Metastatic breast cancer symptoms: What are the early signs of metastatic breast cancer?

Overview: What does metastatic breast cancer feel/look like?

Metastatic breast cancer, also called stage IV breast cancer, is breast cancer that has spread to other areas of the body. Although any body part can be affected, breast cancer cells usually spread to the bones, spinal cord, liver, brain, or lungs. Sometimes, people may have cancer that has spread beyond the breast and regional lymph nodes when they are first diagnosed with breast cancer. However, most people with metastatic breast cancer have already been treated and diagnosed with early-stage breast cancer. Although metastatic breast cancer is not curable, the 5-year survival rate with treatment is 30%. The symptoms of metastatic breast cancer will vary depending on what part of the body the cancer cells have migrated to. 

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What are the early signs of metastatic breast cancer?

The early signs of metastatic breast cancer will depend on what parts of the body the cancer spreads to. Early general signs of metastatic breast cancer include fatigue, depression, problems sleeping, and pain. 

Other metastatic breast cancer symptoms

Metastatic breast cancer symptoms will vary based on the parts of the body the cancer invades. When people are first diagnosed with metastatic breast cancer, the parts of the body the cancer most commonly affected are:

• Bones (about 40% to 75% of patients)

• Lungs (5% to 15%)

• Tissues around the lungs (5% to 15%)

• Liver (3% to 10%)

• Brain (<5%)

Other organs can be affected as well, although this does not happen as often. In addition to those above, metastatic breast cancer can also spread to:

• The heart

• The intestines

• The adrenal glands

The general symptoms of metastatic breast cancer include:

• Fatigue

• Depression

• Difficulty sleeping

The most common symptoms of bone metastasis include:

• Bone pain

• Fractures

• Elevated calcium (hypercalcemia)

Lung metastasis symptoms include:

• Shortness of breath

• Cough

• Coughing up blood

• Chest pain

A brain metastasis will have symptoms such as:

• Headache

• Confusion

• Pain

• Facial numbness or palsy

• Speech problems

• Vision problems

• Changes in mental state

• Seizures

50 percent of people with stage IV breast cancer will eventually develop liver metastasis though it’s usually not the first place where the breast cancer cells spread. There may be no symptoms at first, but when they do occur, the most common symptoms are:

• Pain

• Nausea

• Vomiting

• Loss of appetite

• Weight loss

• Yellowing of the eyes and skin (jaundice)

Metastatic breast cancer vs. non-metastatic breast cancer symptoms

Non-metastatic breast cancer is a tumor located only in the breast, chest wall, or nearby lymph nodes. Metastatic breast cancer has spread to other body parts outside of the original tumor site, such as the bones, brain, liver, or lungs. Many general symptoms are alike, but metastatic breast cancer may have unique symptoms based on where the cancer has spread in the body. 

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Types of metastatic breast cancer: How can I tell which one I have? 

Metastatic breast cancer is the final and most advanced stage of breast cancer. About 20% to 30% of women treated for early-stage breast cancer will later be diagnosed with metastatic breast cancer. There are different types of breast cancer, and any of them can metastasize. The specific type is based on where the breast cancer started and whether or not the cancer has spread. In situ, breast cancer is a pre-cancer that has not spread to the rest of the breast tissue. Invasive breast cancer is breast cancer that has spread to the surrounding breast tissue. Most breast cancers are invasive; the two most common types of invasive breast cancer are invasive ductal carcinoma and invasive lobular carcinoma.

There are also several subtypes of stage IV breast cancer based on their sensitivity to hormones or proteins that may promote the growth of cancer cells: estrogen, progesterone, and the protein human epidermal growth factor 2 (HER2). It’s impossible to identify the subtype of breast cancer until cells from the tumor have been tested. Testing cancer will help providers determine the most appropriate treatments. 

Many breast cancer treatments, such as hormone therapy and targeted therapy, exploit the cancer’s sensitivities to hormones or HER2 to fight off the cancer. Targeted therapies aim to stop specific protein variants or gene mutations that feed breast cancer. Systemic therapies rely on drugs as opposed to surgery or radiation. Some types of cancer are more difficult to treat successfully than others:

• Luminal A breast cancer tumors are slow-growing and are sensitive to estrogen (ER+) and progesterone (PR+) but not sensitive to HER2 (HER2-)

• Luminal B breast cancer tumors grow fast and are estrogen positive (ER+) and are either HER2 positive (HER2+) or have high levels of a protein (Ki-67) that indicates fast cancer cell growth

• HER2-enriched breast cancer tumors grow faster than luminal cancers and are sensitive only to the HER2 protein

• Triple-negative breast cancer tumors are aggressive and fast-growing and are not sensitive to estrogen, progesterone, or HER2—this is the hardest breast cancer to treat with the fewest treatment options

When to see a doctor for metastatic breast cancer symptoms

See a doctor immediately if any signs of metastatic breast cancer are experienced.

A metastatic breast cancer diagnosis involves multiple tests. Most people will be treated by a specialist in cancer treatment called an oncologist. In addition to a medical history and physical exam, the oncologist will perform tests such as:

• Blood tests to measure blood cells, electrolyte levels, liver function, kidney function, and any enzymes or proteins that indicate a cancer has spread

• Bone scans to look for bone cancer

• Chest X-rays to look for lung cancer

• CT scans to look for or measure tumors in the bones, lungs, liver, or lymph nodes

• An MRI to measure the size of tumors

• A PET scan used with radioactive markers to find tumors in the body

• A biopsy to both diagnose breast cancer and determine its subtype and other properties of the cancer cells

Complications of metastatic breast cancer

Untreated metastatic breast cancer is fatal. With treatment, people can live with cancer for several years.

How to treat metastatic breast cancer symptoms

Metastatic breast cancer is not curable but treatable. Almost 1 in 3 people treated for metastatic breast cancer live more than five years with treatment.

Healthcare professionals pursue three goals with stage IV breast cancer treatment: slow down the progress of the cancer, maximize quality of life, and minimize the side effects of treatment. Depending on where the breast cancer spreads to in the body, treatments to achieve these three goals may include:

• Hormone therapy blocks or lowers sex hormones (estrogen and progesterone) that promote the growth of hormone-sensitive carcinomas. This includes selective estrogen receptor modulators (SERMs) such as tamoxifen, aromatase inhibitors, and ovary suppressors

• Targeted therapy drugs that specifically interfere with the cancer’s ability to divide or survive; these include biologic drugs and small molecule inhibitors 

• Chemotherapy to kill cancer cells

• Immunotherapy to increase the immune system’s ability to fight off cancer cells

• Radiation therapy to kill cancer cells or slow their growth

• Surgery to remove part or all of a tumor

• Symptom relief medications such as pain relievers

• Supportive care

In addition to the above therapies, people with metastatic breast cancer may also consider enrolling in a clinical trial to try treatments that are still in the experimental phase. A healthcare provider can discuss the treatment options and determine which clinical trials are available for your situation.

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Living with metastatic breast cancer 

Metastatic breast cancer is not curable. Living with metastatic breast cancer means balancing treatment with quality of life. Like all profound questions, people will find their own answers to this balance. No matter what the choice, living with the diagnosis can be helped by playing a prominent role in the process:

• Keep all follow-up appointments with members of the care team

• Take medications as instructed

• Consider signing up for clinical trials of new drugs that have not yet been approved by the Food and Drug Administration (FDA)

• Keep a symptom diary and a side effect diary and share that with the care team at each opportunity

• Always talk to the care team about how the disease and the treatment is affecting your quality of life

• Join a support group

• Get mental health support from a counselor, social worker, or psychologist to manage and understand your feelings and mood throughout the process

• Stay physically active

• Eat healthy, quit smoking, and cut down on alcohol

• Continue to participate in activities that you love and enjoy

FAQs about metastatic breast cancer symptoms

How long can you have breast cancer without knowing?

Except for a small percentage of people, most people with metastatic breast cancer have already been diagnosed and treated for early-stage breast cancer. That is why attending all of your follow-up medical appointments is important so you can be monitored for recurrence. During these visits, it’s vital to ensure the oncologist knows about any new symptoms or physical changes. 

Where does breast cancer usually metastasize first?

When first diagnosed with metastatic breast cancer, 40% to 75% of people have had the cancer spread to the bones. Metastases to other organs, such as the lungs or liver, are much less common when the condition is first diagnosed, but they will often be affected as the disease progresses.

When to stop treatment for metastatic breast cancer?

There are no set rules for stopping metastatic breast cancer treatment. The goals of treatment are to extend life and maintain quality of life. The right balance between these two is a decision only the patient can make. However, at some point, the oncologist will discuss transitioning from treatment to supportive care when treatments are no longer effective.

What’s next? Additional resources for people with metastatic breast cancer symptoms

Test and diagnostics

• Breast cancer-metastatic: diagnosis, American Society of Clinical Oncology (ASCO)

• Metastatic breast cancer, Cleveland Clinic

Treatments

• Breast cancer-metastatic: types of treatments, American Society of Clinical Oncology (ASCO)

• Metastatic breast cancer, Johns Hopkins Medicine

• Symptom management in metastatic breast cancer, The Oncologist

• Treatment of Stage IV (metastatic) breast cancer, American Cancer Society

Scientific studies and clinical trials

• Survival rates for breast cancer, American Cancer Society

More information on related health conditions

• Breast cancer treatments and medications, SingleCare