Metastatic Breast Cancer

Metastatic breast cancer means breast cancer that has spread to other parts of the body. It is also called stage IV (4) breast cancer or advanced breast cancer. Breast cancer most often spreads to the bones, lungs, liver, brain, and distant lymph nodes.  

Source: National Cancer Institute

Even if breast cancer is found in another part of the body, it is still breast cancer. For example, breast cancer that spreads to the bones is not bone cancer. It is breast cancer in the bones. This matters because breast cancer treatments usually work best.

Metastatic breast cancer can happen in different ways:  

• De novo metastatic breast cancer − Breast cancer has already spread to distant sites when it is first diagnosed.  
• Recurrent metastatic breast cancer − Breast cancer comes back after earlier treatment and has spread to another part of the body.  

If you have metastatic breast cancer, it is normal to have questions, concerns, and worries. You do not have to figure everything out at once, and you do not have to do it alone. Your care team, loved ones, and cancer support resources can help you understand your options, make decisions, and take the next step. 

Subtypes of Metastatic Breast Cancer 

At the metastatic stage, your breast cancer is most often described by its biomarker status. Biomarkers are things about cancer cells that make them different from normal cells. This includes:  

• The type of cells that are changed by the cancer  
• The types of genes or proteins the cancer might make  

Biomarker testing can be done on your blood, tissue, or bodily fluid. The results can help your care team choose treatments that may work best for you. 

Anyone can be diagnosed with metastatic breast cancer. Many different things can influence whether breast cancer has already spread when it is first found, or whether it comes back and spreads after earlier treatment. Some of these considerations are related to the cancer itself, while others may involve timing, access to care, or past treatment. Having one or more of these factors does not mean metastatic breast cancer will happen. Your care team can help you understand what these factors may mean for you. 

For de novo metastatic breast cancer, these may include:

• A cancer type that grows or spreads more quickly, such as inflammatory breast cancer or triple-negative breast cancer
• Delays in finding cancer or starting care
• Barriers to care, such as trouble getting appointments, transportation, insurance coverage, or trusted health information 

For recurrent metastatic breast cancer, these may include:

• The stage of the first breast cancer, including tumor size and whether cancer was in lymph nodes
• The cancer subtype, such as HR-positive, HER2-positive, or triple-negative breast cancer
• The grade of the cancer, which describes how abnormal the cancer cells look under a microscope and how fast they are likely to grow
• How the cancer responded to earlier treatment
• How much time has passed since the first breast cancer treatment 

For some people, breast cancer can come back months or years after treatment. This can happen without known reasons and even if original treatment was successful.

If you are worried about recurrence, talk with your care team. They can explain your follow-up plan, what symptoms to look out for, and when to call. 

If your doctor thinks breast cancer has spread or returned, you may need more tests. This can feel stressful and may bring up a lot of questions. Testing gives you and your care team important information. The results can help show where the cancer is and guide the next steps in your care. 

Diagnosis usually takes more than one doctor’s appointment. Testing may depend on where the cancer has spread. Tests may include: 

• Imaging
  • Bone scans, CT scans, or other imaging may be used for bone symptoms.
  • Brain imaging may be used if you have headaches, weakness, vision changes, or other signs that need to be checked. 
• Biopsy – A doctor removes a small sample of tissue, so it can be checked under a microscope. When possible, a biopsy of the new area can help confirm that the cancer is breast cancer and not another type of cancer.
• Blood tests 

Your care team will also test the metastatic tumor for biomarkers. This is important because the cancer may express different biomarkers than an earlier breast cancer diagnosis. New test results may open the door to different treatments. 

Getting a Second Opinion

Many people find that it helps to get a second or even third opinion from another oncologist or cancer center. Talking with a second doctor can help you better understand your disease and how to treat it. Ask your doctor for suggestions of someone to see for a second opinion. Or, use these resources:

• American Society of Clinical Oncology
• National Cancer Institute-Designated Cancer Centers

Treatment for metastatic breast cancer is tailored to your needs, priorities, and overall health. The goals are to: 

• Slow cancer growth
• Manage symptoms
• Help you live longer
• Support your quality of life 

Your treatment plan will depend on many things, including your cancer subtype, biomarker results, where the cancer has spread, symptoms, past treatments, and your goals. Your voice matters in every treatment decision. 

Side Effects

Coping with the side effects of treatment can be challenging. It can be scary to read or hear all the possible side effects. It can be especially overwhelming considering that treatment may be an ongoing part of your life. 

Remember: All treatments can cause side effects, but many side effects can be treated or managed. Tell your care team about your symptoms early, even if they seem small. Speaking up can help your team respond sooner and help you feel better. 

Common therapies and related side effects may include: 

• Hormone therapy - Hot flashes, vaginal discharge or dryness, post-menopausal symptoms, joint stiffness, weight gain, and pain or soreness at the injection site 
• Chemotherapy - Nausea and vomiting, fatigue, hair loss, mouth sores, cognitive changes, low blood counts, numbness or tingling in the feet, nail and skin changes, diarrhea, weight change, and skin rash 
• Targeted therapy - Skin rash, diarrhea, fatigue, mild nausea and vomiting, low blood counts, hair loss, mouth sores, abnormal liver or blood tests, and risks for bleeding 

Call your care team right away if you have:

• New or worsening pain
• Trouble breathing
• Fever or signs of infection
• Severe headache, confusion, weakness, or vision changes
• Side effects that keep you from eating, drinking, sleeping, or doing daily activities 

Clinical Trials

Clinical trials may also be an option. A clinical trial is a research study that tests new ways to prevent, find, or treat cancer. Clinical trials can be a part of your care at many points in your treatment journey, not just when other treatments stop working. Many people with metastatic breast cancer get their treatment through a clinical trial.

Supportive and Palliative Care

Supportive care helps you feel as well as possible during cancer treatment. It can help with pain, fatigue, nausea, sleep problems, stress, and daily-life concerns. Asking for this kind of support is a strong and important part of your care. Your oncology team can provide support and connect you to the right resources.

Palliative care is a type of supportive care. Palliative care specialists work with your cancer care team to manage symptoms and improve your quality of life. You can receive palliative care at any stage of metastatic breast cancer, even while you are receiving cancer treatment. 

Palliative care is not the same as hospice care — and has different specialists. Hospice care is usually for people who are near the end of life and are no longer receiving treatment to control their cancer. Palliative care can begin much earlier. 

In addition to your primary oncology team, your support team may include many people, such as a dietitian, physical therapist, mental health counselor, social worker, patient navigator, or financial counselor. Ask your care team what support is available to you. 

Living with metastatic breast cancer isn’t easy. Some days will be better than others. While there is still no cure, people with metastatic breast cancer are living longer, fuller lives than ever before. 

Costs of Care

Cancer treatment can be expensive. The costs — and the stress of managing them — can feel overwhelming. It can help to talk about costs early, even before bills arrive. As you plan ahead, think about costs such as: 

• Medical bills and prescription drug co-pays
• Time away from work
• Changes in income if you or a caregiver cannot work
• Childcare or transportation costs 

A patient navigator, financial navigator, social worker, or advocate can help you find resources. They may help with insurance questions, costs of care, transportation, work concerns, disability forms, or finding local services. 

Medicare and Social Security Disability Benefits (SSDI) 

People with metastatic breast cancer may qualify for financial support through Medicare and Social Security Disability Insurance (SSDI). SSDI is a federal benefit for people who cannot work because of a serious health condition.

A social worker, patient navigator, or financial counselor can help you understand your options and apply. 

Caregiver Support

Caring for someone who has metastatic breast cancer is not easy. You may be helping with appointments, medicines, meals, daily tasks, emotions, and decisions about care. You may also be trying to manage work, family, money, and your own feelings. It is normal to feel tired, stressed, worried, or unsure of what to do next. 

You do not have to do everything alone. Caregivers need support, too. Asking for help can make caregiving more manageable and can help protect your own health and well-being.