Common places where breast cancer spreads
When breast cancer spreads beyond the breast, it can feel overwhelming and uncertain. Understanding how and where the cancer may spread can help you feel more in control of your care as you learn what you and your care team can do.
Cancer cells can travel from the primary breast tumor through the bloodstream or lymphatic system and settle in different parts of the body, forming new tumors called metastases (or mets). The most common places breast cancer spreads to are the bones, lungs, liver, and brain. Each of these locations may cause different symptoms and may require different methods for detection. The good news is that there are treatments available to help manage these tumors and the symptoms they cause. Regular monitoring is also an important part of care to catch the spread of breast cancer early.
Bone metastases
Bone is the most common location for breast cancer to spread. Bone mets can cause pain (often in the back, hips, or ribs), bone fractures, as well as high calcium levels (which can lead to fatigue, nausea, or confusion).
During cancer treatment, your care team will monitor the cancer using bone scans (which use an injected radioactive substance to identify bone changes), CT scans, or MRIs to look for new or growing bone mets. If your care team discovers bone mets, there are ways to reduce any symptoms and treat the bone mets. Bone-strengthening drugs like zoledronic acid (Zometa), pamidronate (Aredia), and denosumab (Xgeva or a biosimilar) can help protect bones from endocrine therapy (which can cause bone loss) and treat bone mets. Sometimes, care teams use radiation therapy to target the bone mets and provide relief.
Lung metastases
Lung metastases can cause shortness of breath, a persistent cough, or chest pain. Your care team can monitor your lungs using CT scans, chest X-rays, or PET scans to identify suspicious lung spots. If they find lung mets, you may undergo a biopsy so your doctors can identify your best treatment options.
Treatment for lung mets include medications such as hormone therapy, chemotherapy, or targeted therapy, depending on the nature of the cancer. In some cases, procedures to drain fluid may help relieve breathing difficulties. Other options for lung mets include radiation to the metastasis site to relieve symptoms and limit the growth of the tumors. Surgery is occasionally used to remove lung mets and relieve the symptoms.
Liver metastases
If breast cancer spreads to your liver, you may not experience obvious symptoms. Some of the symptoms that could occur from liver mets are fever, fatigue, yellowing of the skin or eyes, swelling of the abdomen, nausea, or loss of appetite.
It’s more likely that the metastasis will be seen during routine monitoring of the cancer. Your care team will monitor for signs of liver mets through bloodwork that includes liver function tests. They may also identify liver mets through scheduled imaging tests like an MRI, a CT scan, or an ultrasound. If your doctors suspect liver metastasis, they may want to biopsy your liver to determine the next course of action.
Doctors typically treat liver mets to control the cancer’s growth and manage any symptoms you may have. Options include targeted therapy, chemotherapy, or immunotherapy drugs. In some cases, your care team may utilize liver-directed treatments such as radiation or surgery, as well as ablation or embolization. Ablation is a procedure that uses heat or cold to destroy tumor cells. Embolization allows doctors to deliver chemotherapy directly to the liver.
Brain metastases
While the brain is a less common target for the spread of breast cancer, it’s important to pay attention to any new or ongoing symptoms and let your care team know about them. Symptoms of brain metastases include headaches, dizziness, vision changes, difficulty with balance, memory problems, and seizures.
Doctors use MRI scans to detect brain metastases. Treatments for brain mets can relieve symptoms and include:
- Radiation therapy, directed at the entire brain or targeted to specific metastatic sites in the brain
- Brain surgery, if tumors are easily reached
- Drugs that can cross from the bloodstream into the brain to target cancer
Next steps
Metastatic breast cancer affects everyone differently and treatments will be personalized based on your needs and symptoms. If your doctors detect a new metastatic site, they may adjust your treatment plan to include targeted therapies, radiation, or symptom management strategies to help maintain your quality of life.
What you can do: Stay informed about symptoms that may indicate disease progression and communicate any changes to your care team. If your doctors find a new metastatic site or changes in the spread of the cancer, work with them to understand the next steps, including what to expect and the goal of any proposed treatment options. Keeping up with regular monitoring and discussing all treatment options with your doctor can help you stay ahead of the disease while focusing on what matters most to you.
Connect with other breast cancer patients using the Outcomes4Me private peer community.
