Metastatic Breast Cancer

What is metastatic breast cancer?

Metastatic breast cancer, also called advanced breast cancer or Stage IV breast cancer, is cancer that’s spread (metastasized) from your breast to other areas of your body. Healthcare providers can’t cure metastatic breast cancer, but they can recommend treatments that improve your quality of life and help you live as long as possible. In fact, more people are living longer with metastatic breast cancer as medical researchers find new ways to treat the disease.

Is metastatic breast cancer common?

The most recent data available shows around 170,000 women and people assigned female at birth (AFAB) in the United States are living with metastatic breast cancer. The U.S. National Cancer Institute (NCI) estimates 297,000 women and people AFAB and 2,800 men and people assigned male at birth (AMAB) will receive a breast cancer diagnosis in 2023.

Do all people with breast cancer develop it?

No, they don’t. According to NCI data, about 20% to 30% of women and people AFAB with early-stage cancer later develop metastatic breast cancer.

What are symptoms of metastatic breast cancer?

If you have metastatic breast cancer, you may worry that everyday physical issues are signs that cancer is growing and spreading. But try to remember that not every change means breast cancer is getting worse.

For example, fatigue is a common symptom of metastatic cancer. It’s also a side effect of common cancer treatments like chemotherapy and radiation. That said, don’t hesitate to talk to your healthcare provider if you always feel exhausted, don’t have much appetite or notice you’re losing weight without trying.

There are other specific symptoms that may be signs of metastatic breast cancer. Those symptoms depend on where the cancer spreads:

Bones

• Sudden joint pain or bone pain.
• Bones that fracture (break) more easily.
• Numbness or muscle weakness in your arms and legs.
• Swelling.

Brain

• Worsening headaches or pressure in your head.
• Issues like double vision, blurred vision or seeing flashes of light.
• Seizures.
• Nausea and vomiting.
• Behavior or personality changes.

Lungs

• Cough that won’t go away.
• Difficulty catching your breath (dyspnea).
• Chest pain.
• Frequent chest infections.

Liver

• Jaundice.
• Itchy skin or rash.
• Stomach pain, loss of appetite, nausea and vomiting.

What causes metastatic breast cancer?

Most metastatic breast cancer is recurrent cancer, meaning it’s cancer that came back after treatment and is affecting tissue and organs located far from the original breast cancer tumor. That said, about 6% of women and people AFAB who receive a breast cancer diagnosis already have metastatic breast cancer.

Breast cancer typically comes back when treatment doesn’t destroy all cancer cells. Treatments can reduce tumors so much that tests don’t detect their presence. Even surgery to remove a cancerous tumor isn’t always 100% effective. Cancer cells can move into nearby tissue, lymph nodes or the bloodstream before the surgery.

These weakened cancer cells can remain in your body after treatment. Over time, the cells get stronger. They start to grow and multiply again. These cells may travel through your bloodstream and lymphatic system, using your lymph nodes and blood vessels to carry cancer to other areas of your body. Your lymph nodes and blood vessels carry fluid throughout your body, which makes it easy for breast cancer cells to find new places to settle and form new tumors.

Breast cancer cells may start forming new tumors right away, eventually causing symptoms or signs that show breast cancer has spread. Sometimes, they lie dormant — meaning they’re not growing or spreading — for months or years after treatment. That’s one reason why metastatic breast cancer may appear long after you’ve finished treatment.

How is metastatic breast cancer diagnosed?

If you have symptoms of metastatic breast cancer, your provider may recommend the following tests:

• Biopsy, to remove a sample of tissue so a medical pathologist can examine it under a microscope.
• Blood tests, including complete blood count and comprehensive metabolic panel.
• Bronchoscopy, which uses a scope to look inside your lungs — this can be done if there’s a concerning spot in your lungs.
• Imaging tests, including bone scans, chest X-rays, CT, MRI, PET and ultrasound.
• “Taps,” to remove fluid from an area with symptoms. For example, a pleural tap removes fluid from the lung area. A spinal tap removes fluid from the spinal cord area.

How is metastatic breast cancer treated?

Right now, there isn’t a cure for metastatic breast cancer. Healthcare providers focus on treatments that cause the fewest possible side effects while helping people live for as long as they can, with the best possible quality of life. That means there’s no one way to treat metastatic breast cancer. Providers develop treatment plans based on factors like:

• Type of breast cancer. Healthcare providers use different treatments for metastatic triple-negative breast cancer than other more common types of breast cancer such as hormone-positive breast cancer.
• Where cancer has spread. For example, breast cancer in your lungs may receive different treatment than breast cancer in your liver.
• Past breast cancer treatment. Providers consider how cancer reacted to treatment and how treatment affected you.
• Lab test results.Medical pathologists examine cancer cells under a microscope to see how the cells look and act.

What are specific treatments for metastatic breast cancer?

• Chemotherapy.
• Hormone therapy.
• Immunotherapy.
• Targeted therapy.

How long does treatment last?

If you’ve had treatment for early-stage breast cancer, you may be familiar with treatment plans where you receive cancer drugs over a specific time. Then, the goal was to eliminate cancer. Now, the goal is to shrink new tumors, keep cancer from spreading and help you manage symptoms. That means you may receive treatment indefinitely.

Do providers treat metastatic breast cancer with surgery?

Metastatic breast cancer often spreads to more than one area, so healthcare providers typically don’t recommend surgery. They may suggest surgery to ease specific symptoms. For example, if there’s breast cancer in your liver, they may do surgery to remove tumors that keep your liver from working as it should.

Can metastatic breast cancer be prevented?

Unfortunately, there’s no way to prevent breast cancer from spreading. It’s important to remember metastatic breast cancer doesn’t happen because of something you did or didn’t do. You may develop metastatic breast cancer because some cancerous cells survived treatment and spread through your bloodstream or lymphatic system.

How can I lower my risk?

One way to lower your risk is to keep an eye on your overall health and watch for potential metastatic cancer symptoms. While treatment can’t cure metastatic cancer, it can slow it down.

What can I expect if I have metastatic breast cancer?

If you’re receiving treatment, you’ll have regular follow-up appointments with your healthcare provider. They’ll check on your overall health and ask you about any new symptoms or concerns. They’ll do tests to see if treatment is making a difference.

What are metastatic breast cancer survival rates?

According to the U.S. National Cancer Institute, 1 in 3 women and people AFAB were alive five years after diagnosis. When you think about survival rates, try to remember that they’re just estimates. A survival rate doesn’t indicate how long someone will live with metastatic breast cancer.

It’s also important to remember lots of factors may affect your situation, from the kind of breast cancer you have and any past treatments to your overall health. If you have questions about metastatic breast cancer survival rates, talk to your healthcare provider. They know you, and they’re your best resource for information on what you can expect.

What’s it like to live with metastatic breast cancer?

In some ways, living with metastatic breast cancer may feel very familiar. You’re still receiving treatment, you’re still managing symptoms and you’re still trying to cope with the daily challenges of having a serious illness. The difference is there’s cancer in different parts of your body and it’s not likely to go away.

That’s probably very hard news to hear. It may feel like you’ve lost control of your life or make you feel helpless. If that’s your situation, there are things you can do to help manage stress and your specific situation:

• Consider palliative care for metastatic breast cancer. In palliative care, healthcare providers help you manage treatment side effects and symptoms. More than that, palliative care offers resources that help you take care of your mental health.
• Eat the most nutritious diet for your needs.Treatment may affect your appetite. If you’re concerned about your diet, ask to speak with a nutritionist. They’ll have suggestions for food choices.
• Take it easy. Living with metastatic breast cancer can feel like you’re running a never-ending marathon. Do your best to slow down and take things one step at a time.

When should I see my healthcare provider?

Contact your provider if you notice changes in your body that may be signs of breast cancer in a new area in your body.

What questions should I ask my healthcare provider?

If you’ve been diagnosed with metastatic breast cancer, ask your provider:

• What are my treatment options?
• What’s my prognosis?
• What side effects can I expect?
• Will complementary therapy help me feel better?
• What if I want to stop treatment?
• How can I feel my best during treatment?

Does metastatic breast cancer go into remission?

It can, but that depends on the type of breast cancer. For example, one study found examples where treatment put metastatic HER2-positive breast cancer into remission for nine years. (Remission means you don’t have symptoms and tests don’t find signs of cancer. Healthcare providers may use the term “no evidence of disease.”)

If you’re receiving treatment for metastatic breast cancer, your healthcare team will explain if the kind of breast cancer you have is likely to go into remission after spreading.

What happens if I decide to stop treatment?

Setting goals is part of metastatic breast cancer treatment. Your goal may be to continue treatment indefinitely, regardless of side effects. On the other hand, you may want to stop treatment if you feel it affects your quality of life. Regardless, stopping treatment is a major decision. It’s also a very personal one.

If you’re considering treatment goals, ask your healthcare team what you can expect from treatment. Take time to talk to those you love so they know why you’ve decided to stop treatment. And know that stopping treatment doesn’t mean stopping care. Your healthcare team will be with you and ready to help however they can.

A note from Cleveland Clinic

If you have metastatic breast cancer, the disease that started in your breast has spread to other parts of your body. If you’ve had breast cancer, you may have believed — and hoped — this day would never come. If you just learned you have breast cancer, you may feel overwhelmed by the news you have an incurable illness. Whatever your situation, it may help to know that there are many treatments that can help you live as long as possible and with a good quality of life. It may also help to know that your healthcare providers recognize the challenges of living with metastatic breast cancer. They’ll help do everything that they can to support you.