Metastatic Breast Cancer
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Metastatic breast cancer is cancer that has spread (metastasized) to other organs in the body. Another name for metastatic breast cancer is stage IV breast cancer.
Mehran Habibi, M.D., breast surgeon and medical director of the Breast Health Services Center at Johns Hopkins Bayview Medical Center, discusses this diagnosis, how it’s treated and why patients have reason for hope.
What You Need to Know
- Metastatic breast cancer is serious, but the diagnosis does not always mean the end of life.
- The most common place for breast cancer to spread is to the bones. The liver and the lungs are other areas where breast cancer can metastasize.
- In about 15% of cases, metastatic breast cancer can be detected at the time of diagnosis. It can affect people who had breast cancer without seeking treatments, patients with aggressive breast cancer types (such as triple-negative breast cancer) and those with breast cancer not detected by screening.
Symptoms of Metastatic Breast Cancer
Symptoms depend on where the cancer has metastasized. According to Habibi, common areas include the bones of the spine, the lungs and the liver. The symptoms can be back pain, shortness of breath, cough and fatigue.
Some types, including triple negative breast cancer, can also spread to the brain. “The patient can experience headache, convulsions, changes in mood, and difficulty with speech or field of vision,” Habibi says.
People who have been treated for breast cancer should be on the lookout for symptoms such as:
- Back or neck pain
- Pain in the bones
- Profound fatigue or malaise (feeling generally unwell)
- Headache
- Seizures
- Vision changes
Reporting these symptoms is important, says Habibi. “Patients are usually the first and best people to notice something is not right, and can ask for guidance from their physicians.
“After completion of the active phase of cancer care, and in the absence of specific symptoms, we usually do not recommend routine metastatic workup.
“Doing a lot of unnecessary testing can harm the patient,” he explains. “Small abnormalities in one test can lead to additional test and biopsies, which can be very stressful to the patient, and repeated testing without symptoms has not been shown to improve outcomes.
“However, patients should continue with their routine follow-ups as prescribed by their surgeon, medical oncologist and primary care doctor, the latter of whom plays a very important role in the survivorship phase.”
Diagnosing Metastatic Breast Cancer
To diagnose metastatic breast cancer, your doctor may recommend one or more tests:
Blood Tests
- A complete blood count (CBC) to assess your bone marrow function
- Tests for minerals and enzymes (serum chemistry) that can provide evidence of spreading cancer or other health conditions
- Tests for proteins that signal the presence of cancer (biomarkers)
Imaging Tests
Preventing Metastatic Breast Cancer
Habibi advises: “Having a routine evaluation by your PCP and or cancer specialist would assist in diagnosing any cancer recurrence; taking the hormone therapy medications also can decrease the chance of cancer recurrence.
“Maintaining a healthy lifestyle, including staying at a healthy weight and avoiding alcohol, can help in reducing the chance of recurrence.”
Metastatic Breast Cancer Treatment
Metastatic breast cancer can have different presentations for each patient, and can behave differently from one person to the next. But for most, individualized treatment can slow the spread of cancer, lessen the impact of symptoms or both.
“We see patients with a whole host of presentations and degrees of aggressiveness. We’re not looking at all metastatic diagnoses with the same lens. When planning treatment and supportive care, we look at each individual patient and consider all aspects of their health and well-being.”
“The mainstay of therapy in the setting of metastatic disease is systemic therapy,” Habibi explains.
Systemic (all over) therapies use medicines, and may include:
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Chemotherapy, a systemic (all over the body) treatment that can address breast cancer throughout the whole body. Habibi explains that chemotherapy in metastatic breast cancer is used to suppress and stop the growth of the cancer and kill the cancer cells.
“Using chemotherapy over several months can create a window of time to see how the natural history of disease is behaving. In some cases, the cancer may balloon with rampant metastasis,” he says. “But, if the cancer responds to the chemo and disease is controlled and limited to one local area of metastasis, that spot can be addressed with surgery or radiation treatments.”
Chemotherapy can also be used for patients who have more than a few areas of spreading cancer. “For patients in the middle spectrum, we shift to a systemic approach to treatment,” Habibi says.
“After a full assessment, including scans that identify areas of disease, patients work with medical and radiation oncologists and surgeons to see where they can target treatment.” - Endocrine therapy, which uses hormones to address breast cancer cells that are hormone-receptor positive; in other words, the cells are sensitive to estrogen or other hormones.
- Immunotherapy for breast cancer, which uses the body’s immune system to identify the cancer cells as invaders and fight them.
Local therapy: Examples of this approach include surgery and radiation directed at one or more specific spots where breast cancer has spread. Local therapy can be used to address oligometastatic (OH-li-go met-a-STAT-ic) breast cancer, which is breast cancer that has spread to just one spot or to a limited number of areas.
“If a metastatic area remains stable with treatment, it can be treated as a chronic disease,” Habibi says, noting that in these situations, the strategy is preventing the cancer from advancing. For oligometastatic breast cancer, he says that a combination of chemotherapy, radiation treatments or surgery to remove cancerous areas can address symptoms and extend life.
Regional therapy includes surgery or radiation to treat metastatic cancer in nearby affected lymph nodes.
Aggressive and Advanced Metastatic Breast Cancer
Habibi says the most extreme situations involve patients who are diagnosed with a very fast, aggressive breast cancer that has already spread to multiple organs and begins to overwhelm the body. “For those patients, palliative (symptom) care is important, concentrating on local control, pain management and avoiding bleeding and infection.”
What is the prognosis for stage IV breast cancer?
Whether a patient’s metastatic breast cancer is the oligometastatic type or the most challenging, widespread sort, the best possible care addresses the patient as a unique individual. And according to Habibi, there are more reasons for hope than ever before.
“Advancements in treatment options have extended the survival of patients with metastatic breast cancer, which had a stigma of being untreatable just a generation ago.
“Even within the last decade, all aspects of care have seen a good amount of progress. Better diagnostic tests such as improved PET and CT scans are helping us find cancers faster and initiate treatment. And targeted therapies such as radiation, surgery and systemic treatments have seen improvements as well.”
