Metastatic Breast Cancer: What You Should Know
What does it mean to have metastatic, or stage 4, breast cancer? A Rogel Cancer Center oncologist explains the diagnosis and how its treated.
After hearing a diagnosis of metastatic breast cancer, a rush of questions emerges. But often, its not until long after leaving the doctors office.
Metastatic means the cancer has spread beyond the breast and immediate lymph nodes to other organs or tissues in the body, most often the bones, brain, lungs or liver. Its considered stage 4 breast cancer, which means the cancer has progressed to its most advanced stage.
But even though its moved to other organs, it still behaves like breast cancer and is treated with breast cancer therapies.
More than 154,000 U.S. women are estimated to have metastatic breast cancer, according to the Susan G. Komen organization. Men can have metastatic breast cancer too, but its rare.
To help patients fill in information gaps, N. Lynn Henry, M.D., Ph.D., the breast oncology disease lead for the University of Michigan Rogel Cancer Center, explains the nuances of stage 4 metastatic breast cancer.
What are the differences between metastatic breast cancer, stage 4 breast cancer and advanced cancer?
If any doctor uses the term advanced, ask for clarification, Henry adds.
When does metastatic breast cancer appear?
What are the symptoms?
Symptoms of bone metastases:
Most Common Places It Spreads
It’s still breast cancer, even if it’s in another organ. For example, if breast cancer spreads to your lungs, that doesn’t mean you have lung cancer. Although it can spread to any part of your body, there are certain places it’s most likely to go to, including the lymph nodes, bones, liver, lungs, and brain.
Symptoms Of Secondary Breast Cancer
The symptoms of secondary breast cancer depend on where in the body the cancer has spread to. If it has spread to the bones there might be a painful area in a bone. If it has spread to a lung it may cause breathlessness.
Some people have general symptoms. They may feel generally unwell for no obvious reason. Tell your doctor or nurse if you have any new symptoms. If you are worried, we have more information about the symptoms of secondary breast cancer.
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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.
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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What Happens When Cancer Spreads To The Lymph Nodes
Medically Reviewed by: Dr. BautistaUpdated on: August 26, 2021
Lymph nodes are an important part of the bodys immune system, responsible for attacking germs, bacteria, and viruses. When cancer appears in the lymph nodesits an indicator of cancer spreading from other regions of the body.1 Although, in some cases, it could be the result of cancer originating in the lymph nodes or other parts of the lymphatic system. When cancer originates in the lymph nodes, it is diagnosed as lymphoma.
As cancer cells multiply and overtake healthy functioning cells, they travel at more aggressive rates and grow into new tumors. This progression is referred to as metastasis and is one of the factors that determine a cancer diagnosis, outlook, and treatment.
To further understand what happens when cancer spreads to different lymph nodes, its important to factor in if and how far the cancer cells have metastasized, as well as the tumor size and location. Early symptoms may include:
- Swelling of the lymph nodes, particularly in the neck, armpit, or in the groin area
- Stomach swelling
- Shortness of breath
- Pain, headaches, and dizziness
Other signs of cancerous cells may be fatigue, extreme weight loss, and adverse effects in regions of the body where there is tumor growth.
Looking For More Of An Introduction
If you would like more of an introduction, explore these related items. Please note that these links will take you to other sections on Cancer.Net:
- ASCO AnswersFact Sheet: Read a 1-page fact sheet that offers an introduction to metastatic breast cancer. This free fact sheet is available as a PDF, so it is easy to print.
- ASCO AnswersGuide:Get this free 52-page booklet that helps you better understand breast cancer. The booklet is available as a PDF, so it is easy to print.
- Cancer.Net Patient Education Video: View a short video led by an ASCO expert in metastatic breast cancer that provides basic information and areas of research.
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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:
About The Lymph Nodes
The lymphatic system helps protect us from infection and disease. It also drains lymph fluid from the tissues of the body, before returning it to the blood.
The lymphatic system is made up of fine tubes called lymphatic vessels. They connect to groups of lymph nodes throughout the body.
Lymph nodes are small and bean-shaped. They filter bacteria and disease from the lymph fluid. When you have an infection, lymph nodes often swell as they fight the infection.
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Getting Back On Track: How Bone Metastases Are Treated
Oncologists have a range of tools that can help alleviate the pain and discomfort of bone metastases as well as treat the cancer itself, including:
Other ways to effectively manage pain and discomfort from bone metastases include using hot and cold compresses practicing relaxation methods like meditation, physical therapy, or yoga and doing other gentle forms of exercise. Ask your health care team about programs that can help keep you safely active. Strong muscles protect bones, stresses Huston, and being active makes you feel better both physically and psychologically.
Lung Metastasis: Symptoms Can Be Subtle
Many people who have metastatic breast cancer develop lung metastases. Usually the symptoms are shortness of breath and/or a chronic cough. The symptoms can be fairly subtle, and they typically come on slowly, since the cancer has to use up a lot of your lungs before it compromises your breathing.
There are a couple of different places the cancer can appear in your lung. One is in nodulesusually severalthat show up on a chest X ray. If it shows up in only one nodule, your doctor may want to do a needle biopsy or a full biopsy to find out if its lung cancer or a breast cancer that has spread.
Another form of metastasis in the lung is called lymphangitic spread. In this situation, the cancer spreads along the lymphatics and instead of forming nodules it occurs in a fine pattern throughout the lung. This isnt all cancer. Some of the changes in the lung are due to a lack of lymphatic drainage and fibrosis in the lymph channels. This type of metastasis is subtler and harder to detect on a chest X ray, but it, too, will ultimately cause shortness of breath, since it takes up room and scars the lungs, making them less able to expand and contract and bring oxygen into your bloodstream.
Source: DrSusanLoveResearch.org retrieved September 2016
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Metastatic Breast Cancer Treatment And Planning
After a diagnosis of metastatic breast cancer, its helpful to take all the time you need to gather information and make decisions about your treatment. Learn about the medical specialists that may be involved in your care, treatment options, genetic testing, taking a break from treatment, and more.
SurgeryDoctors sometimes recommend surgery for metastatic breast cancer in order, for example, to prevent broken bones or cancer cell blockages in the liver. Learn more.
ChemotherapyChemotherapy is used in the treatment of metastatic breast cancer to damage or destroy the cancer cells as much as possible. Learn more.
Radiation TherapyYour doctor may suggest radiation therapy if youre having symptoms for reasons such as easing pain and controlling the cancer in a specific area. Learn more.
Hormonal TherapyHormonal therapy medicines are used to help shrink or slow the growth of hormone-receptor-positive metastatic breast cancer. Learn more.
Targeted TherapyTargeted therapies target specific characteristics of cancer cells, such as a protein that allows the cancer cells to grow in a rapid or abnormal way. Learn more.
Local Treatments for Distant Areas of MetastasisLocal treatments are directed specifically to the new locations of the breast cancer such as the bones or liver. These treatments may be recommended if, for example, the metastatic breast cancer is causing pain. Learn more.
Thermal Ablation Or Cryoablation
Thermal ablation or cryoablation can be used alone or in combination with surgery. These procedures involve destroying cancer cells by either heating or freezing them. For example, radiofrequency ablation involves inserting a needle into individual tumours in the liver and destroying them with heat. RFA is a specialist treatment and not widely available. Your treatment team can tell you if it may be suitable for you.
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How Does Breast Cancer Spread
Breast cancer can invade and grow into the tissue surrounding the breast or it can travel to other parts of the body and form a new tumor there. Nearly all types of cancer have the ability to spread , but whether or not it will spread is often linked to what type of breast cancer you have.
Breast cancer can spread in three ways:
Every cancer is different, but the type of breast cancer you have typically plays a role in how aggressive or slow moving it is and where its most likely to spread, says Dr. Roesch.
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.
Breast Cancer In The Spine Understanding Metastatic Breast Cancer
Physician, Psychiatrist, Breast Cancer Survivor- Lifer, Mother, Speaker and Blogger
Image of the spine
If you are a music fan or hear the news, by this time you must have come across this very disheartening news that Olivia Newton Johns breast cancer has returned in her spine which is why her concerts are being canceled. Ms. Newton John has been an advocate in the breast cancer community and she established the ONJCC in Australia where active research to combat breast cancer is happening . As a woman dealing with metastatic breast cancer for the last year, I wish she hadnt joined this club and I am truly saddened for her. She was first diagnosed with Breast Cancer in 1992 and now 25 years later, she has been found to have breast cancer in her spine. I can imagine how devastating it must be for her and her family as I too live with metastatic breast cancer. I wish her great success in her upcoming treatment and sincerely pray that she will go in remission.
If the patient has one metastatic lesion, their odds of going to remission are much higher as the single focus of the disease can be targeted. As in case of Ms, Newton John, the spot in her spine can be targeted via radiation. For some women, with an isolated spot say in the liver, it can be embolized or resected . Majority women, however, will have multiple foci of disease.
A Little Bit About The Internal Mammary Lymph Nodes
The internal mammary nodes are located behind the ribs. Ribs are made of bone, but in the front, they turn into cartilage just before they join the sternum.
So, each rib attaches to the sternum with cartilage and each of these cartilage bars is around 5 cm long. Thus, it can be very difficult to remove an internal mammary node. There is an internal mammary artery and vein along with the lymph ducts and other veins.
If you need to remove an internal mammary node, the cartilage in front needs to be cut out. Cartilage, unfortunately, does not grow back or heal and this will leave a gap which makes the rib essentially useless.
So, it is a judgement call by the surgeon as to whether or not one should attempt a surgical approach to remove internal mammary nodes with positive metastasis. This is because surgical removal is just too damaging to the function of the chest and ribs.
However, electron beam radiotherapy is an effective treatment for internal mammary nodes. The electrons penetrate to about the correct depth to reach the internal mammary nodes.
Treatment of Stage IIIa Breast Cancer
The treatment for women with stage IIIa breast cancers tends to be a modified radical mastectomy and locoregional radiotherapy.
Often, chemotherapy is given as adjuvant therapy, but in some cases , pre-operative chemotherapy is also recommended. Breast conservation is generally not a good option with stage IIIa breast cancers.
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If Your Breast Cancer Has Spread
Even if your breast cancer has spread to other parts of your body, it does not necessarily mean its not treatable. If the cancer cannot be removed, the goal of treatment is to improve symptoms, improve quality of life and extend survival.
Some women live with breast cancer for several years as they learn to adjust and accept that theyll be on treatment for an indefinite period of time, explains Dr. Roesch. Your cancer team will help you learn and cope with what you can expect on this journey.
Stages Of Breast Cancer: Stage Iiib
A stage IIIb breast cancer is one in which the tumor may be of any size but it has grown into the chest wall or the skin of the breast. A stage IIIb designation also applies if there is evidence of either
- axillary lymph node metastasis
- internal mammary node metastasis
presenting in such a way as to suggest that total surgical removal is not possible.
There is a unique type of breast cancer, inflammatory breast cancer, that causes the breast to appear red and swollen. This is because the cancer cells block some of the lymphatic vessels. Inflammatory breast cancers tend to have a poorer prognosis and are generally stage IIIb at least.
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What Are The Symptoms Of Metastatic Breast Cancer In The Lungs
If your breast cancer has metastasized to your lungs, you may not notice any symptoms right away. Your first symptoms are likely to feel a little like cold or flu symptoms. They might include persistent cough, shortness of breath, difficulty breathing, wheezing, or fatigue. You could also experience pain in your lungs, coughing up blood, loss of appetite, weight loss, or recurrent chest infections.
Testing Lymph Nodes For Cancer
A swollen lymph node can be felt with your fingertips and sometimes, and if large enough, can be seen. However, there are other areas of the body where lymph nodes are more difficult to find and dont present symptoms on the surface. The only way to confirm a cancer diagnosis in the lymph nodes is through a biopsy.
A biopsy is performed by using a long, thin needle to remove part of the lymph nodes or lymphatic tissue and reviewing it under a microscope to see if there are cancerous cells. The number of cancer cells will determine the course of treatment. There are additional tests to also determine how far cancer has spread and the cancer stage. All of this plays a part in the type, frequency, and outlook of treatment.
If you are wondering, is cancer of the lymph nodes terminal, understand that cancer spreadto the lymph nodes does not automatically determine which stage its in.3 Typically, if its traveled far from its originating tumor source, it could indicate a later stage, though there are several tests that can be performed to get a clearer picture. These include:
Not all of these tests are necessary to confirm cancer staging, but they each help deliver more information to make an accurate diagnosis. Furthermore, cancer staging is assigned at the time of diagnosis but can be restaged following treatment. This is based on if cancer has stopped its growth or metastasized to other areas of the body.
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