Where Does Breast Cancer Spread?

Breast cancer is a type of cancer that begins in the breast. Among women in the United States, it is the most prevalent cancer, accounting for roughly 30% of all new cancer diagnoses, according to the American Cancer Society. Although breast cancer originates in the breast, it can spread to other body parts, known as metastatic cancer. Research conducted in 2017 revealed that around 155,000 women in the United States were living with metastatic breast cancer. This article aims to provide a comprehensive overview of metastatic breast cancer, including the familiar places where it is detected, how it is diagnosed and treated, and preventive measures.

What is metastatic cancer?

Metastatic cancer, also known as stage 4, refers to the spread of cancer to other body parts from its initial location. Sometimes, cancer spreads before diagnosis, while other times, it happens after treatment. Even those treated for early-stage breast cancer can later be diagnosed with metastatic breast cancer. Virtually any type of cancer can metastasize, indicating advanced-stage cancer. Metastasis can occur months or even years after initial treatment. Researchers also recognize oligometastatic cancer, which only occurs in a few small areas and is considered more treatable.

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What’s the difference between metastatic and recurring breast cancer?

Recurrence of cancer refers to the reappearance of cancer after the initial treatment. This occurs when the treatment fails to eliminate all cancer cells in the tumor, allowing the remaining cells to grow into detectable tumors over time. Recurrence is a possibility for almost all types of cancer, much like metastasis. Some types of recurrent cancer can occur remotely and therefore fall under the category of metastatic cancer.

Breast cancer may recur locally, regionally, or distantly:

  • Local recurring breast cancer occurs when a new tumor develops in the breast that was initially affected. If the breast has been removed, the tumor may grow in the chest wall or nearby skin.
  • Regional recurring breast cancer happens in the same region as the original cancer. In the case of breast cancer, this may be the lymph nodes above the collarbone or in the armpit.
  • Distant recurring breast cancer happens when cancer cells travel to a different part of the body. This new location is far away from the original cancer. When cancer recurs distantly, it’s considered metastatic cancer.

Read more: What Types of Breast Cancer Have the Highest Recurrence Rates?

Where are the common sites that breast cancer metastasizes to?

According to the National Cancer Institute, the most common metastasis locations for breast cancer are the following:

  • bones
  • lungs
  • liver
  • brain

The frequency that breast cancer metastasizes to each site can vary based on the population studied. A 2017 study in Scientific Reports included a group of 4,932 people with metastatic breast cancer. Researchers determined the metastatic site (or sites) for each person and found that:

  • 65.1 percent of people had bone metastases
  • 31.4 percent of people had lung metastases
  • 26 percent of people had liver metastases
  • 8.8 percent of people had brain metastases

Additionally, 33.5 percent of people had metastasis in multiple organs. The most common combination of sites was the bones and lungs.

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Bone metastasis

Bones are often the first site that breast cancer metastasizes to. Any bone can be affected, although the most common ones include the following:

  • spine
  • pelvis
  • ribs
  • long bones in the arms and legs

At first, distinguishing between bone metastasis and joint conditions such as arthritis or strain can be challenging. However, the pain caused by bone metastasis gradually becomes constant and does not subside even with rest.

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Lung metastasis

It is possible to have metastasis in the lungs without awareness, as symptoms may not always manifest. A follow-up scan after your initial treatment may be the first time your doctor discovers a lung metastasis. Although symptoms may be present, they can be initially mistaken for a pre-existing lung condition or a respiratory infection, such as the common cold or flu. However, the symptoms persist long after a respiratory illness should have cleared up.

Liver metastasis

Breast cancer that has spread to the liver may not exhibit noticeable symptoms initially, much like lung metastasis. However, routine blood tests can reveal elevated liver enzymes, indicating liver damage and serving as a potential indicator.

Brain metastasis

It is common for breast cancer to spread to other parts of the body in individuals who have brain metastasis. As per a 2016 study, aggressive forms of breast cancer, such as triple-negative or HER2-positive breast cancer, are more likely to spread to the brain.

Other, less familiar areas of breast cancer may spread to

Breast cancer metastasis isn’t limited to the sites we’ve listed above. Breast cancer can also apply to other body areas, although this is much less common. Some examples include the following:

  • female reproductive tracts, like the ovaries, cervix, and endometrium
  • digestive tracts, such as the esophagus, stomach, and colon
  • pancreas
  • kidneys
  • thyroid
  • eye

What are the symptoms of metastatic breast cancer?

It should be noted that not all individuals with metastatic breast cancer will exhibit symptoms. If symptoms do arise, they can differ based on the location and severity of the metastasis. Let’s examine the symptoms associated with each common site of metastasis.

Bone metastasis symptoms

Metastasis to the bones may cause:

  • severe bone pain
  • bones that are more brittle and can break easily
  • Spinal cord compression, which can lead to:
    • pain in your back or neck
    • weakness or numbness in a particular area
    • trouble urinating or having a bowel movement
  • Low blood cell counts, which can cause symptoms like:
    • anemia
    • easy bruising or bleeding
    • frequent infections

As bone tissue continues to be damaged, calcium can be released into the blood, leading to a condition called hypercalcemia, which causes symptoms like:

  • fatigue
  • nausea
  • increased thirst
  • constipation
  • irritability
  • confusion

Lung metastasis symptoms

Metastasis in the lungs may cause:

  • chronic cough
  • chest pain
  • fatigue
  • shortness of breath
  • wheezing
  • coughing up blood

Liver metastasis symptoms

Metastasis to the liver may cause:

  • jaundice, or yellowing of the skin and the whites of the eyes
  • upper right abdominal pain
  • bloating
  • itchiness
  • loss of appetite
  • nausea or vomiting
  • fatigue

Brain metastasis symptoms

Metastasis in the brain may cause:

  • headache
  • nausea or vomiting
  • weakness or numbness in your limbs
  • seizures
  • changes in personality or behavior
  • trouble with memory
  • slurred speech or difficulty speaking
  • difficulties with balance or walking
  • changes in vision like blurry vision or vision loss

Symptoms that may accompany any form of metastatic breast cancer

Nonspecific symptoms that may accompany any form of metastatic breast cancer include:

  • fatigue
  • a general feeling of unwellness (malaise)
  • loss of appetite
  • unintentional weight loss
  • fever

If you’re going through treatment for cancer, the tumor may not directly cause some of the symptoms you’re experiencing but rather by the treatment itself. It’s important to discuss any symptoms with your doctor, who can offer guidance and potentially recommend therapies to alleviate them.

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What causes metastatic breast cancer, and who’s at risk?

Metastatic breast cancer occurs when cancer cells detach from the primary tumor and spread to other body areas through the circulatory or lymphatic systems. These cells may settle in a different location and potentially form a new tumor quickly or several years after the initial treatment.

Anyone that’s been diagnosed with breast cancer can go on to develop metastatic breast cancer. Generally speaking, some of the factors below may increase the likelihood of breast cancer metastasizing:

  • Having a more aggressive type of breast cancer, like triple-negative breast cancer
  • being diagnosed with breast cancer that’s at a later stage, such as cancer that’s already spread to nearby lymph nodes or the chest wall
  • having cancer that’s growing quickly

How is metastatic breast cancer diagnosed?

Several tests are used to confirm a diagnosis of metastatic breast cancer. These include:

  • Blood tests: In these tests, a blood sample is taken from a vein in your arm. Some standard blood tests that may be ordered include a complete blood count and a metabolic panel. Your doctor may also order tests for breast cancer tumor markers.
  • Imaging tests: Imaging tests allow your doctor to see what’s happening inside your body and check for suspicious areas. Some examples of imaging tests that may be used include:
    • X-rays
    • ultrasound
    • computed tomography (CT) scan
    • magnetic resonance imaging (MRI) scan
    • positron emission tomography (PET) scan
    • bone scan
  • Tissue biopsy: If imaging shows a suspicious area, your doctor will take a biopsy from that area to be analyzed in a laboratory. A tissue biopsy results can confirm a metastatic breast cancer diagnosis.

In diagnosing cancer, the tests used may vary depending on the location of the spread. For instance, a bone scan can detect bone metastasis, while a head MRI can be employed to detect brain metastasis. Additionally, other tests may also be utilized based on the affected site. For instance, when there is suspicion of lung metastasis, a bronchoscopy may be conducted to check for any cancer indications in the airways.

How is metastatic breast cancer treated?

Although there is no cure for metastatic breast cancer, available treatments focus on preventing its progression, alleviating symptoms, and enhancing both the duration and quality of life. On and quality of life.

Treatments are highly individualized. What’s recommended can depend on things like:

  • the location and extent of the metastasis
  • whether or not the cancer is positive for hormone receptors (HR) or HER2
  • whether or not specific genetic changes are present
  • which treatments you’ve previously received
  • your age and overall health
  • your personal preference

Potential treatment options for metastatic breast cancer include:

Hormone therapy

In cases where the cancer is found to have hormone receptors (estrogen or progesterone), hormone therapy could be suggested as a possible course of action. This treatment option aims to hinder the ability of hormones to influence cancer cells, thereby impeding or halting their progression.

Drugs that are used for hormone therapy include tamoxifen and aromatase inhibitors like:

  • anastrozole (Arimidex)
  • exemestane (Aromasin)
  • letrozole (Femara)

Sometimes, hormone therapy will also be combined with a targeted therapy drug.

Chemotherapy

In cases where the cancer does not respond to hormone therapy or lacks hormone receptors, chemotherapy may be suggested as a viable treatment option. This approach involves using drugs that impede the growth or eradicate cancer cells. Additionally, chemotherapy can be paired with other therapies, including targeted therapy and immunotherapy. For instance, if the cancer is HR-negative and HER2-positive, targeted therapy drugs for the HER2 protein can be combined with chemotherapy.

Targeted therapy

Targeted therapy uses drugs that target specific proteins on or inside breast cancer cells. There are many types of targeted therapy drugs:

  • Cures for HER2-positive cancers, including but not limited to:
    • trastuzumab (Herceptin)
    • pertuzumab (Perjeta)
    • lapatinib (Tykerb)
    • tucatinib (Tukysa)
    • ado-trastuzumab emtansine (Kadcyla), a targeted therapy drug linked to a chemotherapy drug
  • drugs for HR-positive cancers like:
    • palbociclib (Ibrance)
    • ribociclib (Kisqali)
    • abemaciclib (Verzenio)
    • everolimus (Afinitor)
    • alpelisib (Piqray)
  • drugs that target cancers with mutations in BRCA1 and BRCA2 like olaparib (Lynparza) and talazoparib (Talzenna)

Sacituzumab-govitecan (Trodelvy) may also be used for triple-negative breast cancer. This treatment is a targeted therapy drug that’s linked to a chemotherapy drug.

Immunotherapy

Did you know that immunotherapy can help your immune system fight cancer cells? For metastatic breast cancer, one example of immunotherapy is pembrolizumab, also known as Keytruda. Excitingly, researchers are constantly exploring new approaches to immunotherapy. Recently, a clinical trial of a personalized immunotherapy treatment for metastatic breast cancer showed great potential in shrinking tumors. The therapy involves using tumor-fighting cells from trial participants to combat cancer cells.

Other treatments

The treatments for metastatic breast cancer typically involve systemic approaches that affect the entire body rather than just one area. Additionally, there may be other treatment options available for this condition.

For example, radiation therapy or surgery may help with cancer spread to specific areas. These include the following:

  • bones
  • brain
  • spinal cord
  • chest wall

People with bone metastasis can experience reduced bone pain and increased bone strength by using bisphosphonates, which are bone-building drugs.

Deciding which treatment is best for you

Deciding on the best treatment option for you requires information and careful consideration. Although you should work with your doctor to understand your votes, the choice is yours. As you consider the possibilities, keep these tips in mind:

  • Don’t rush into anything: Consider your choices, and get a second opinion if necessary.
  • Bring someone to your doctor appointments: Take notes or ask your doctor if you can record your visit. This can help ensure that you don’t forget anything that’s discussed.
  • Ask questions: Have your doctor explain each treatment’s potential benefits, risks, and side effects.
  • Consider a clinical trial: Find out if there are any clinical trials for which you may be eligible. There may be an experimental treatment option available for your specific cancer.

Receiving a diagnosis of metastatic breast cancer can be a daunting experience. However, there are several treatment options available that can alleviate symptoms and extend life expectancy. While there is no definitive cure, some women have been known to live for numerous years with metastatic breast cancer. Studies are underway to investigate methods of halting cancer cell growth, fortifying the immune system, and impeding cancer metastasis, and there may be additional treatment alternatives in the future.

Can you prevent or lower your risk for metastatic breast cancer?

There isn’t a definitive way to guarantee that your cancer won’t recur or metastasize after treatment, but you can reduce your risk. These steps include:

  • Managing weight: If you have obesity or overweight, talk to your doctor about healthy ways to manage your weight. A 2017 research review notes that increases in inflammation associated with obesity may create an environment that promotes cancer growth and metastasis.
  • Staying active: Keeping active is great for your overall health. It may also reduce recurrence and metastasis, perhaps due to the beneficial effect that physical activity can have on the immune system.
  • Eating a balanced diet: While we’re still learning more about diet and breast cancer, a 2017 research review suggests that excess intake of fats and carbs may impact the development of metastatic breast cancer. To eat a balanced diet, aim to do the following:
    • eat more fresh fruits and vegetables, whole grains, legumes, poultry, and fish
    • lower your consumption of red or processed meats
    • avoid sugar-laden foods
  • Cutting back on alcohol: Drink in moderation or not at all. Moderate drinking is one drink per day for women and two for men. Alcohol is a risk factor for developing breast cancer, but its impact on cancer metastasis or recurrence is still unclear.

Takeaway

Cancer that has spread to other body parts is known as metastatic cancer. In the case of breast cancer, it commonly metastasizes to the bones, lungs, liver, and brain. The symptoms of metastatic breast cancer vary depending on the affected area, and a doctor may carry out blood tests, imaging tests, and tissue biopsies to diagnose it. Although there is no definite cure for metastatic breast cancer, treatments available can help reduce cancer and improve the quality of life. Furthermore, researchers continue developing newer, more effective therapies for metastatic breast cancer.

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