Metastatic Breast Cancer

Many times, cancer cells will stay where they start growing (primary location) — in this case, your breast.

But if the cells grow and multiply quickly (aggressively), they can move out of your breast and travel into nearby lymph nodes or blood vessels. From there, they can travel to other parts of your body. And small breast cancer tumors can grow in those places.

 There are two different types of metastatic breast cancer:

• De novo metastatic breast cancer: Cancer has already spread to other parts of your body when it’s first diagnosed.
• Distant recurrence: This is diagnosed after the original breast cancer treatment. A few cells start growing abnormally again (cancer recurrence) — and spread outside your breast. This is the most common type of breast cancer metastasis.

Metastatic breast cancer symptoms vary based on where it’s growing. If it’s spread to your bones, you might have ongoing pain and swelling. Or bones that break easily. If it’s in your liver, you might have yellowing in your eyes and skin or stomach pain. Brain metastases often cause headaches, nausea and even seizures or personality changes. All of these are signs that you’ll want to get things checked out.

What to expect at your first visit

Going to an appointment to talk about having cancer can feel stressful. But your provider will make sure you’re comfortable telling them what’s been going on.

It’s important to share if you have symptoms and for how long you’ve had them. Your provider will also want to know about other health conditions you may have. And if you or anyone in your family have had other cancers.

During this visit, your provider will also go over what to expect from treatment. They’ll do physical and breast exams. And they’ll order tests to help them confirm a diagnosis.

Testing for metastatic breast cancer

We use several blood tests for cancer, like a complete blood count (CBC) and comprehensive metabolic panel (CMP) to see if the cancer has spread.

We may also test for tumor markers — something your cells make when you have cancer. Tumor markers for breast cancer are called CA (cancer antigens) 15-3 and 27-29. There’s also a newer blood test for cancer called a circulating tumor test. This looks for cancer cells moving through your bloodstream.

Other tumor tests include ones to look for genetic changes (gene mutations) and what kind of receptors the cells have. Receptors are proteins growing on the cell surface. They attract and connect with hormones and other proteins. And they influence how cells grow, multiply and react to breast cancer treatment. The three receptors are estrogen and progesterone and the protein HER-2/neu.

Your provider will also order imaging tests to get a closer look at your breasts and other organs, like:

• Mammogram.
• Breast ultrasound.
• CT scan (computed tomography scan).
• Bone scan.
• MRI (magnetic resonance imaging).
• PET scan (positron emission tomography scan).

Depending on what the imaging tests show, we may check your lungs with a test called a bronchoscopy. Or we might do tests called “taps” to remove fluid from an area that looks suspicious. For example, we can use a spinal tap (lumbar puncture) to remove spinal fluid, a pleural tap (thoracentesis) to remove fluid from your lungs or an abdominal tap to remove fluid from your abdomen (also known as ascites). If we see what looks like abnormal tissue, we’ll remove it and do a biopsy to look for cancerous cells.

Second Opinions for Metastatic Breast Cancer

A metastatic breast cancer diagnosis can change your life in seconds. And while it might be hard to wrap your head around everything, one thing is certain. You want to be sure you have the best providers by your side as you go through treatment. That’s why we encourage second opinions.

Second opinions can help you feel more in control of your care. We work to schedule an appointment for you as soon as possible. Our expert providers will go over your test results and talk with you about treatment options. And they’ll make sure to listen to your concerns and answer any questions you have. Our team is here to help you feel more confident about your treatment.

Meet Our Metastatic Breast Cancer Team

If you choose Cleveland Clinic, you’ll have peace of mind knowing you have the experience of providers from different specialties working together to confirm your diagnosis and build a highly personalized treatment plan. Depending on where the cancer has metastasized, your care team may include:

• Oncologists.
• Oncology nurses.
• Oncology social workers.
• Dietitians.
• Palliative care (a comprehensive team that specializes in cancer symptom management).

Other specialists that may be involved in your care include:

• Pathologists (providers who specialize in reading biopsies or surgical samples).
• Radiologists or interventional radiologists (providers that specialize in doing procedures using imaging techniques).
• Gastroenterologists (stomach and gut specialists).
• Pulmonologists (lung specialists).
• Orthopaedists (bone surgery specialists).
• Hepatologists (liver specialists).

Metastatic breast cancer treatment aims to shrink tumors, slow their growth and improve symptoms. Your personalized treatment plan focuses on where the cancer has spread, how the cancer cells behave (tumor biology) and if you’ve had breast cancer treatment in the past.

The main treatment we use is systemic therapy. This sends medications into your bloodstream to reach cancer cells throughout your body. This could include a combination of:

• Chemotherapy.
• Hormonal therapy.
• Immunotherapy.
• Targeted therapy.

As you go through treatment, we’ll keep an eye on how well the cancer responds to it and how you respond to the side effects. Treatment for metastatic cancer is often ongoing. So, we want to be sure you have the best treatment for your needs.

Surgery isn’t effective once the cancer has spread to other areas. The same holds true for radiation therapy. But you may have surgery to help with any cancer-related symptoms, like broken bones, caused by metastases. Or you may have radiation to help with pain relief or slow cancer growth in a specific part of your body and in your breast (breast wounds, breast pain, breast bleeding).

Living with Metastatic Breast Cancer

Living with metastatic breast cancer may sometimes feel overwhelming. Treatment is ongoing and may cause side effects like fatigue and nausea. But there are many ways to continue living life to the fullest. Your care team is here to help you manage your condition, physically and emotionally.

That’s one of the reasons why cancer treatment follow-up care is so important. You’ll see your care team every few months so they can check your progress. They’ll talk with you about how you’re feeling and will do a physical exam. They’ll also do tests to see how you’re responding to treatment.

This helps them figure out if you’ve gone into remission, which means you may have fewer cancer signs and symptoms. Your quality of life plays a big part in this decision. It’s important to understand that having or stopping treatment is up to you. There may be situations during your treatment journey where you may need a break from your treatment. If that’s the case, your team will discuss that with you. Your care team is here to help you decide what’s best.

Taking the Next Step

There’s a lot to consider when you find out you have metastatic breast cancer. Treatment will likely be ongoing. And, sometimes, you just aren’t going to feel like yourself. We’re here to help you through what it takes to live with metastatic breast cancer. From the latest treatments to supporting your physical and emotional well-being, our expert, caring providers want to make sure you feel as good as possible. We’re here to help you keep moving forward with your life.