CONDITIONS

Metastatic Breast Cancer

What Is Metastatic Breast Cancer

Breast cancer is characterized by the abnormal and rapid growth of cells in breast tissue. Metastatic breast cancer is the most advanced stage of invasive breast cancer in which the cancerous growth has metastasized (spread to other parts of the body). According to the Metastatic Breast Cancer (MBC) Network, an estimated 20-30% of all breast cancer cases will become metastatic. Metastatic breast cancer is often difficult to treat, especially if the cancer has spread to more than one site outside of the local breast area. According to a 2012 study published in scientific journal Current Oncology, the median survival rate for metastatic breast cancer is approximately 2 – 3 years, despite the significant advancements in management techniques by scientists and researchers.

What Causes Metastatic Breast Cancer

Metastatic breast cancer develops when earlier stages of breast cancer either go undiagnosed or progress despite best treatment efforts. Scientists and researchers are not sure of what causes cancerous cell growth to occur in breast cancer patients. The leading theory on the cause of breast cancer revolves around gene mutations. This comes out of research that found that mutations to certain genes, such as the BRCA1 and BRCA2 genes, can influence cancerous cell growth. The source of gene mutation is still a large research question. Some BRCA gene mutations are inherited, while others are acquired. Theorized causes of acquired gene mutation include certain chemicals, radiation, and other environmental factors.

Risk Factors For Metastatic Breast Cancer

The following factors may influence your risk of developing metastatic breast cancer:

  • Sex. Though breast cancer can occur in both women and men, male patients account for only 1% of the cases of breast cancer.  This is thought to be related to the presence of certain hormones in women (estrogen/progesterone), which have been linked to cancerous cell growth. According to the American Cancer Society, approximately two thirds of invasive breast cancer cases occur in women ages 55 and older.
  • Genetic predispositions. According to the Susan G. Komen foundation, women who have mutations in the BRCA genes have a higher risk of developing breast cancer. About 55-65% of women with mutations in the BRCA1 gene will develop breast cancer by age 70. About 45% of women with mutations in the BRCA2 gene will develop breast cancer by age 70. This is compared to an 8% chance of developing breast cancer for the general population. The Susan G. Komen Foundation also reports that BRCA mutations can influence the risk of developing more aggressive forms of breast cancer. BRCA mutations have been linked to higher rates of second primary cancer (a second tumor unrelated to the first).
  • Type and location of cancer at diagnosis. Cancer Treatment Centers of America reports that women who have second or third stage breast cancer upon first diagnosis are more likely to develop metastatic breast cancer than those who are diagnosed at an earlier stage. The risk of developing metastatic breast cancer also increases with the presence of both large tumors and cancer in the lymph nodes at diagnosis.

Diagnosing Metastatic Breast Cancer

Metastatic breast cancer is characterized by the spread of cancerous growth to other parts of the body such as the bones, liver, or lungs. Sites of cancerous growth beyond the breast are known as metastases. According to the American Cancer Society, the following tests can be used to detect and asses cancerous growth throughout the body:

Biopsy. A biopsy tests a sample of cells for cancerous growth. Biopsies are usually conducted after other imaging tests have been performed and have indicated the presence of potentially cancerous growth. Most biopsies are outpatient procedures, though certain cases may require brief hospitalization/monitoring depending on the location and size. Different types of biopsies include:

  • Fine needle aspiration biopsy, in which the targeted tissue is extracted with a thin needle and examined beneath a microscope. The biopsy site can be located through ultrasound imaging or palpations (feeling for the growth).
  • Core needle biopsy. The needle for this procedure is larger than in a fine needle aspiration biopsy and may or may not be assisted by vacuum suction, though the rest of the procedure is the same.
  • Surgical biopsy. This is the least common form of biopsy, and involves the surgical removal of the biopsy site. Excisional biopsies remove the entire targeted mass while incisional biopsies remove only part of the mass. These procedures often require anesthesia and are done in an operating room.
  • Mammograms utilize x-rays to produce images of the breast. In order to get the best visual of the breast, the breast is tightly pressed between two plates. Flattening the breast between the plates may cause pain or discomfort, but the procedure typically only lasts a few seconds.

Mammogram.  Mammograms utilize x-rays to produce images of the breast. In order to get the best visual of the breast, the breast is tightly pressed between two plates. Flattening the breast between the plates may cause pain or discomfort, but the procedure typically only lasts a few seconds.

Ultrasound. Ultrasounds utilize sound waves to produce images. Ultrasounds may be used to assess cancerous growths in the breast tissue or other areas of the body.

Magnetic resonance imaging (MRI). MRIs use magnetic and radio waves to produce detailed images of the body. MRIs can be used in combination with injections of contrast dyes to highlight cancerous areas.

Nipple discharge exam. Nipple discharge can be a sign of cancerous growth. A nipple discharge exam involves the collection and microscopic examination of nipple discharge to test for the presence of cancerous cells.

Ductal lavage and nipple aspiration. In a ductal lavage, a catheter (thin tube) is inserted into the nipple after the area is given local anesthesia. A saline solution is injected through the catheter to rinse the nipple duct and collect cells for examination. A nipple aspiration also tests for the presence of cancerous cells, though it is less invasive as it uses suction cups placed externally on the nipple instead of a catheter insertion. These tests are only performed on women with a high risk of developing breast cancer.

Blood tests. Blood tests can be used for many different purposes, including testing for the presence of certain proteins in the blood.

 

 

Symptoms of Metastatic Breast Cancer

Metastatic breast cancer can present itself in many different ways, depending on where the cancer has metastasized to. The National Breast Cancer Foundation lists the following as potential symptoms of metastatic breast cancer according to common locations of metastases:

Metastasis in bone

  • Intense and worsening pain
  • Swelling
  • Weak/fragile bones

Metastasis in brain

  • Intense headache
  • Disruptions to vision/vision loss
  • Seizures
  • Vomiting
  • Nausea
  • Behavioral/personality changes

Metastasis in liver

  • Jaundice (yellowing of skin/eyes)
  • Itchy skin or rash
  • Abdominal pain
  • Lack of appetite
  • Nausea
  • Vomiting

Metastasis in lungs

  • Chronic cough
  • Shortness of breath
  • Chest pain

The following may also be signs of metastatic breast cancer:

  • Lump(s) in  breast
  • Changes to the appearance of breast/nipple skin, which may resemble dimpling, like the skin of an orange
  • Nipple discharge
  • Breast/nipple tenderness or pain
  • Swelling/dimpling of the breast

 

Prognosis

The prognosis for metastatic breast cancer varies from patient to patient, as it is dependent on the type of metastases and the individual’s response to treatment. Unfortunately, metastatic breast cancer is still considered to be an incurable disease. The median survival rate following a diagnosis of metastatic breast cancer is about 2-3 years. This number is a median, meaning that there are a considerable number of patients who live both shorter and longer than this statistic.

Living With Metastatic Breast Cancer

Living with metastatic breast cancer can be a difficult task due to its advanced state and potential treatment side effects. The following tips can help you live more comfortably with metastatic breast cancer:

  • Explore all treatment options. Educate yourself on potential treatment methods and ask your doctor questions. Be sure to seek out reliable sources both online and in print. See the resources section for sources of information on metastatic breast cancer.
  • Weigh the benefits and risks of each treatment options. Ask yourself what the aim of your treatment should be, and what you wish to accomplish as you live with the disease.
  • Consider palliative care, a type of medical care specialized to help patients with terminal illnesses remain comfortable while living out their disease
  • Get support either through your loved ones or through community support groups. For more information on metastatic breast cancer support groups, inquire within your local hospital or visit the Metastatic Breast Cancer Network.
  • Live out your dreams and goals to help you be as happy as possible. Don’t let prognosis or statistics discourage you from accomplishing want you want to accomplish.

Screening

According to the US Preventative Service Task Force, the guidelines for breast cancer screening are as follows:

  • Women less than 50 years of age: mammogram at the discretion of the patient’s physician, assuming the patient visits the physician for yearly checkups.
  • Women ages 50 – 74: mammogram once every other year in addition to yearly checkups. Women at especially high risk of developing breast cancer should be tested more frequently at the discretion of their doctors.

Medication And Treatment

Since cancerous growth has spread beyond the local breast area in metastatic breast cancer, surgical options are less likely to be considered since they cannot eliminate all of the cancerous growths with one procedure and may further weaken the patient. Treatment for metastatic breast cancer is mainly focused on the management of symptoms and the slowing of overall cancer growth. Treatment options for metastatic breast cancer include:


Hormone therapy including anti-estrogens, which stop the production of estrogen, aromatase inhibitors, which lower the level of estrogen in the body but do not stop its production, and other hormones such as megestrol acetate and fluoxymesterone. Hormone therapy may be accompanied by the removal of the ovaries (oophorectomy), radiation therapy directed at the ovaries, or ovarian suppression using lutenizing hormone-releasing hormone (LHRH) in order to slow the rate of estrogen production by the ovaries.

Side effects of hormone therapy include:

  • Changes to the menstrual cycle
  • Hot flashes and/or night sweats
  • Decreased sex drive
  • Vaginal dryness
  • Nausea
  • Vomiting
  • Joint pain
  • Fatigue
  • Changes in behavior or mood

Chemotherapy using one of four types of chemotherapy agents: alkylating agents, anthracyclines, antimetabolites, and microtubule inhibitors.

Side effects of chemotherapy include:

  • Nausea/vomiting
  • Mouth sores
  • Hand and foot rashes
  • Loss of appetite
  • Loss of hair
  • Increased chance of infection
  • Easy bleeding or bruising
  • Fatigue
  • Infertility
  • Tissue damage
  • Increased risk of second cancer

Targeted therapy, which work to stop particular cellular functions that lead to the reproduction of cancer cells. Targeted therapy drugs used to treat stage IV breast cancers include:

  • Trastuzumab
  • Pertuzumab
  • Ado-trastuzumab emtansine
  • Lapatinib
  • Bevacizumab
  • Everolimus

Side effects of targeted therapies include:

  • Diarrhea
  • Vomiting
  • Nausea
  • Skin rash/irritation
  • Heart failure (rare but serious)
  • Weakened immune system
  • Low white blood cell count
  • Mouth sores

Alternative and complimentary therapies including:

  • Acupuncture
  • Yoga
  • Hypnosis
  • Guided imagery
  • Meditation
  • Tai Chi
  • Massage
  • Chiropractic therapy
  • Medical marijuana
  • Prayer/Spiritual therapy
  • Local or online support groups

Metastatic breast cancer and its treatments may cause considerable pain. To help keep patients comfortable throughout their disease and treatment, doctors may prescribe the following pain management treatments:

  • Acetaminophen, available either in prescription or over-the-counter strength
  • Non-steroidal anti-inflammatory drugs (NSAIDs), also available in either prescription or over-the-counter strength
  • Opioid pain-relievers are prescription only and can be much more powerful than acetaminophen or NSAID pain relievers. Popularly prescribed opioids include oxycodone, morphine, hydrocodone, and fentanyl. Opioids are addictive and may cause dependency following treatment. Possible side effects of opioids include nausea, constipation, drowsiness, and fatigue.
  • COX-2s. This class of drugs is among the more controversial options for pain management due to recent studies suggesting the link between COX-2s and increased risk of heart attack and stroke. Ask your doctor if COX-2s are right for you.

For more information on pain management, visit thirdAGE’s pain management condition center.


Since metastatic breast cancer is considered to be incurable, many patients and doctors choose a palliative approach to treatment. In palliative treatment, doctors and patients focus on physical and emotional comfort during treatment rather than aggressive elimination of the disease. This can help a patient relieve stress, anxiety, and pain while they live with their disease. Palliative care for metastatic breast cancer may include:

  • Prescription or over the counter pain medications
  • Chemotherapy or targeted therapies to slow overall cancer growth and prolong life expectancy
  • Working with a social worker to help a patient adjust to changes advanced stage breast cancer brings to daily life
  • Alternative treatments such as acupuncture and massage 
  • Joining a support group online or in your community
  • Psychological therapy sessions
  • Working with a dietitian or nutritionist to outline a diet and exercise plan
  • Meditation, prayer, or spiritual counseling

For more information on palliative care, visit the thirdAGE palliative care condition center.

Complementary and Alternative Treatment

There are many complimentary techniques that can help manage treatment side effects, reduce overall pain, and help to increase general wellness throughout breast cancer treatment. These include:

Acupuncture,  a form of traditional Chinese medicine in which small needles are inserted at points around the body to restore the flow of bodily energy. It has been proven to reduce overall stress, stimulate the immune system, and reduce bodily inflammation. Acupuncture can be used as either a complimentary therapy (i.e., to reduce side effects of chemotherapy) or as an alternative therapy (to boost the immune system to fight off cancer cells).

Herbal therapies,  Because the risk of cancerous cell growth increases with overall body inflammation, the use of anti-inflammatory herbs may help to decrease the risk of developing breast cancer. Anti-inflammatory herbs include:

  • Turmeric
  • Green Tea
  • Echinacea
  • Goldenseal
  • Pau D’Arco
  • Wheatgrass
  • Berberis family
  • Huang Qi

Clinical research on the effectiveness of herbal therapies is limited as it is still ongoing. However, many of these herbs have been used in other medicine forms (such as traditional Chinese medicine and aryuvedic medicine) as anti-inflammatory medicines for centuries.

Mind/body techniques, which help to strengthen the mind and body connection in order to reduce anxiety, stress, and improve overall health. These include:

  • Yoga,  Yoga can help to relieve physical symptoms of pain as well as emotional stress and anxiety. Studies have shown that women who do a regular practice of yoga (30-60 minutes, 3-4 times per week) while undergoing treatment for breast cancer experience less fatigue, reduced insomnia, and better overall quality of life than patients who do not practice yoga.
  • Hypnosis, Hypnotherapy has been shown to reduce pain, nausea, and fatigue in cancer patients.
  • Guided imagery. In guided imagery, therapists work with patients to create a positive mental picture of their self and disease. Studies have proven this method of alternative treatment to be very effective. In a 2012 study on guided imagery in radiation therapy patients, 86% of the patients described the therapy as helpful and 100% reported that they would recommend the therapy to others.
  • Meditation, A 2008 study of mindful meditation in cancer patients found that meditation helps to improve the patients’ overall quality of life, decreases the level of stress, and decreases the frequency of physical symptoms. 
  • Tai Chi. Tai Chi is a form of moving meditation in which the body gains strength and balance. Tai chi helps to lower anxiety and lessen stress.

Massage. Massage has been proven to reduce anxiety, pain, and fatigue as well as increase immune function in cancer patients.  According to the Pacific College of Oriental Medicine, a 2003 study of 230 cancer patients found that patients who received one 45-minute massage each week for a month felt less pain and took eight fewer doses of pain medication than those who did not receive massages. Massage therapy has also been shown to increase the body’s NK cell level (which are crucial in fighting off cancerous growth) as well as inhibit inflammatory stress hormones such as cortisol. There are many different types of massage that may be beneficial for breast cancer patients. To find a licensed therapeutic masseuse, visit The American Massage Therapy Association.

Chiropractic therapy. Chiropractic therapy focuses on the alignment of the body’s skeletal system in order to promote overall wellness and reduce pain.

Prayer/spiritual therapy. According to the National Cancer Institute, a study of 418 cancer patients found that a higher level of meaning and peace led to a decline in depression and psychological distress. The effect of prayer on recovering patients is still a topic of debate. While some believe that the power of others praying can produce extraordinary results, a 2006 study published by the American Heart Journal found a slight negative correlation between prayer and recovery. Patients that knew they were receiving prayer experienced a slightly higher rate of complication than those that did not know they were receiving prayer.

Support Groups. Local or online support groups can significantly bolster a patient’s confidence and feeling of security. Studies have long shown that support groups help to decreased stress, anxiety depression, and treatment complications. To find a support group in your area, visit your local hospital or The American Cancer Society.

Care Guide

If you are caring for someone with metastatic breast cancer, consider the following tips:

  • Read up on metastatic breast cancer. Educate yourself on the cancer as well as available treatment and side effects. This will help you to be an informed caretaker.
  • Be patient with your loved one as you both adjust to the changes the disease makes in your life.
  • Remain a source of positivity. The prognosis of metastatic breast cancer can be discouraging. Be sure to remain an encouraging, positive source for your loved one as often as possible.
  • Be open with your loved one. Share your feelings with them and be receptive of the feelings they share with you.
  • Encourage your loved one to live life to the fullest. Do your best to help them reach any dreams or goals they might have.
  • Try a stress management technique. Caregivers often overlook their own health. Try a stress management technique such as yoga, meditation, walking, or other personal hobbies.

When To Contact A Doctor

Contact a doctor if you experience any of the following:

Persistent:

  • Nausea
  • Vomiting
  • Diarrhea
  • Headache
  • Cough
  • Shortnes of Breath

Unexplained pain or soreness in any area of the body

  • Confusion
  • Skin rash
  • Heart palpitations
  • Any other symptoms of metastatic breast cancer

 

Questions For Your Doctor

To find a breast cancer specialist, click here

 

 

Questions For A Doctor

You may want to ask your doctor the following questions following a metastatic breast cancer diagnosis:

  • Where has my cancer metastasized?
  • How advanced is my cancer?
  • What are the sizes of my tumors/areas of cancerous growth?
  • What is my prognosis?
  • What are the available treatment options?
  • What are the potential side effects of these treatments?
  • Are there alternative or complementary treatments that you could recommend?
  • What clinical trials am I eligible for?
  • Should I consider participating in a clinical trial?
  • Should I consider a palliative care treatment plan?
  • How will this cancer affect my fertility?
  • Will I still be able to have children?

 

Resources

For more information on metastatic breast cancer, visit: