Breast Cancer in Women: Metastasis (Spreading)

What is breast cancer metastasis?

Breast cancer is a growth of abnormal cells in the breast. A growth of cancer cells is called a tumor. Breast cancer is metastatic when the cancer spreads beyond the tumor in the breast and beyond the lymph nodes in the nearby armpit. This happens when cells shed by the tumor spread (metastasize) to other parts of the body through the bloodstream or lymph system.

After the cancer spreads, it can form new tumors in other parts of the body. These tumors are called metastases. As the cancer spreads through the blood, it most often travels to the bones of the pelvis, spine, upper arms and legs, ribs, and skull. Metastases are also commonly found in the liver, lungs, and brain.

Metastases happen most often within 3 years after initial treatment for breast cancer, but they can occur many years, even decades, later.

How does breast cancer occur?

Cancers are uncontrolled growths of abnormal cells. It is not known why they happen. Any woman can get breast cancer, but some women are more likely to develop it than others. You have a greater risk of breast cancer if:

• You have a mother, sister, or daughter who has had breast cancer.
• You or a parent, sister, brother, son, or daughter has changes in the genes called BRCA1 or BRCA2. Blood tests usually show these gene changes in families with many women who have had breast or ovarian cancer.
• You have had breast cancer before.
• You had your first menstrual period before age 13.
• Your menopause (when you stopped having periods) was after the age of 55.
• You are over 50 years old.
• You never gave birth to a child or you had your first child after age 30.
• You did not breast-feed.
• You had radiation therapy to the chest (including your breasts) before age 30.
• You have taken hormone therapy with estrogen or progesterone after menopause.
• You are overweight after going through menopause.
• You are physically inactive.
• You drink alcohol, especially if you are past menopause.

What are the signs and symptoms?

The most common symptom of breast cancer is a painless lump in the breast. The symptoms of metastasis depend on where the cancer has spread. Bone metastases usually cause pain. An enlarged liver found during a physical exam often indicates spread to the liver. Tumors in the lungs may cause a cough or shortness of breath. Tumors in the brain may cause headache, blurred vision, poor balance, trouble speaking, or weakness on one side of the body.

How is it diagnosed?

A physical exam and tests may show tumors growing in other parts of your body. Tests usually include:

• blood tests to check your liver and bones
• a chest X-ray
• a bone scan to look for signs of cancer spreading to the bones
• a CT scan (computed tomography) of your liver or chest
• a CT or MRI (magnetic resonance imaging) of your brain.

How is it treated?

The treatment for breast cancer depends on the size of the tumor and how much it has spread. Almost always surgery is done to remove the tumor or all or part of the breast. Some lymph nodes in the armpit area will also be removed.

For breast cancer that has spread, treatment may include radiation, chemotherapy, or hormone therapy. You may have just one type of treatment or a combination of treatments. These treatments are not expected to cure the metastatic cancer, but they usually slow down growth of tumors or make them smaller so that symptoms lessen or go away for a while.

• Radiation is given to a specific part of the body, usually a bone or the brain, to kill cancer cells and shrink tumors. This will lessen or get rid of the pain or brain symptoms. When a tumor is in the bone, radiation therapy will lower the risk of bone fracture.
• During chemotherapy anticancer drugs are given, usually through your veins (IV), to kill cancer cells. Sometimes just pills are used, or the treatment may include both pills and IV drugs.
• Hormone therapy may also be called anti-hormone treatment. Hormone therapy keeps cancer cells from getting or using the natural hormones (estrogen and progesterone) they need to grow. Drugs commonly used for this purpose are tamoxifen and anastrozole (Arimidex).

Sometimes biological therapy, such as the drugs trastuzumab (Herceptin, given IV) or lapatinib (Tykerb, taken as pills), is used to block the growth of cancer cells.

You will probably take medicine to relieve pain. Even severe pain can be controlled with a combination of medicines that usually includes narcotics. People taking narcotics to control pain do not become drug addicts. As radiation or chemotherapy treatment relieves the pain, the need for pain medicine will lessen and can even go away.

How long will the effects last?

How long you will live after the discovery of metastatic breast cancer depends on how much the cancer has spread and how sensitive the cancer is to the drugs used to treat it. Treatment of metastases can sometimes give years of further good control of the cancer.

How can I take care of myself?

• Rest often and follow the treatment plan that your healthcare provider gives you.
• Ask your healthcare provider for an exercise prescription to follow when you have finished your treatments.
• Consult with a dietitian to improve your diet to heal tissue after treatment and to fight the cancer.
• Join a breast cancer support group.
• Ask your healthcare provider any questions you have about the course of the disease, treatments, side effects of the treatments, support groups, and anything else that concerns you.
• Spend time with the people and activities you most enjoy.
• Ask your provider about alternative methods of pain control, such as relaxation techniques, guided imagery, and hypnosis.
• For more information, contact:
  • American Cancer Society, Inc.
    Phone: 800-ACS-2345 (800-227-2345)
    Web site: http://www.cancer.org
  • National Cancer Institute
    Phone: 1-800-4CANCER, or 1-800-422-6237 (TTY: 1-800-332-8615)
    Web site: http://www.cancer.gov

How can I help prevent the spread of breast cancer?

Taking antihormone drugs such as tamoxifen or anastrozole (Arimidex) for 5 or more years after breast cancer is discovered can help prevent recurrence and spread of the cancer.

Because the chance for cure and control depends on finding the cancer early and treating it before it spreads too far, be sure to tell your healthcare provider about any new sign or symptom you have.