Lobular Carcinoma In Situ (LCIS) is not breast cancer. It is a condition where abnormal cells are found in the lobules of the breast. The atypical cells have not spread outside of the lobules into the surrounding breast tissue.

LCIS is highly treatable and seldom becomes invasive cancer. However, having LCIS in one breast increases the risk of developing breast cancer in either breast.

What Does The Term “In Situ” Mean?

Although LCIS is not considered breast cancer, it still has the term carcinoma in the name. The earliest stages of cancers are called “carcinoma in situ.” Carcinoma means “cancer” and in situ means “in the original place.”

What Is The Difference Between Lobular Carcinoma In Situ (LCIS) and Ductal Carcinoma In Situ (DCIS)?

LCIS is a collection of abnormal cells found in the lobules, or milk glands, of the breast. LCIS is a breast condition and is not considered breast cancer. DCIS is early-stage breast cancer that is found in the milk ducts of the breast.

Materials on this page courtesy of National Cancer Institute

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Invasive lobular breast cancer (ILC) is invasive breast cancer that begins in the lobules (milk glands) of the breast and spreads to surrounding normal tissue. It can also spread through the blood and lymph systems to other parts of the body. 

Invasive lobular breast cancer is the second most common type of breast cancer. Over 10% of invasive breast cancers are invasive lobular carcinomas.

Though mammograms are helpful and important, they are less likely to detect invasive lobular breast cancer than other types of breast cancers. Invasive lobular cancer doesn’t always appear clearly on a mammogram, instead an MRI might be needed.

What Is The Difference Between Invasive Lobular Carcinoma (ILC) and Lobular Carcinoma In Situ (LCIS)?

Lobular carcinoma in situ (LCIS) is not breast cancer; it is a condition where abnormal cells are found in the milk glands, or lobules, of the breast and have not invaded any other area. Invasive lobular carcinoma (ILC) is cancer that began growing in the lobules (milk glands) of the breast and is invading the surrounding tissue. Cancer staging done by a physician, along with a physical exam and medical history can help identify the best treatment options.

Over 80% of the time, invasive lobular carcinoma (ILC) is ER+ and HER2-. Sometimes invasive lobular breast cancer can be larger than it appears to be when reviewing a mammogram because of the way it grows. It can be commonly identified as a higher stage cancer.

Invasive lobular carcinoma is known for being a slow growing tumor, usually grade I or II. Slow growing, grade I tumors don’t usually respond well to chemotherapy, so hormonal therapy is key for this type of cancer.

If it spreads to other organs, becoming Stage IV breast cancer, it typically goes to the colon, uterus, ovary, stomach, lung, bone, and other areas.  

Materials on this page courtesy of National Cancer Institute

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Ductal carcinoma in situ (DCIS) is a non-invasive cancer where abnormal cells have been found in the lining of the breast milk duct. The atypical cells have not spread outside of the ducts into the surrounding breast tissue. Ductal carcinoma in situ is very early cancer that is highly treatable, but if it’s left untreated or undetected, it may spread into the surrounding breast tissue.

What does the term, “in situ” mean?

The earliest stages of cancers are called “carcinoma in situ.” Carcinoma means “cancer” and in situ means “in the original place.”

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Invasive Ductal Carcinoma (IDC) is an invasive cancer where abnormal cancer cells that began forming in the milk ducts have spread beyond the ducts into other parts of the breast tissue. Invasive cancer cells can also spread to other parts of the body. It is also sometimes called infiltrative ductal carcinoma.

• IDC is the most common type of breast cancer, making up nearly 70- 80% of all breast cancer diagnoses.
• IDC is also the type of breast cancer that most commonly affects men.

What Is The Difference Between Invasive Ductal Carcinoma (IDC) And Ductal Carcinoma In Situ (DCIS)?

DCIS means the cancer is still contained in the milk duct and has not invaded any other area. IDC is cancer that began growing in the duct and is invading the surrounding tissue. Cancer staging done by a physician, along with a physical exam and medical history can help identify the best treatment options.

Materials on this page courtesy of National Cancer Institute

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A diagnosis of triple negative breast cancer means that the three most common types of receptors known to fuel most breast cancer growth–estrogen, progesterone, and the HER2/neu gene–are not present in the cancer tumor.  This means that the breast cancer cells have tested negative for hormone epidermal growth factor receptor 2 (HER2), estrogen receptors (ER), and progesterone receptors (PR).  

Since the tumor cells lack the necessary receptors, common treatments like hormone therapy and drugs that target estrogen, progesterone, and HER2 are ineffective. Using chemotherapy to treat triple negative breast cancer is still an effective option. In fact, triple negative breast cancer may respond even better to chemotherapy in the earlier stages than many other forms of cancer.

Who Is At Risk For Triple Negative Breast Cancer?

Triple negative breast cancer occurs in about 10-20% of diagnosed breast cancers and is more likely to affect younger people, African Americans, Hispanics, and/or those with a BRCA1 gene mutation.

What Is The Prognosis For Triple Negative Breast Cancer?

Triple negative breast cancer can be more aggressive and difficult to treat.  Also, the cancer is more likely to spread and recur.  The stage of breast cancer and the grade of the tumor will influence your prognosis. Research is being done currently to create drug therapies that are specific for triple negative breast cancer.

Interested in learning more? Watch the free webinar, Facing TNBC: Self-Advocacy & Decision Making.

Material on this page courtesy of Johns Hopkins Medicine

The post Triple Negative Breast Cancer appeared first on National Breast Cancer Foundation.

Accounting for 1 to 5% of all breast cancer cases, inflammatory breast cancer (IBC) is a rare and aggressive type of breast cancer. IBC occurs when cancer cells infiltrate the skin and lymph vessels of the breast. IBC is harder to diagnose than other types of breast cancer and tends to occur in younger women. It also spreads more quickly than other types of breast cancer.

Table of contents

• Symptoms
• Inflammatory breast cancer rash
• Causes
• Diagnosis
• Treatment
• Inflammatory breast cancer metastasis
• FAQs

What are the symptoms of inflammatory breast cancer?

Unlike many other types of breast cancer, inflammatory breast cancer does not typically start with a distinct lump or tumor in the breast that can be felt or isolated. But when the lymph vessels of the breast (the small tubes that drain lymph fluid away from the breast tissue and carry it to the lymph nodes) become blocked by breast cancer cells, symptoms begin to appear.

Inflammatory breast cancer symptoms may include:

• Areas of skin discoloration that are pink, red, or purple, which typically cover more than one-third of the breast
• A persistent rash that looks like an insect bite or a bruise
• Swelling or firmness, typically in one breast
• Persistent itching, pain, and/or burning; one breast may feel warmer than the other
• Skin may appear pitted like an orange peel
• Nipple changes including inversion (turning inward), flattening, or dimpling
• Swollen lymph nodes near collarbone or under arm

If you have these symptoms, it does not necessarily mean you have inflammatory breast cancer, but you should see a physician. You may initially be treated with antibiotics to rule out a breast infection or allergy. But if symptoms persist, you should see a breast specialist.

Inflammatory breast cancer rash

A rash is one of the first and most common symptoms of IBC. The rash may appear suddenly, even overnight, and look red, pink, purple, or discolored. The rash is typically large, covering at least one-third of the breast, and can appear on and around the entire breast. It can appear with or without associated itchiness. For some, a rash can look more like a bruise.

Inflammatory breast cancer rashes are caused by a blockage of lymph vessels (small drainage tubes) in the breast that results in redness, swelling, and inflammation. For some, the rash or bruise may be persistent and not go away. For others, the rash or bruise may come and go over a period of time. However, rashes and other symptoms often become worse and more persistent as the cancer progresses.

Other conditions that lead to breast rash

Inflammation of breast tissue is most typically seen in women who are breastfeeding, have infections, allergies, and other conditions that may also lead to a breast rash. These conditions include:

• Mastitis: This infection of the breast is most often seen in pregnant or lactating women. Mastitis symptoms include breast pain, swelling, redness, and flu-like symptoms. If your primary care physician or gynecologist diagnoses mastitis, but symptoms persist after a one-week treatment of antibiotics, it’s important to be seen by a breast specialist.
• Paget’s disease of the breast: Another rare breast cancer, Paget’s disease of the breast is more treatable than IBC and is also characterized by itching, redness, and scales on or around the nipple. Paget’s disease often stems from an underlying breast cancer and typically begins in the nipple ducts and then spreads to the surface and the areola.
• Nipple dermatitis: Also known as eczema, nipple dermatitis is characterized by dry, itchy skin that may feature small raised bumps and red or brown patches. It often appears on people who have eczema elsewhere on their bodies and may recur. Nipple eczema can be treated with moisturizers and medication.
• Breast skin dermatitis: This type of skin irritation caused by an allergic reaction to soap, detergent, a piece of clothing, an insect sting, or perfume. It can be treated by discontinuing contact with these items and using over-the-counter steroid cream and anti-itch medications.
• Breast abscesses: Often caused by bacteria, a breast abscess is a collection of pus in the breast. They may appear as a hot, swollen, red mass on the breast and can also cause fever, nausea, and chills.

Not all breast problems are breast cancer. However, if you have any new or unusual changes in your breasts, including size, redness, rashes, itching or irritation, or bruising, it is important to contact your doctor.

What causes inflammatory breast cancer?

There is no clear cause of inflammatory breast cancer.

Most IBC is considered invasive ductal carcinoma, a type of cancer that forms from the cells that line milk ducts in the breast and then spreads to other parts of the breast tissue or other parts of the body, although the symptoms and treatment differ.

Inflammatory breast cancer, which is more common in women under the age of 40, Black women, and those who have a higher body mass index (BMI), develops when cancerous cells block lymph vessels, which are small tubes that allow lymph fluid to drain out of the breast. This blockage is what creates the swelling and discoloration in the breast.

When a breast cell develops changes in its DNA, the abnormal cancerous cell can grow and divide rapidly. Cancerous cells can spread to lymph nodes and other organs and tissues in the body.

Despite the name, inflammatory breast cancer is not caused by inflammation. Rather, the term refers to the inflamed appearance of the breasts.

How is inflammatory breast cancer diagnosed?

While it can be more difficult to diagnose inflammatory breast cancer because there is not a lump to view on a mammogram or feel during an exam, it is typically diagnosed through a clinical exam and a biopsy. A skin punch biopsy is when a sample of the skin and tissue immediately underneath the skin is taken. A pathologist will then test the skin and tissue to determine if it is cancerous. Additional tests, including MRI or ultrasound, may also be recommended.

If the biopsy results show that the skin and dermal lymphatics (network of small blood vessels) of the breast skin contain cancer cells, this confirms it is inflammatory breast cancer. A diagnosis of IBC is classified as Stage 3 breast cancer, since it includes cancer of the skin of the breast. If the cancer has spread outside of the breast and skin to other organs of the body, it is classified as Stage 4.

How is inflammatory breast cancer treated?

Typically, IBC grows rapidly and requires aggressive treatment, beginning with chemotherapy and followed by a mastectomy to remove the cancer. Radiation, hormone therapy, and/or additional chemotherapy may also be provided post-surgery. However, treatment options may vary based on what type of hormone receptors the original cancer had. Additionally, breast reconstruction is usually not done when the original diagnosis was IBC because of the high risk of local and regional recurrence, as well as the risk for metastatic recurrence.

According to the American Cancer Society, the 5-year relative survival rate for Stage 3 IBC is 52%. However, with advances in early detection and aggressive treatment, the survival rate for inflammatory breast cancer patients has improved significantly in recent years.

Inflammatory breast cancer metastasis

Inflammatory breast cancer grows and spreads (metastasizes) quickly, often spreading to nearby lymph nodes, which are small, bean-shaped structures in the body that support the immune system. This can cause lymph nodes to become swollen and painful. IBC can also metastasize (spread) to organs such as the brain, bones, liver, and lungs if not diagnosed promptly.

Once breast cancer spreads from the breast to other parts or systems of the body, it is considered metastatic breast cancer and is classified as Stage 4. Tests can determine if and how IBC has spread to other parts of the body.

Inflammatory breast cancer FAQs

Does a breast cancer rash appear suddenly?

Yes, breast cancer rashes associated with inflammatory breast cancer do appear suddenly, sometimes overnight.

What kind of breast cancer starts with a rash?

Inflammatory breast cancer typically starts with a rash, rather than a lump. The rash can appear suddenly and cover one-third or more of the breast. Paget’s disease of the breast, another type of breast cancer, may also show up as a rash or redness.

How can you tell if a rash is cancerous?

Only lab tests, such as a biopsy, can determine if a rash is a symptom of inflammatory breast cancer or another form of breast cancer. Schedule an appointment with your doctor or a breast specialist, who can take a closer look and determine more about the rash.

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It is possible to be diagnosed with breast cancer during pregnancy, although it is rare and the breast cancer is not caused by the pregnancy. Women who are diagnosed with breast cancer during pregnancy have tremendous additional strain due to concern for the safety of the unborn child. It can be a traumatic and extremely difficult situation, but there is still hope for both mother and child, thanks to the many treatment options available.

If you are pregnant and have been diagnosed, be sure to communicate carefully with your obstetric care team as well as your oncology team, and it never hurts to verify that they have open communication with each other. Your medical team will take extra care in designing the treatment plan that best controls the breast cancer while protecting your unborn child.

What Cancer Treatments Are Safest During Pregnancy?

Your treatment plan will depend on the size of the tumor, its location, and the term of your pregnancy. As with women who are not pregnant, surgery is usually the first step for treating early-stage breast cancer. Surgery during pregnancy can be safely performed with little risk to your unborn child, so your medical team will most likely proceed by removing the lump with a lumpectomy or mastectomy, and possibly some lymph nodes from under the arm.

Chemotherapy may be a treatment option, depending on your cancer type and the stage of your pregnancy. There are specific windows of time during pregnancy that is safe to receive chemotherapy without harming the baby.

Radiation, if recommended, is always done after the baby is born because radiation is not safe for an unborn child.

The effects of hormone therapy on unborn children is not entirely understood. Because of this, if hormone therapy is prescribed, it will most likely be used only after the baby is born.

Although the cancer itself cannot spread to and harm the unborn child, sometimes the best treatment plan for the mother may put the unborn child at risk. These decisions will require the expertise and consultation between your obstetrician, surgeon, medical oncologist, and radiation oncologist. You will also need the emotional support of family and friends and may benefit from the professional assistance of a skilled counselor or psychologist.

The post Breast Cancer During Pregnancy appeared first on National Breast Cancer Foundation.

Medullary Carcinoma

Medullary carcinoma accounts for 3-5% of all breast cancer types.  The tumor usually shows up on a mammogram, but does not always feel like a lump.  At times, it feels like a spongy change of breast tissue.

Tubular Carcinoma

Making up about 2% of all breast cancer diagnosis, tubular carcinoma cells have a distinctive tubular structure when viewed under a microscope. It is usually found through a mammogram and is a collection of cells that can feel like a spongy area of breast tissue rather than a lump. This type of breast cancer is known for being slow growing and is usually associated with DCIS. Typically this type of breast cancer is found in women aged 50 and above and usually responds well to hormone therapy.

Mucinous Carcinoma (Colloid)

Mucinous carcinoma represents approximately 1% to 2% of all breast cancers. The main differentiating features are mucus production and cells that are poorly defined. It also has a favorable prognosis in most cases.

Paget’s Disease Of The Breast Or Nipple

This condition (also known as mammary Paget’s disease) is a rare type of cancer affecting the skin of the nipple and often the areola, which is the darker circle of skin around the nipple. Most people with Paget’s disease evident on the nipple also have one or more tumors inside the same breast; generally either ductal carcinoma in situ or invasive breast cancer (1–3). Paget’s disease is frequently misdiagnosed at first because the first noticeable symptoms can easily be confused with more common skin conditions affecting the nipple. Like all breast cancers, the prognosis for Paget’s disease depends on a variety of factors, including the presence or absence of invasive cancer and whether or not it has spread to nearby lymph nodes.

Metaplastic Breast Cancer

Metaplastic Breast Cancer is a very rare and aggressive form of breast cancer. It accounts for less than 1% of all breast cancer diagnoses. Metaplastic breast cancer often resembles invasive ductal carcinoma (IDC) on imaging scans, making a correct diagnosis difficult.

Phyllodes Tumors

Phyllodes tumors in the breast are usually benign (non-cancerous), with only a small percentage found to be malignant (cancerous). Though rare, the presence of malignant phyllodes tumors in the breast often requires a mastectomy as part of treatment. It is necessary to get very wide margins around the tumor in order to prevent it from recurring, or coming back, in the same place.

Angiosarcoma of the Breast

Angiosarcoma of the breast is an extremely rare form of breast cancer, accounting for only 0.1% to 0.2% of all breast cancers. It occurs in the breast and in the skin of the arms, and is usually seen in those who have had extensive prior radiation of the chest wall, such as mantle radiation for cancer treatment as a child or young person. Angiosarcoma can grow and spread quickly.

Materials on this page courtesy of National Cancer Institute

The post Other Types appeared first on National Breast Cancer Foundation.

When breast cancer recurs, or returns, to another part of the body months or years after the initial breast cancer diagnosis and treatment (also referred to as distant recurrence), it is called metastatic breast cancer. When the first diagnosis of breast cancer is metastatic, it is called de novo metastatic breast cancer. This typically means that the cancer has already spread out of the breast and into other areas of the body by the time the initial diagnosis of breast cancer is made.

Invasive ductal carcinoma (IDC) makes up 85% of breast cancer cases. The most common distant areas for invasive ductal breast cancer to spread to are the bones, lungs, liver, and brain. Another type of breast cancer, invasive lobular carcinoma (ILC), makes up about 12% of breast cancers. When ILC spreads, it usually travels to different organs, primarily the uterus, ovaries, stomach, intestines, and sometimes brain.

There is currently no cure available for metastatic breast cancer, but more and more women are living longer with the disease by managing it as a chronic illness with a focus on quality of life as a primary goal. The focus of treatment is to control the disease through continuous treatment and monitoring.

Table of Contents

Click on the following links to jump to additional information about metastatic breast cancer.

Metastatic breast cancer facts & statistics
How does breast cancer spread, or metastasize?
What are the symptoms of metastatic breast cancer?
Metastatic breast cancer in the bones
Metastatic breast cancer in the lungs
Metastatic breast cancer in the liver
Metastatic breast cancer in the brain
How is metastatic breast cancer diagnosed?
Metastatic breast cancer treatment
Metastatic breast cancer prognosis
Metastatic breast cancer survival rate
Metastatic breast cancer and genetic mutations
Metastatic breast cancer FAQs

Metastatic breast cancer facts & statistics

• An estimated 168,000 women in the United States are living with metastatic breast cancer.¹
• The 5-year survival rate for women with metastatic breast cancer is increasing, especially among women ages 15-39.²
• Approximately one-third of women with metastatic breast cancer have lived with the disease for 5 or more years.³
• Some women may live for 10 years or longer with metastatic breast cancer.⁴
• Approximately 85% of patients diagnosed with MBC have had an early-stage breast cancer diagnosis, though most patients with early-stage breast cancer do not go on to develop MBC.⁵
• Nearly 30% of women initially diagnosed with early-stage breast cancer will ultimately develop metastatic breast cancer.⁶
• While rare, men can also develop metastatic breast cancer.⁷

How does breast cancer spread, or metastasize?

The spread of cancer (metastasis) usually happens through the following steps⁸:

• Cancer cells invade nearby healthy cells. When a healthy cell is taken over by cancer, the healthy cells begin to replicate (reproduce) more abnormal (cancerous) cells.
• Cancer cells penetrate into the circulatory or lymph system. Once cancer cells replicate, they can break away from where they first formed and enter the circulatory system (bloodstream) or lymphatic system (lymph nodes).
• Migration through circulation. Cancer cells that have broken away from their original location can be carried by the circulatory system or lymph system to other, distant parts of the body, where they can begin forming new tumors.
• Cancer cells lodge in capillaries. Cancer cells may become lodged in the capillaries (tiny vessels) of other parts of the body. Once the cells become lodged and stop moving, they can start dividing and migrating into the surrounding tissue at the distant location.
• New small tumors grow. Cancer cells begin to form small tumors (micrometastases) at the new location elsewhere in the body.

Even if breast cancer has spread to another part of the body, it is still breast cancer and is referred to as metastatic breast cancer. For example, if breast cancer cells have spread to the bones, the diagnosis is metastatic breast cancer with bone metastases, not bone cancer.

What are the symptoms of metastatic breast cancer?

While early stage breast cancer may not have any signs or symptoms, advanced cancer such as metastatic breast cancer may have signs and symptoms that the patient is aware of. However, metastatic breast cancer symptoms may vary, depending on how far the breast cancer has spread and where in the body the new cancer growth has invaded. 

According to Johns Hopkins, people, especially those who have been treated for breast cancer, should watch for symptoms such as: 

• Unusual or persistent back or neck pain (that is not explained by an injury or exercise)
• Pain in the bones
• Unexplained shortness of breath
• Profound fatigue or malaise (feeling generally unwell)
• Headache
• Seizures
• Mood changes
• Difficulty with speech
• Vision changes

Metastatic breast cancer symptoms by location

Metastatic breast cancer may have additional, specific symptoms, depending on the location of the metastases. Below is an overview of common sites of breast cancer metastasis, as well as the signs and symptoms associated with each. Remember that even if breast cancer has spread to another part of the body, it is still breast cancer. All symptoms should be reported to your physician.

Metastatic breast cancer in the bones

Metastatic breast cancer with bone metastasis is when breast cancer has spread from the original location in the breast to the bones. Although breast cancer can spread to any bone, the most common bones for breast cancer to spread to include the spine, pelvis, and thigh.⁹ Even though the breast cancer has spread to the bones, it is still breast cancer. Metastasis to the bones is the most common type of breast cancer metastasis, impacting approximately 70% of individuals with metastatic breast cancer.¹⁰

Symptoms of metastatic breast cancer in the bones

Sometimes metastasis to the bones can have no symptoms. But if symptoms are present, some of the first signs of metastatic breast cancer in the bones can include¹¹:

• Severe, progressive bone pain, particularly in the spine, ribs, pelvis, or long bones in the arms and legs. Bone pain is the most common symptom of bone metastasis. 
• Swelling of a joint within the skeletal system.
• Weak or fragile bones that are more easily fractured or broken (not as a result of osteoporosis). Such fractures are known as pathological fractures. 
• Weakness in the arms or legs
• High levels of calcium in the blood (hypercalcemia), which can cause nausea, vomiting, constipation, or confusion

Metastatic breast cancer in the lungs

Breast cancer metastasis to the lungs is when breast cancer has spread from the original location in the breast to one or both lungs. Approximately 60% of metastatic breast cancer patients will experience lung metastasis in their life.¹²

Symptoms of metastatic breast cancer in the lungs

Lung metastases rarely produce symptoms in metastatic breast cancer patients. However, if lung metastases do produce symptoms, they can include¹³:

• Chronic cough (a cough that doesn’t go away)
• Inability to take a full breath (shortness of breath)
• Pain or discomfort in the chest area
• Difficulty in catching one’s breath after physical exertion, such as walking up stairs

Metastatic breast cancer in the liver

Breast cancer metastasis in the liver is when breast cancer has spread from the original location in the breast to the liver. Between 5% and 12% of people with metastatic breast cancer will have the liver as the first site of metastasis. However, about 50% of individuals with metastatic breast cancer will develop liver metastases at some point.¹⁴

Symptoms of metastatic breast cancer in the liver

Liver metastases rarely produce symptoms. But when they do occur, symptoms can include:¹⁵

• Jaundice: yellowing of the skin and whites of the eyes; the skin turning dark orange or ashened in color
• Itchy skin or rash
• Abnormally high enzymes in the liver, determined through a blood test
• Abdominal pain, particularly in the right side
• Weakness
• Loss of appetite
• Nausea and vomiting
• Stool color turning light gray

Metastatic breast cancer in the brain

Breast cancer metastasis in the brain means that breast cancer has spread from the original location in the breast to the brain. Even though the breast cancer has spread to the brain, it is still breast cancer. Brain metastasis occurs in approximately 10-15% of women with metastatic breast cancer.¹⁶ However, it is assumed that more patients may have brain metastasis without any symptoms.

Symptoms of metastatic breast cancer in the brain

Metastasis of breast cancer to the brain can cause a variety of symptoms, including¹⁷:

• Persistent, progressively worsening headaches or pressure in the head
• Memory loss
• Vision disturbances, such as blurred vision, double vision, loss of vision, or seeing flashes of light
• Slurred speech 
• Dizziness
• Balance problems
• Weakness or paralysis on one side of the body
• Numbness or tingling in the extremities
• Nausea or vomiting
• Seizures
• Strokes
• Mood, personality, or behavioral changes
• Impaired judgment

If you notice these symptoms, be sure you talk with your physician. They could be important for getting the treatment you need.

How is metastatic breast cancer diagnosed?

Metastatic breast cancer is often initially investigated based on symptoms. For someone newly diagnosed with Stage 2 or Stage 3 breast cancer, a “staging workup” may be performed to determine if there is any evidence of metastasis (cancer spread) to other organ sites in the body.

Additionally, if someone has Stage 1 breast cancer, and the cancer cells in the breast show the presence of vascular (blood stream) invasion or lymphatic (lymph node) invasion, scans may be conducted to rule out the presence of metastatic disease in other areas of the body.

If a patient is experiencing symptoms of metastatic breast cancer, particularly if the patient had received a previous diagnosis of breast cancer, doctors may order tests to check for metastatic breast cancer.

Tests for metastatic breast cancer

There is no one test to confirm a diagnosis of metastatic breast cancer. Instead, doctors may perform a “staging workup” using a combination of blood and imaging tests to check for metastatic breast cancer. Tests to diagnose metastatic breast cancer may include (not limited to):

• Blood tests, including tumor markers in some patients. Blood tests may also include:
  • Complete blood count (CBC) to assess the body’s bone marrow function
  • Liver enzymes to check for liver metastasis
  • Calcium levels to check for bones metastasis
• Whole-body bone scan, with or without x-rays of specific bones
• MRI (magnetic resonance imaging) of the spine or brain
• CT (computer tomography) scan of the chest, abdomen, pelvis, or brain
• PET (positron emission tomography) scan 
• X-ray or ultrasound of the abdomen or chest
• Bronchoscopy, if there is a persistent cough or trouble breathing
• Biopsy of any suspicious areas
• Tap: Removal of fluid from the area with symptoms to check for cancer cells
  • Pleural tap (thoracentesis): Removes fluid between the lung and chest wall
  • Spinal tap (lumbar puncture): Removes fluid from around the spinal cord
  • Abdominal tap (paracentesis): Removes fluid from the abdominal cavity

Metastatic breast cancer treatment

Because it is incurable, metastatic breast cancer treatment focuses on shrinking tumors, slowing tumor growth, relieving symptoms, improving patients’ quality of life, and increasing longevity.

Most treatments for metastatic breast cancer are systemic treatments. Systemic treatments are drug therapies that work throughout the whole body, rather than focusing on one specific treatment area. Systemic therapies for metastatic breast cancer may include any combination of:

• Hormonal therapy: A type of drug therapy that keeps breast cancer cells from receiving or using the natural female hormones in the body (estrogen and progesterone) which they need to grow. Hormonal therapy also blocks the ability of healthy breast cells to receive hormones that could stimulate breast cancer cells to regrow. These drugs are commonly combined with CDK4/6 inhibitor therapy.
• Chemotherapy: A treatment method that uses a combination of drugs to either destroy cancer cells or slow down the growth of cancer cells. Chemotherapy is a systemic therapy, meaning that the drugs travel in the bloodstream throughout the entire body.
• Targeted therapy: A treatment method that uses drugs to target specific proteins on cancer cells that may help them grow or spread. Targeted drugs work to destroy or slow down cancerous cell growth and are most commonly used to treat cancer cells that are HER2-positive.
• Immunotherapy: A relatively new form of treatment for women with metastatic breast cancer, which uses the patient’s immune system to fight the cancer.

Metastatic breast cancer drugs

Typically, treatment with one type of drug regimen continues until the cancer starts growing again or until the side effects of the drug become intolerable. At that point, a new drug therapy will be prescribed. Common types of drugs used to treat metastatic breast cancer are listed below.¹⁸ This is not an exhaustive list and all drugs and medications should be discussed with your healthcare provider. NBCF does not endorse any specific medications or brands.

Hormone receptor-positive (HER2+) cancer drugs

• Tamoxifen
• Aromatase inhibitors
• CDK4/6 inhibitor
• Everolimus
• PI3K inhibitor such as alpelisib (Piqray)
• AKT inhibitor such capivasertib (Truqap)

Hormone receptor-negative (HER2-) cancer drugs

• Trastuzumab (Herceptin)
• Pertuzumab (Perjeta)
• Antibody-drug conjugate
• Kinase inhibitor
• Fam-trastuzumab deruxtecan (Enhertu)—for HER2-low cancers
• PARP inhibitor—for women with a BRCA gene mutation

Other metastatic breast cancer immunotherapy drugs

• Pembrolizumab (Keytruda)
• Atezolizumab (Tecentriq)

Local and regional treatment for metastatic breast cancer

Systemic drugs and medications are the most common treatments for metastatic breast cancer. However, local and regional treatments, such as surgery, radiation, or chemotherapy are sometimes used.

These treatments are unlikely to resolve metastatic breast cancer, but they can help prevent or treat the symptoms of the underlying metastatic disease. For example, radiation therapy is sometimes used to radiate the bones of patients with bone metastases that are causing pain. While this does not treat the underlying metastatic disease, it can help relieve bone pain and prevent fractures in some patients. Radiation is also commonly used for metastatic disease to the brain.

Latest treatments for metastatic breast cancer

With the help of metastatic breast cancer clinical trials, many new treatments for metastatic breast cancer, including new drug therapies, are currently under study and treatment is improving. To learn more about metastatic breast cancer clinical trials and look for a trial that might be right for you, search the metastatic breast cancer clinical trial database.

Palliative care and complementary therapies for metastatic breast cancer

Many patients diagnosed with metastatic breast cancer choose to begin palliative care, either immediately upon diagnosis or if symptoms or treatment side effects begin to affect their quality of life. Palliative care is not a treatment for metastatic breast cancer, nor is it hospice care.

Instead, palliative care is supportive care that focuses on the management of symptoms or side effects that are disruptive to a patient’s quality of life. Palliative care may include specialized pain management options, drug therapy to alleviate nausea and increase appetite, emotional care from trained professionals, and more. The goal of palliative care is quality of life preservation or restoration.

Like palliative care, complementary therapies are also not treatments for metastatic breast cancer. Instead, they are practices such as yoga, meditation, acupuncture, mindfulness, and more that focus on a person’s overall physical, mental, and emotional health and well-being. Many patients find complementary therapies soothing and helpful in a time of uncertainty or distress.

Metastatic breast cancer prognosis

While metastatic breast cancer cannot be completely cured with current cancer treatments available, there is research underway to find better ways to treat, and eventually cure, the disease. With current advancements, many women with metastatic breast cancer are living longer and with increased quality of life by treating it as a chronic illness.

A metastatic breast cancer diagnosis can be overwhelming. Many individuals diagnosed with MBC find it helpful to participate in a support group where they can communicate with and support others with the same diagnosis. NBCF offers virtual and in-person support groups, and there are other support groups available nationwide as well. METAvivor in particular offers support groups and other services specifically for metastatic breast cancer patients.

NBCF hosts weekend retreats for those living with metastatic breast cancer and their caregivers. Metastatic retreats are a time for metastatic patients to come together, along with their caregivers, to offer one another support, hope, and encouragement for what lies ahead. Treatment sessions include the opportunity to ask questions of a breast medical oncologist, end-of-life discussions, opportunities for patients to express their hopes and fears, yoga, meditation, mindfulness, laughter sessions, and card selections for children and grandchildren when they reach future milestones. Email help@nbcf.org for more information on NBCF metastatic retreats.

Metastatic breast cancer survival rate

According to the American Cancer Society, the 5-year relative survival rate for metastatic breast cancer in women—also called distant breast cancer because the cancer has spread to distant parts of the body—is 31%. The 5-year relative survival rate for metastatic breast cancer in men is 20%, according to the American Cancer Society.

However, survival rates vary widely between individuals based on factors such as a person’s age and general overall health at the time of diagnosis, as well as how each individual responds to treatment methods.

A metastatic breast cancer diagnosis can be scary and overwhelming, and you may experience a range of emotions, from sadness and anger to fear and panic. There is no right or wrong way to process or react to receiving a diagnosis of this magnitude. But there is reason to hope. It is important to remember that treatments for metastatic breast cancer are continually improving and more people are living longer and with higher quality of life than ever before.

NBCF is here to offer you help and support, no matter what diagnosis or treatment you are facing. Please reach out directly at help@nbcf.org for educational information, financial aid resources, information about NBCF metastatic retreats, or any other needs stemming from your diagnosis.

Metastatic breast cancer and genetic mutations

All patients diagnosed with metastatic breast cancer should consider being tested for the presence of a gene mutation. Reasons for genetic testing include:

• There are specific drug therapies, such as PARP inhibitors, that are available only for patients who carry a breast cancer gene mutation.
• It is important that a patient’s family know if there is a gene mutation that was the original cause of breast cancer. If a patient tests positive for a genetic mutation, each of their siblings and children have a 50% chance of carrying the breast cancer gene mutation. If a patient was genetically tested prior to 2012, it is important for them to be retested as there have been new breast cancer gene mutations discovered by scientists since that time.

Metastatic breast cancer FAQs

Is it possible to get Stage 4 metastatic breast cancer without going through Stages 1-3 first?

If breast cancer is not detected before it spreads, Stage 4 metastatic breast cancer may be your first diagnosis, called de novo metastatic breast cancer.

If metastatic breast cancer is diagnosed as part of breast cancer recurrence (weeks, months, or years after an initial breast cancer diagnosis and treatment), you may have already experienced Stage 1, Stage 2, or Stage 3 as part of your initial breast cancer diagnosis.

How long can you live with Stage 4 metastatic breast cancer?

Longevity with metastatic breast cancer varies widely between individuals. According to the American Cancer Society, the 5-year relative survival rate for metastatic breast cancer is 31%. That means that at the end of 5 years, 31% of women diagnosed with metastatic breast cancer are still alive. However, it is becoming more common for individuals to live longer with metastatic breast cancer, some even 10 years or more beyond diagnosis. Commonly, the patients with the longest longevity are those whose cancer cells are hormone receptor-positive (HR+) and HER2-negative.¹⁹

What are the final stages of metastatic breast cancer?

Metastatic breast cancer end-of-life symptoms may include²⁰:

• Considerable pain that progresses
• Pronounced fatigue and sleep
• Breathing difficulties
• Lack of appetite
• Weight loss
• Confusion
• Digestive issues
• Emotional changes

Once all available treatment options have been exhausted, or the patient decides to discontinue treatment, many patients will choose to focus on palliative care (supportive care that focuses on the management of symptoms or side effects that are disruptive to a patient’s quality of life) and hospice care to manage the final stages of metastatic breast cancer.

What causes death in metastatic breast cancer?

Infection is the most common cause of death in metastatic breast cancer, followed by organ failure. As patients discontinue treatments as they stop being effective, the next, new treatment undertaken will often be more toxic and accompanied by more side effects. Toward the end of treatment, the drugs are very toxic and usually the benefit of the treatment is minimal. Cancer drugs, commonly chemotherapy used after other treatments have been exhausted, can affect the functioning of the heart, liver, and other organs. Blood counts are also impacted, making it hard for the body to fight infection.

Who has the longest survival for metastatic breast cancer?

Currently, postmenopausal women whose metastatic breast cancer cells are hormone receptor-positive (HR+) and HER2-negative have the longest survival rates. This is likely due to the recent development of a new classification of drugs, CDK4/6 inhibitors. When combined with hormonal therapy, these drugs are enabling women to live longer, sometimes up to 10 years or longer, with metastatic breast cancer than in the past.²¹

Sources:

¹ National Institutes of Health
² National Institutes of Health
³ National Institutes of Health
⁴ National Institutes of Health
⁵ Johns Hopkins Medicine
⁶ National Institutes of Health
⁷ American Cancer Society
⁸ Cancer Research UK
⁹ Mayo Clinic
¹⁰ National Institutes of Health
¹¹ Mayo Clinic
¹² National Institutes of Health
¹³ Breastcancer.org
¹⁴ Breastcancer.org
¹⁵ Penn Medicine
¹⁶ Moffitt Cancer Center
¹⁷ Moffitt Cancer Center
¹⁸ American Cancer Society
¹⁹ National Library of Medicine
²⁰ Medical News Today
²¹ National Library of Medicine

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