Metastatic breast cancer: symptoms, signs, treatment and risks of metastases in the breast

Medically reviewed: 1, March 2024

Symptoms: Bloated Stomach

Metastatic Breast Cancer – Definition

Metastatic breast cancer, also known as stage IV or advanced breast cancer, signifies the spread of malignant cells beyond the initial site—the breasts—into distant organs. Secondary tumors typically appear in bones, lungs, liver, or brain. Approximately 5-10% of patients receive a metastatic diagnosis at first presentation, while roughly 30% of those treated for earlier stages will eventually experience recurrence despite seemingly successful treatment. Prognosis varies widely depending on numerous factors, including location(s) of metastases, number of lesions present, patient age, molecular subtype of breast cancer, duration since original diagnosis, and response to prior treatments among others. There is currently no cure for metastatic breast cancer, though advancements in research continue unabated, providing hope for improved therapeutic interventions and quality of life measures.

What Is Breast Cancer?

Breast cancer originates in the breast tissue when abnormal cells grow uncontrollably, forming tumors. These malignant growths typically develop in either lobules (milk glands) or ducts (tiny tubes transporting milk to nipples). Early detection and treatment significantly improve prognosis; however, if undetected or untreated, breast cancer cells may invade surrounding tissues and nearby lymph nodes, potentially leading to metastasis.

Why does Breast Cancr metastasises?

When cancerous cells break away from the primary tumor site in the breast, they enter blood vessels or lymphatic channels, enabling them to travel throughout the body. This process forms microscopic deposits called micrometastases, invisible even under imaging techniques. Over time, some of these clusters evolve into larger, detectable lesions in vital organs, marking the beginning of metastatic breast cancer. Common sites where metastases occur include bones, lungs, liver, and brain.

Metastatic Breast Cancer and Its Classification: An ICD-10

Metastatic breast cancer signifies the spread of malignant cells from the original tumor site to distant organs. Medical coders utilize International Classification of Diseases, Tenth Revision (ICD-10) codes to document diagnoses accurately.

The ICD-10 code categorizes metastatic breast cancer into two main categories depending on the presence or absence of secondary dissemination:

C50.9: Breast carcinoma, NOS (Not Otherwise Specified) – When no explicit metastasis has been identified, assign this general code indicating the presence of primary breast cancer without specifying morphologic subtypes.

C78-C80: Secondary malignant neoplasm of respiratory and digestive organs – Apply these codes exclusively for reporting confirmed instances of metastatic breast cancer involving specified sites outside the breast region. For instance:

• C78.0: Secondary malignant neoplasm of bronchus and lung
• C78.1: Secondary malignant neoplasm of heart and mediastinum
• C78.2: Secondary malignant neoplasm of pleura
• C78.3: Secondary malignant neoplasm of thorax
• C78.4: Multiple secondary malignant neoplasms of respiratory organs
• C78.5: Unspecified secondary malignant neoplasm of respiratory organ
• C79.0: Secondary malignant neoplasm of esophagus
• C79.1: Secondary malignant neoplasm of stomach
• C79.2: Secondary malignant neoplasm of small intestine
• C79.3: Secondary malignant neoplasm of large intestine
• C79.4: Secondary malignant neoplasm of liver and biliary tract
• C79.5: Secondary malignant neoplasm of spleen
• C79.6: Secondary malignant neoplasm of peritoneum
• C79.7: Secondary malignant neoplasm of retroperitoneum
• C79.8: Multiple secondary malignant neoplasms of digestive organs
• C79.9: Unspecified secondary malignant neoplasm of digestive organs

Note that additional codes representing histological variants, laterality, behavior, grade, extent, and stage supplement primary and secondary malignancy codes based on guidelines provided by relevant authorities such as American College of Surgeons Commission on Cancer (CoC) or Centers for Medicare & Medicaid Services (CMS).

Primary Breast Cancer and Metastatic Breast Cancer

Breast cancer is a complex disease with varying levels of severity. At its core, there are two main types: primary breast cancer and metastatic breast cancer. In understanding these concepts, we can better navigate conversations surrounding diagnosis, treatment options, and overall prognosis.

Primary breast cancer refers to malignant cells originating within the breast tissue itself. This form accounts for approximately 80% of diagnosed cases and primarily affects women, although men can develop breast cancer too (accounting for less than 1% of diagnoses). Treatment often involves:

• surgery,
• radiation therapy,
• chemotherapy,
• hormone therapy,
• targeted therapies,
• or some combination thereof, based on individual patient needs.

With proper management and regular screening, primary breast cancer has favorable survival rates, especially when detected early.

Common locations for metastatic breast cancer

When discussing metastatic breast cancer, certain areas emerge frequently due to their predilection for secondary involvement. These common sites include:

• Bones:

accounting for around 70% of instances, bone metastases commonly affect vertebrae, ribs, pelvis, and long bones like femurs and humeri. Symptoms may encompass pain, fractures triggered by minimal trauma, hypercalcemia causing confusion or kidney stones, spinal cord compression leading to weakness or paralysis, and decreased mobility.

• Lungs:

occurring in nearly half of metastatic cases, lung involvement manifests through cough, shortness of breath, chest discomfort, hemoptysis, fatigue, loss of appetite, weight loss, and occasionally pneumothorax. Pleural effusions requiring drainage might signal pleural metastasis.

• Liver:

affecting approximately one third of individuals with metastatic breast cancer, hepatic dissemination results in symptoms like jaundice, abdominal distention caused by ascites, nausea, vomiting, pruritus, abdominal pain, and dark urine. Hepatomegaly may accompany physical examination findings.

Brain: comprising 10-15% of metastatic events, central nervous system invasion generally brings neurological complications such as headaches, seizures, altered mental status, cognitive impairment, gait instability, visual disturbances, focal weakness, numbness, speech difficulties, hearing changes, and coordination problems. Diplopia, vertigo, insomnia, depression, personality alterations, memory decline, balance issues, tremors, and bladder or bowel dysfunction can ensue as well.

Symptoms and Signs of Metastatic Breast Cancer

General symptoms

In recognizing signs indicative of progression towards late-stage or metastatic breast cancer, it becomes crucial to discern patterns suggestive of potential systemic spread. Although individual experiences vary greatly, here lies a compilation of general symptoms warranting vigilance and prompt consultation with healthcare professionals:

Persistent fatigue, lethargy, or debility unexplainable by daily activities, stress, sleep habits, or concurrent illnesses.

Unintentional weight fluctuations regardless of dietary modifications.

Loss of appetite resulting in reduced food intake or malnutrition over extended periods.

Increasingly frequent occurrences of persistent nausea, indigestion, bloating, constipation, diarrhea, or abdominal cramps potentially attributable to internal organ compromise.

Swelling, stiffness, warmth, redness, tenderness, or sensitivity impacting body regions devoid of direct injury, infection, or inflammation.

Unexpected emergence of skin rashes, irritations, bruises, unusual lumps, or blemishes possibly heralding underlying neoplastic growth.

Newfound vulnerabilities to repeated infections, manifested through recurrent fevers, chills, night sweats, sores, wounds, coughing, wheezing, sneezing, sinus pressure, vaginal discharge, painful urination, blood in stool, or any prolonged symptom defying resolution.

Altered sensory perceptions involving vision, audition, olfactory acuity, taste, touch, temperature discrimination, proprioception, spatial awareness, or cognition merits attention.

Emotional labialities, sudden mood swings, increased anxiety, depressed states, impaired judgment, delirium, or hallucinations necessitate comprehensive evaluation.

Specific symptoms based on metastatic site

Delving deeper into specific bodily locations whereby breast carcinoma commonly colonizes, particular telltale signals arise demanding astute observation:

Metastatic Breast Cancer in the Bone

1. Acute episodes of excruciating joint or bone pain exacerbated during movement, radiating throughout limbs or torso.
2. Pathological fractures precipitated by innocuous strain amidst previously unaffected skeletal segments.
3. Hypercalcemic crisis presenting as disorientation, sluggishness, muscle twitching, arrhythmias, hypertension, renal calculi, polyuria, polydipsia, or cardiac arrest under extreme circumstances.
4. Vertebral damage eliciting radicular pain, diminished reflexes, spasm, paresis, paralysis, or autonomic nerve disruption.
5. Dactylitis characterized by sausage-like digit expansion combined with intense throbbing emanating predominantly from hands and feet.

Lung metastases

1. Chronic hacking cough accompanied by rusty expectoration tainted pinkish-red hues suggestive of pulmonary hemorrhages.
2. Shortness of breath worsening gradually even without significant exertion reflecting compromised respiratory function.
3. Wheezing, pleuritic chest discomfort aggravated by inspiration, expiration, coughing, laughing, deep breathing, or positional shifts.
4. Hemoptysis typified by blood-tinged saliva owing to intravascular clot formation or eroded vasculature.
5. Chest tightness culminating in spontaneous pneumothoraces necessitating urgent intervention to restore negative pressures stabilizing alveolar integrity.

Liver metastases

1. Jaundiced appearance featuring icteric sclerae, dermal pigmentation, orchromaturia, melena, or clay-colored stools betraying obstructed bilirubinate recycle cascades.
2. Portal hypertension engendering splenomegaly, caput medusa, peripheral edema, or ascites impeding visceral motion encumbered by overwhelming fluid accumulation.
3. Abnormal serology panels inclusive of transaminase elevations exceeding threefold threshold values accompanied by elevated alkaline phosphatase denoting aberrant hepatobiliary activity.
4. Parenchymal destruction inciting steatohepatitis, fibrosis, cirrhosis, or ultimate end-organ failure impending mortality risk unless corrected timely.

Brain metastases

1. Headaches exacerbated incrementally during morning hours, relieved partially postprandially subsiding within days.
2. Seizure susceptibility potentiating convulsive paroxysms ranging from localized motor jerks to grand mal manifestations threatening airway security.
3. Encephalopathies contributing to impaired executive functions concerning language processing, problem-solving skills, decision-making faculties, or behavior regulation.
4. Sensory deficits entailing partial or complete losses encompassing sight, sound, smell, taste, tactility, vibration sensation, thermoregulation capacity, or stereognosis aptitudes.
5. Motor deterioration adversely influencing muscular strength, ambulation competency, manual dexterity, fine motor skills, or gait stability jeopardizing independence vitality and self-care capabilities.

Detecting Metastatic Breast Cancer: diagnostic methods

Imaging Techniques

Imaging plays a critical role in the identification and surveillance of metastatic breast cancer. Various imaging methods can aid in determining the extent of the disease and guiding subsequent therapeutic decisions. We will discuss four major types: X-rays and bone scans, CT scans, PET scans, and MRI scans.

• X-rays and bone scans:

Traditional X-ray imaging, mainly focusing on the skeleton, serves as a useful tool in spotting bone lesions induced by breast cancer metastases. Moreover, bone scintigraphy, utilizing small quantities of radioactive materials, helps highlight hot spots representing abnormally heightened osteogenic activity. Such scans may facilitate early recognition of otherwise undetectable skeletal afflictions.

• CT scans:

Also called computed tomography, this method uses specialized X-ray equipment and powerful computers to deliver cross-sectional views of the human body, thereby enabling doctors to observe any mass, structure, or organ more closely. Doctors may prescribe CT scans when seeking extensive exploration of suspected sites harboring possible metastases.

• PET scans:

Position emission tomography combines computerized imaging with the administration of mildly radioactive sugar molecules that travel through the bloodstream before being absorbed by actively growing cancer cells. PET scans excel in pinpointing metabolically aggressive lesions dispersed throughout the body, making them a preferred option for surveilling diffuse metastatic breast cancer.

• MRI scans:

Magnetic resonance imaging utilizes strong magnets and radio waves rather than radiation to obtain detailed pictures of internal tissues and organs. Typically employed for neurologic or soft tissue evaluations, MRI scans can complement other imaging modalities to enhance diagnostic precision and evaluate questionable areas identified via alternative means.

Biopsies

Biopsies remain the definitive approach for conclusive diagnosis, allowing cytologists and pathologists to examine cellular morphology under a microscope. Different kinds of biopsies include:

• Needle biopsy:

Performed using thin needles designed to collect representative samples efficiently. Depending on the scenario, these procedures range from fine-needle aspiration (FNA), capable of gathering loose groups of cells or fluids, to core-needle biopsy (CNB), suitable for obtaining substantial tissue fragments required for ancillary immunohistochemistry and genomic profiling.

• Surgical biopsy:

When non-surgical sampling proves inconclusive, surgeons perform open or minimally invasive operations aimed at acquiring sufficient sections of suspect tissue. Usually indicated for lesions exhibiting complex architecture, surgical biopsies require precise planning and execution given inherent tradeoffs between cosmetic outcomes, wound healing, and analytical robustness.

Blood tests

Bloodwork represents another integral aspect of managing metastatic breast cancer, serving multiple purposes:

• Confirming systemic dissemination via circulating tumor cells (CTCs) enumeration
• Monitoring therapeutic effectiveness through serum tumor marker quantification (CA 15-3, CA 27.29)
• Evaluating baseline functionality of key organ systems (liver, kidneys, etc.) ahead of commencing chemo-regimens
• Periodic assessment of medication safety profiles and dose adaptations based on observed toxicities

Metastatic Breast Cancer Treatment Options

Battling breast metastatic cancer can feel overwhelming, but understanding available treatment options may provide some comfort. This guide outlines systemic and local treatment methods along with clinical trial possibilities. It is important to always seek guidance from healthcare professionals.

Systemic Therapies

Systemic therapies target cancer cells throughout the body and typically involve oral medications or intravenous injections. Various types exist, each having distinct mechanisms.

• Chemotherapy:

Powerful drugs destroy rapidly dividing cells, including cancer cells. Potential side effects encompass hair loss, nausea, fatigue, and reduced blood cell counts. Chemo might serve as initial treatment, adjuvant therapy after surgery, neoadjuvant therapy before surgery, or palliative care for advanced stages.

• Hormonal Therapy:

Postmenopausal women with hormone receptor-positive tumors benefit from suppressing estrogen production or blocking estrogen’s interaction with cancer cells. Tamoxifen and aromatase inhibitors belong to this category. Men with breast cancer may also receive anti-estrogen treatment. Possible side effects range from hot flashes and vaginal dryness to bone thinning.

• Targeted Therapy:

Precision medicines focus on specific molecular abnormalities within cancer cells, leaving healthy cells unharmed. Examples include trastuzumab and pertuzumab, both effective against human epidermal growth factor receptor 2 (HER2)-positive cancers. Side effects depend on medication but generally cause less harm than chemotherapeutics.

• Immunotherapy:

These revolutionary treatments harness patients’ immune systems, enabling them to recognize and attack cancer cells. Some immunotherapies boost existing defenses, whereas others introduce man-made proteins called monoclonal antibodies. Checkpoint inhibitors represent one popular subset of immunotherapy agents. Adverse reactions remain milder compared to chemo yet differ based on drug selections.

Local Treatments

Localized interventions tackle malignancies affecting only certain areas rather than spreading across the body. Such techniques primarily aim at eliminating detectable cancer cells.

• Radiation Therapy:

High-energy particles damage DNA inside targeted cancer cells, preventing proliferation and leading to cell death. Common applications span external beam radiation and brachytherapy—internal radiological intervention. Besides skin irritation, potential consequences involve fatigue and breast tissue firmness.

• Surgery:

Surgical removal represents another primary approach, where physicians excise cancerous masses alongside nearby tissues. Lymph node dissection constitutes part of the procedure when regional nodes appear compromised. In addition to surgical complications like bleeding and infection, post-operative symptoms may manifest due to changes in physical appearance and sensation around operated regions.

Coping With Advanced Metastatic Breast Cancer

Dealing with advanced metastatic breast cancer presents emotional challenges beyond managing physical health concerns. We have curated a three-part guide discussing emotional support, complementary therapies, and practical assistance, empowering those diagnosed to face adversity confidently.

Emotional Support

Emotional wellbeing plays a vital role in overall quality of life. Seeking professional assistance ensures adequate psychological care.

• Counseling and Psychotherapy: Working closely with mental health specialists helps process feelings associated with diagnosis, treatment, and lifestyle modifications. Through evidence-based talk therapies, patients develop coping skills addressing depression, anxiety, grief, anger, isolation, and fear.
• Joining Support Groups: Connecting with people enduring similar situations provides solace amidst shared struggles. Many organizations offer peer-led group sessions locally or online, fostering camaraderie and mutual understanding without judgment.

Practical Assistance

Navigating complex medical environments requires logistical know-how easing burdens on patients and loved ones.

• Care Coordination:

Collaborate with case managers or social workers who streamline communication among multidisciplinary team members involved in disease management. They facilitate seamless transitions between different stages of care, arrange appointments, monitor progress, ensure consistency across varying settings, and coordinate referrals when needed.

• Financial Advice:

Consult financial advisors specialized in healthcare costs for counsel regarding insurance matters, bill payments, government aid programs, prescription assistance initiatives, travel accommodations, transportation services, homecare equipment provisions, and workplace leave policies. Well-versed experts navigate intricate fiscal landscapes efficiently, helping alleviate economic strains caused by extended treatments.

Metastatic Breast Cancer Survival Rate: What You Need to Know

Survival rates indicate the percentage of people still alive after a certain period following diagnosis, usually given in intervals of years. It is crucial to remember that these statistics represent statistical averages and cannot predict individual outcomes accurately. Several factors affect survival rates, including patient age, overall health, cancer subtype, location, extent of spreading, treatments received, and response to therapy.

Relative vs. Absolute Survival Rates

There are two types of survival rates—relative and absolute. Relative survival rates compare patients diagnosed with breast cancer to those without it. They account for deaths due to any cause, giving a better perspective on how well specific therapies work against cancer. In contrast, absolute survival rates simply count the number of individuals living within a defined interval post-diagnosis, regardless of whether death was caused by cancer or another reason. Both measures have their utility when discussing prognosis.

Typical Survival Rate Statistics

According to the American Cancer Society, the five-year relative survival rate for metastatic breast cancer ranges between 22% and 26%. However, several studies suggest that median survivals may extend past two years depending on the favorable characteristics mentioned earlier. Improved systemic treatments have resulted in enhanced quality of life and longer lifespans even with distant disease presence. Furthermore, some cases show long-term remission exceeding ten years despite initial advanced staging.

Factors Impacting Survival Rates

Various elements influence metastatic breast cancer survival rates, such as:

1. Patient Age: Younger women tend to have higher survival rates compared to older counterparts. Nevertheless, elderly patients must receive appropriate evaluation and treatment since many live decades post-diagnosis.
2. Overall Health: Comorbidities, functional status, and sociodemographic determinants play significant roles impacting therapeutic choices, tolerability, and ultimately, survival.
3. Cancer Subtype: Hormone receptor-positive (HR+)/HER2-negative tumors typically exhibit superior prognoses than triple-negative or HER2-positive subtypes.
4. Location & Extent of Spreading: Bones generally correlate with better outlooks versus visceral sites like lungs and liver. Moreover, fewer lesions often signify improved chances of successful management.
5. Treatments Received: Standard therapies encompass chemotherapy, targeted hormonal agents, immunotherapy, bone-targeted radiopharmaceuticals, and local interventions tailored to organ involvement patterns. Enrollment in clinical trials offers experimental alternatives advancing novel methodologies.