Metastatic Breast Cancer Diagnosis: Understanding Stage 4 Breast Cancer

Metastatic breast cancer (MBC), also known as Stage 4 breast cancer, occurs when cancer cells spread beyond the breast to other parts of the body. The term “metastatic” describes this process of cancer spreading. Advanced or distant breast cancer are other terms used to describe MBC. Understanding the diagnosis process is crucial for effective management and care.

Understanding Metastatic Breast Cancer: Cancer spreading to other parts of the body.

When breast cancer reappears in a distant location after initial treatment, it’s diagnosed as metastatic breast cancer (MBC), also known as distant recurrence. However, in some cases, de novo metastatic breast cancer is diagnosed when the cancer has already spread at the time of the initial breast cancer diagnosis. This indicates the cancer was already advanced when first detected.

Invasive ductal carcinoma (IDC), the most common type of breast cancer (85% of cases), frequently spreads to the bones, lungs, liver, and brain. Invasive lobular carcinoma (ILC), accounting for about 12% of breast cancers, tends to metastasize to organs like the uterus, ovaries, stomach, intestines, and sometimes the brain.

Currently, there is no cure for metastatic breast cancer. However, treatments are continuously improving, enabling many women to live longer and maintain a good quality of life. Managing MBC as a chronic condition with ongoing treatment and monitoring is the primary focus.

Navigating Metastatic Breast Cancer: Essential eBooks

The NBCF offers valuable resources, including two free eBooks by breast cancer expert Lillie Shockney, focusing on breast cancer recurrence:

Breast Cancer Recurrence
Most Asked Questions About Breast Cancer Recurrence

Comprehensive Guide to Metastatic Breast Cancer

Metastatic breast cancer facts & statistics
How breast cancer spreads (metastasis)
Recognizing metastatic breast cancer symptoms
Metastatic breast cancer in bones
Metastatic breast cancer in lungs
Metastatic breast cancer in liver
Metastatic breast cancer in brain
Metastatic breast cancer diagnosis methods
Metastatic breast cancer treatment approaches
Understanding metastatic breast cancer prognosis
Metastatic breast cancer survival rates
Genetic mutations and metastatic breast cancer
Metastatic breast cancer FAQs
Stories of hope for metastatic breast cancer

Key Facts and Statistics about Metastatic Breast Cancer

Approximately 168,000 women in the U.S. are estimated to be living with metastatic breast cancer.¹
The 5-year survival rate for metastatic breast cancer is improving, especially for women aged 15-39.²
About one-third of women with metastatic breast cancer live for 5 years or more.³
Some individuals can live 10 years or longer with metastatic breast cancer.⁴
Around 85% of MBC patients had a prior diagnosis of early-stage breast cancer, although most early-stage patients do not develop MBC.⁵
Nearly 30% of women initially diagnosed with early-stage breast cancer will eventually develop metastatic breast cancer.⁶
Men can also develop metastatic breast cancer, although it is rare.⁷

Understanding Breast Cancer Metastasis: How Cancer Spreads

Metastasis, the spread of cancer, generally occurs through these stages:⁸

Invasion of Nearby Cells: Cancer cells invade and take over healthy cells, leading to the replication of more cancerous cells.
Penetration into Circulatory/Lymph Systems: Cancer cells enter the bloodstream or lymphatic system.
Migration through Circulation: Cancer cells travel through the circulatory or lymphatic systems to distant parts of the body.
Lodging in Capillaries: Cancer cells become trapped in capillaries in distant locations.
Growth of New Tumors: New tumors (micrometastases) form at the distant site.

Even when breast cancer spreads, it remains breast cancer. For example, if breast cancer spreads to the bones, it’s metastatic breast cancer with bone metastases, not bone cancer.

Recognizing Symptoms of Metastatic Breast Cancer

Early-stage breast cancer may not present noticeable symptoms. However, advanced cancers like metastatic breast cancer may have recognizable signs. Symptoms can vary based on the extent and location of the metastasis.

Johns Hopkins recommends that individuals, especially those with a history of breast cancer, should be vigilant for symptoms like:

Persistent back or neck pain without clear cause (injury or exercise)
Bone pain
Unexplained shortness of breath
Extreme fatigue or feeling unwell (malaise)
Headache
Seizures
Mood changes
Speech difficulties
Vision changes

Location-Specific Symptoms of Metastatic Breast Cancer

Symptoms of metastatic breast cancer can be location-specific, depending on where the cancer has spread. It’s crucial to remember that even if breast cancer spreads, it is still breast cancer. Report any symptoms to your doctor.

Metastatic Breast Cancer in the Bones: Bone Metastasis

Bone metastasis occurs when breast cancer spreads to the bones, most commonly the spine, pelvis, and thigh. It remains breast cancer even when in the bones. Bone metastasis is the most frequent type of MBC, affecting about 70% of MBC patients.¹⁰

Identifying Symptoms of Bone Metastasis

Bone metastasis may sometimes be asymptomatic. When symptoms are present, early signs can include:¹¹

Severe, progressive bone pain, especially in the spine, ribs, pelvis, or long bones. Bone pain is the most common symptom.
Joint swelling within the skeletal system.
Weak bones prone to fractures (pathological fractures), not due to osteoporosis.
Arm or leg weakness.
Hypercalcemia (high blood calcium), causing nausea, vomiting, constipation, or confusion.

Metastatic Breast Cancer in the Lungs: Lung Metastasis

Lung metastasis is when breast cancer spreads to one or both lungs. Approximately 60% of metastatic breast cancer patients experience lung metastasis during their lifetime.¹²

Recognizing Symptoms of Lung Metastasis

Lung metastases are often asymptomatic. If symptoms occur, they may include:¹³

Persistent cough
Shortness of breath
Chest pain or discomfort
Difficulty breathing after exertion

Metastatic Breast Cancer in the Liver: Liver Metastasis

Liver metastasis is when breast cancer spreads to the liver. The liver is the initial metastasis site in 5% to 12% of MBC cases, but about 50% of MBC patients eventually develop liver metastases.¹⁴

Identifying Symptoms of Liver Metastasis

Liver metastases are often asymptomatic. When symptoms appear, they can include:¹⁵

Jaundice: yellowing of skin and eyes, darkened skin
Itchy skin or rash
Elevated liver enzymes in blood tests
Right-side abdominal pain
Weakness
Loss of appetite
Nausea and vomiting
Light gray stool

Metastatic Breast Cancer in the Brain: Brain Metastasis

Brain metastasis occurs when breast cancer spreads to the brain. It is still breast cancer even when in the brain. Brain metastasis occurs in about 10-15% of women with metastatic breast cancer.¹⁶ The actual incidence might be higher, with some cases being asymptomatic.

Recognizing Symptoms of Brain Metastasis

Brain metastasis can cause various symptoms, including:¹⁷

Persistent, worsening headaches or head pressure
Memory loss
Vision problems (blurred vision, double vision, vision loss, light flashes)
Slurred speech
Dizziness
Balance issues
Weakness or paralysis on one side of the body
Numbness or tingling in extremities
Nausea or vomiting
Seizures
Strokes
Mood, personality, or behavior changes
Impaired judgment

Report these symptoms to your physician for timely diagnosis and treatment.

Diagnosing Metastatic Breast Cancer: Tests and Procedures

Diagnosing metastatic breast cancer often starts with symptom evaluation. For those diagnosed with Stage 2 or Stage 3 breast cancer, a “staging workup” may be done to check for metastasis.

In Stage 1 breast cancer, if cancer cells show vascular or lymphatic invasion, scans might be ordered to rule out metastasis.

If a patient has symptoms of metastatic breast cancer, especially with a prior breast cancer history, doctors will order tests to investigate.

Diagnostic Tests for Metastatic Breast Cancer

There is no single test for Metastatic Breast Cancer Diagnosis. Doctors use a “staging workup” combining blood and imaging tests. These tests may include:

Blood Tests:
- Tumor markers (in some cases)
- Complete blood count (CBC) for bone marrow function
- Liver enzymes for liver metastasis
- Calcium levels for bone metastasis
Imaging Tests:
- Whole-body bone scan (with or without bone X-rays)
- MRI of spine or brain
- CT scan of chest, abdomen, pelvis, or brain
- PET scan
- X-ray or ultrasound of abdomen or chest
Bronchoscopy: for persistent cough or breathing issues
Biopsy: of suspicious areas
Fluid Tap: to check for cancer cells in symptomatic areas:
- Pleural tap (thoracentesis) for lung fluid
- Spinal tap (lumbar puncture) for spinal fluid
- Abdominal tap (paracentesis) for abdominal fluid

Metastatic Breast Cancer Treatment Strategies

As metastatic breast cancer is currently incurable, treatment focuses on managing tumor size and growth, alleviating symptoms, enhancing quality of life, and extending survival.

Systemic treatments, using drugs to target cancer throughout the body, are the primary approach. These may include:

Metastatic Breast Cancer Medications

Treatment typically continues with a drug regimen until cancer progresses or side effects become unmanageable. Then, a new therapy is prescribed. Common drug types include:¹⁸ (Note: This is not exhaustive; discuss all medications with your healthcare provider. NBCF does not endorse specific brands.)

Hormone Receptor-Positive (HR+) Cancer Drugs

Tamoxifen
Aromatase inhibitors
CDK4/6 inhibitors
Everolimus
PI3K inhibitors (e.g., alpelisib)
AKT inhibitors (e.g., capivasertib)

HER2-Positive (HER2+) Cancer Drugs

Trastuzumab (Herceptin)
Pertuzumab (Perjeta)
Antibody-drug conjugates
Kinase inhibitors
Fam-trastuzumab deruxtecan (Enhertu) for HER2-low cancers
PARP inhibitors for BRCA gene mutation carriers

Immunotherapy Drugs

Pembrolizumab (Keytruda)
Atezolizumab (Tecentriq)

Local and Regional Treatments

While systemic drugs are primary, local and regional treatments like surgery, radiation, or chemotherapy are sometimes used to manage symptoms of metastatic disease. For example, radiation can relieve bone pain from bone metastases and prevent fractures. It’s also used for brain metastasis.

Advances in Metastatic Breast Cancer Treatment

Clinical trials are crucial for developing new treatments. To find relevant trials, search the metastatic breast cancer clinical trial database.

Palliative and Complementary Care

Palliative care focuses on managing symptoms and side effects to improve quality of life. It’s not a cancer treatment or hospice care. Complementary therapies like yoga, meditation, and acupuncture can also support overall well-being.

Understanding Metastatic Breast Cancer Prognosis

While a complete cure is not currently possible, research aims to improve treatments and find a cure. Many women live longer and better with MBC, managing it as a chronic condition.

Support groups can be beneficial. NBCF offers virtual and in-person support groups, and METAvivor provides specific support for MBC patients.

NBCF also hosts retreats for MBC patients and caregivers, offering support, hope, and educational sessions. Contact [email protected] for retreat information.

Encouragement and Hope for Metastatic Breast Cancer

For inspiration, read Tracy’s 18+ year MBC survivor story:

Confessions of an 18-year MBC Thriver
Spoiler Alert: She Lives

Metastatic Breast Cancer Survival Rates

The 5-year relative survival rate for metastatic breast cancer is 32% for women and 20% for men, according to the American Cancer Society. However, survival varies greatly based on individual factors and treatment response.

Despite the challenges, remember that treatments are improving, and hope remains. NBCF offers support and resources at [email protected].

Genetic Mutations and Metastatic Breast Cancer: The Importance of Testing

Genetic testing is recommended for all MBC patients due to:

Targeted therapies like PARP inhibitors for gene mutation carriers.
Family risk assessment. Positive results mean a 50% chance of siblings and children carrying the mutation.
Advances in genetic testing; retesting is advised if prior testing was before 2012.

Metastatic Breast Cancer: Frequently Asked Questions

Can you get Stage 4 MBC without prior stages?

Yes, de novo metastatic breast cancer is diagnosed when Stage 4 is the first diagnosis. Recurrent MBC occurs after prior breast cancer diagnosis (Stages 1-3).

How long can you live with Stage 4 MBC?

Survival varies. The 5-year relative survival rate is 32%. However, many live longer, some 10+ years, particularly those with HR+, HER2- cancers.¹⁹

What are the final stages of MBC?

End-of-life symptoms may include:²⁰

Progressive pain
Fatigue and sleepiness
Breathing difficulties
Appetite loss
Weight loss
Confusion
Digestive issues
Emotional changes

Palliative and hospice care are crucial in these stages.

What is the cause of death in MBC?

Infection is the most common cause, followed by organ failure. Late-stage treatments can be toxic and minimally effective, impacting organ function and immunity.

Who has the longest survival with MBC?

Postmenopausal women with HR+, HER2- MBC tend to have longer survival, likely due to CDK4/6 inhibitors combined with hormone therapy.²¹

Stories of Hope: Living with Metastatic Breast Cancer

NBCF’s blog, The Hope Nook, offers inspiring stories from women facing MBC:

Confessions of an 18-Year Metastatic Breast Cancer Thriver
Spoiler Alert: She Lives
Marianne’s Story of Finding Hope with Metastatic Breast Cancer

Sources:

Related Reading:

Breast Cancer During…
Inflammatory Breast Cancer…