chronic pain issues, he says, which is why it’s important for breast cancer patients to be proactive about any new pain they encounter.

New fractures or unexplained fractures can also be a sign of bone metastasis, Dr. Tsarwhas adds. Cancer can weaken bones and make them break more easily. “New lumps or bumps in the lymph node area…could be a sign of recurrent breast cancer as well,” he says.

A person with metastatic breast cancer in their bones may also experience more general cancer symptoms, such as fatigue, lack of appetite, and extreme, unexplained weight loss.

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Triple Negative Breast Cancer

With this type of breast cancer, the breast cancer cells dont have ER+ or PR+ receptors. They dont overproduce the HER2 protein, so hormone therapy isnt very effective.

Instead, triple negative stage 4 breast cancer is usually treated with chemotherapy. Radiation therapy may also be an option, depending on the site of metastasis.

Metastatic Breast Cancer Symptoms And Diagnosis

The most common breast cancer metastasis sites are the bones, the lungs, the brain, and the liver. The symptoms of metastatic breast cancer can be very different depending on the location of the cancer:

• constant back, bone, or joint pain
• difficulty with urinating this can be a sign that the nerves in your back are being pinched by a cancer
• numbness or weakness anywhere in your body
• a constant dry cough
• abdominal bloating, pain, or tenderness
• constant nausea, vomiting, or weight loss
• jaundice
• severe headaches
• vision problems
• seizures
• confusion

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What If A Patient Sees The Term Metastatic On An Online Pathology Report Before Seeing The Oncologist Does That Mean They Have Stage 4

“Because we have electronic medical records now, and everyone has fairly early access to documents like pathology reports, it can cause a lot of anxiety and be very confusing to a patient,” Henry says. “Sometimes a pathology report may say ‘metastatic to lymph node.’ But that may not mean it is stage 4.” It may simply mean the cancer has spread to an adjacent lymph node. Henry emphasizes that patients should talk to their doctor to understand their diagnosis.

How Does Breast Cancer Spread

For the majority of patients with metastatic breast cancer, it means an initial earlier-stage diagnosis spread to distant parts of the body. According to the National Cancer Institute , cancer cells spread throughout the body in a series of steps.

The first step of metastasis for any type of cancernot specifically breast canceris when cancer spreads to nearby healthy tissue in the body. The cancer can then continue to spread to nearby lymph nodes or blood vessels in the body, per the NCI. Once cancer cells move into the body’s lymph nodes or blood vessels, they essentially gain access to the body’s lymphatic system and bloodstream. With that access, cancer cells can stop in a distant location in the body, invade blood vessel walls, and then move into surrounding tissue, growing there until a new tumor forms. New blood vessels then grow to create a blood supply to the new tumor to help it continue to grow.

It’s important to note that this doesn’t happen with every cancer diagnosismost cancer cells will die during this process. But, per the NCI, as long as conditions in the body are “favorable,” metastasis can happen. Some metastatic cancer cells can also remain at a distant site for years, inactive, before they begin to grow again .

As Dr. Tsarwhas explained earlier, breast cancer specifically can spread anywhere in the body, but most often spreads to the brain, bone, liver, and lungs.

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When Metastatic Cancer Can No Longer Be Controlled

If you have been told your cancer can no longer be controlled, you and your loved ones may want to discuss end-of-life care. Whether or not you choose to continue treatment to shrink the cancer or control its growth, you can always receive palliative care to control the symptoms of cancer and the side effects of treatment. Information on coping with and planning for end-of-life care is available in the Advanced Cancer section of this site.

Symptoms Of Metastasis May Vary Depending On Where The Cancer Has Spread To

Here are some symptoms that vary by locations commonly associated with breast cancer metastasis.

Metastasis in the bone may cause:

• Severe, progressive pain
• Bones that are more easily fractured or broken

Metastasis to the brain may cause:

• Persistent, progressively worsening headache or pressure to the head
• Vision disturbances
• Behavioral changes or personality changes

Metastasis to the liver may cause:

• Jaundice
• Abnormally high enzymes in the liver
• Abdominal pain, appetite loss, nausea, and vomiting

Metastasis to the lungs may cause:

• Chronic cough or inability to get a full breath
• Abnormal chest X-ray
• Chest pain
• Other nonspecific systemic symptoms of metastatic breast cancer can include fatigue, weight loss, and poor appetite, but its important to remember these can also be caused by medication or depression.

If you notice these symptoms, be sure you talk with your physician. They could be important for getting the treatment you need.

Interested in learning more? i3Health is hosting an upcoming webinar Metastatic Triple-Negative Breast Cancer: Applying Treatment Advances to Personalized Care. Learn more here.

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What Are The Symptoms Of Metastatic Cancer

Metastatic disease symptoms are tricky because they vary depending on where the cancer cells have spread, Henry says. Some symptoms might be caused by side effects of medication or they might be an indication of depression. Its important to explore the cause.

“I always encourage a patient with a history of breast cancer to call us if she has a new symptom, especially if it sticks around longer than expected,” she says.

These are some common symptoms of metastatic breast cancer by site:

Symptoms of bone metastases:

• Back, bone or joint pain
• Swelling

• Worsening headache or pressure to the head
• Vision problems
• Seizures
• Behavioral changes, confusion or personality changes

Symptoms of liver metastases:

• Abdominal pain, appetite loss, nausea and vomiting

Symptoms of lung metastases:

• Inability to draw a full breath
• Chest pain

What Can I Expect While Living With Metastatic Breast Cancer

Your care team will monitor you every few months to check if the cancer is responding to treatment, and also to see if you are having any side effects. The process of restaging the cancer includes:

• History/physical exam.
• Blood tests.
• Imaging tests, including CTs and bone scan or PET scan.

Before your scans or tests, its normal to feel anxiety. It may help to bring a friend or family member to the appointment with you.

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Talking To Your Healthcare Provider

It is crucial that you talk to your oncologist and healthcare team about any and all symptoms you are experiencing. Some of these symptoms, such as pain, are under-treated in people with metastatic cancer. This is not because healthcare providers fail to treat the symptoms, but because they are simply unaware that a person is coping with them.

Breast Cancer Doctor Discussion Guide

Get our printable guide for your next healthcare provider’s appointment to help you ask the right questions.

With all of the talk about people with cancer being brave or strong, you might hesitate to share symptoms that could make you appear frightened or weak. Yet facing metastatic cancer is frightening, and being able to share your concerns is a sign of strength, not weakness. There is a lot that can be done to ease most of the symptoms of metastatic breast cancer, but the only way that your oncologist can know what you are feeling is if you are brave enough to speak up.

In addition, sharing your symptoms, even if they may seem of little consequence to you, may help your oncologist better recognize the extent of your disease, anticipate potential complications, and suggest the best possible treatments for your disease.