The Symptoms of Metastatic Breast Cancer You Shouldn’t Ignore, According to a Cancer Doctor
Key takeaways:
Most cases of breast cancer are diagnosed in the early stages. This means people are not tested for metastatic disease unless they have symptoms.
The symptoms of metastatic breast cancer depend on where in the body the cancer has spread. The most common areas are the bones, lungs, liver, and brain.
It is important to talk to your cancer provider about any new symptoms or changes in your body. This is the best way to make sure you get any necessary screening for metastatic breast cancer.
When someone first finds out they have breast cancer, they’re usually in the early stages of disease. Only 6% to 10% of people have metastatic breast cancer at the time of their initial diagnosis. Metastatic breast cancer is the most advanced stage of breast cancer. It means the cancer has spread to distant parts of the body.
If you have been diagnosed with breast cancer, it’s common to worry if the cancer has spread. But screening for metastatic breast cancer is not a typical part of the initial testing.
Amy Tiersten, MD, a hematologist and oncologist at Mount Sinai Hospital in New York City, says “It’s not recommended to do routine blood work or routine scans in the follow-up of early stage breast cancer patients looking for metastatic disease. And that’s because it has never been shown to be helpful.” She adds that symptoms drive testing decisions for metastasis.
This means that if you have breast cancer or are in remission, it’s important to know the symptoms of metastatic breast cancer. This way, you can report them at follow-up visits to make sure you’re getting the right testing. “Those visits are about screening patients for any symptoms that could be suggestive of metastatic disease,” says Tiersten. And that starts with knowing the common sites of metastasis and their associated symptoms.
Symptoms of metastatic breast cancer
Metastatic breast cancer — also known as stage 4 breast cancer — is the most advanced stage of breast cancer. It means that the cancer has spread beyond the breast and surrounding lymph nodes to other parts of the body.
The most common sites for metastatic breast cancer to spread are the:
Bones
Lungs
Liver
Brain
The symptoms of metastatic breast cancer usually depend on where the cancer has spread.
Symptoms of breast cancer in the bone
The bones are the most common site of breast cancer metastasis. Although breast cancer can spread to any bone, the most common sites are the ribs, spine, pelvis, and the large bones in the arms and legs.
Symptoms of metastatic breast cancer in the bone may include:
Unexplained bone pain
Weakened bones that are more vulnerable to fractures
Swelling
“We all get aches and pains, but the key finding here is that there’s no explanation [and] no injury. There’s a new pain somewhere, and it’s just not getting better or it’s getting worse,” says Tiersten.
Symptoms of breast cancer in the lung
When breast cancer spreads to the lungs, it doesn’t always cause symptoms. Instead, an imaging study, like an X-ray or CT scan, might pick it up. This might be a scan that is done as part of a treatment follow-up or for some other medical condition.
If someone does experience symptoms of lung metastasis, they can include:
A chronic cough that won’t go away
A cough with blood
Shortness of breath
Chest pain
“[Signs of a lung tumor] could also be something we find on physical exam,” Tierstan explains. “For example, if someone has lung metastases with fluid around the lung, you can hear that with a stethoscope.”
Symptoms of breast cancer in the liver
Breast cancer metastasis in the liver may not present symptoms either. Many times, it may first be picked up by abnormalities on liver function tests. These are blood tests that measure certain levels of enzymes and proteins in the blood that are affected by the liver. Abnormal levels can point to liver disease or damage.
When it does cause symptoms, metastatic breast cancer in the liver might cause:
Abdominal pain
Abdominal bloating
Appetite loss
Vomiting or nausea
Jaundice (yellowing of the skin or eyes)
Itchy skin
Symptoms of breast cancer in the brain
About 10% to 15% of women with metastatic breast cancer will have brain metastases. In most cases, the breast cancer has already spread to another part of the body, such as the bones, liver, or lung. But this is not always the case. For about 17% of women in this group, the brain is the only site of metastasis.
When metastatic breast cancer has spread to the brain, it may cause:
Persistent, worsening headaches
Vision changes
Seizures
Dizziness
Vomiting or nausea
Behavioral or personality changes
The risk of cancer spreading to the brain is usually highest for women with more aggressive subtypes of breast cancer, such as HER2-positive or triple-negative breast cancer.
What about symptoms of breast cancer in the lymph nodes?
If breast cancer has spread to the lymph nodes, it doesn’t necessarily mean you have metastatic breast cancer. But, in general, the more lymph nodes that are involved, the more advanced the breast cancer. This is because cancer cells can travel through the lymph nodes to other parts of the body.
Lymph nodes are normally small and hard to find. But when there’s an infection or cancer, they can grow larger. This can lead to a lump or swelling, most commonly in the armpit or around the collar bone.
When someone is first diagnosed with early-stage breast cancer, their initial testing will screen to see if lymph nodes are affected. This can be done through imaging — like a mammogram or ultrasound — or with a biopsy. And in your follow-up appointments, your provider will continue to perform a physical exam to check for changes to the lymph nodes.
If you’ve had early-stage breast cancer, it’s important to look out for any of these new or unusual body changes. Make sure to talk with your oncologist if you’re concerned.
But Tiersten explains that people should not live in constant fear of metastatic breast cancer. “A lot of patients can do really well with metastatic disease and live many years with good quality and quantity of lives.” She adds, “We have great treatment for it. Patients are living sometimes without evidence of disease for many years more and more.”
The bottom line
If you have early-stage breast cancer, it’s easy to worry that any new symptom could mean the cancer is spreading. Or if you’re in remission, you may wonder if the cancer has returned. The first and most important thing to do is to talk with your provider about any symptoms or changes in your body. It can feel scary to bring up these questions. But it might just mean a few extra tests to put your mind at ease and make sure you’re on the right treatment path.
Why trust our experts?
References
Leone, J. P., et al. (2015). Breast cancer brain metastases: The last frontier. Experimental Hematology & Oncology.
Lim, B., et al. (2016). Current challenges of metastatic breast cancer. Cancer Metastasis Reviews.
