What Are the Symptoms of Metastatic Breast Cancer?

Learn about general, breast, and specific metastatic site symptoms

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The specific signs and symptoms a person may have with metastatic breast cancer can vary significantly from one person to another. Some people will have many symptoms, whereas others may have very few symptoms or none at all; with the cancer being found on imaging tests such as a CT scan or PET scan alone.

The particular symptoms you experience as well as the severity will also depend on a multitude of factors, including where your cancer has spread, the extent of the cancer, and your general health prior to the development of metastatic breast cancer.

As you read about the possible symptoms you may experience, keep in mind that the majority of people do not experience all of these concerns. Rather, they are listed here to help you identify what you may be feeling and better understand why it is happening. We also list some of the symptoms which can occur due to complications of metastatic breast cancer.

Many of these signs are uncommon, but are mentioned so that you will be in a better position to recognize an emergency should one occur.

General Symptoms

There are several symptoms you may experience with metastatic cancer that are often seen with metastatic cancer in general. These symptoms may be associated with metabolic changes in the body and other factors.

Fatigue: Some level of fatigue is experienced by the majority of people with metastatic cancer. Cancer fatigue is different than ordinary tiredness, and may occur even when you are fully rested and sleeping well.

Even though this symptom is almost universal among those living with cancer, it is still very important to talk to your doctor about the level of tiredness you are feeling. Fatigue, though not life-threatening, is frustrating and is considered one of the most troublesome and annoying symptoms.

While fatigue cannot always be treated, there are several potentially reversible causes of fatigue that your doctor will want to evaluate.

Unintentional weight loss: A loss of more than five percent of body weight (roughly 7½ pounds in a 150 pound person) over a six to twelve month period is referred to as unintentional weight loss—or weight loss without trying. Even if you don’t routinely weigh yourself, you may notice that your clothes fit more loosely, or that your cheeks appear shallower.

There are many reasons for weight loss with advanced cancer. One of these is cancer cachexia, which is a syndrome including weight loss, muscle wasting, and loss of appetite. It may seem like your doctor should know if you have lost weight, yet it is important to keep track of this yourself as well. Many people with metastatic breast cancer end up seeing several physicians, and weight loss, especially if it is subtle, can end up being missed.

Loss of appetite: A loss of appetite is common, and can be a very difficult symptom to address with metastatic cancer. There are many possible causes of a loss of appetite, including nausea and vomiting, side effects of cancer treatments, and abdominal metastases.

Depression: In recent years we’ve learned that depression is very common with metastatic cancer, and may actually be the first sign of recurrence for some people.

It can be difficult to distinguish between normal grief and clinical depression. Talk with your doctor about your feelings of depression, even if you believe these feelings are normal given your situation.

Metastatic Site Symptoms

Many times the first symptoms of metastatic breast cancer are related to the regions of the body to which a breast cancer spreads, or where it recurs. The most common areas to which breast cancer spreads include the bones, brain, liver, and lung, though breast cancer can spread to nearly any organ in the body. It is common for people with metastatic breast cancer to develop metastases at multiple sites.

Bone metastases: The most common symptom of bone metastasis is progressive pain and aching in the region where the metastasis has occurred. Sometimes people are unaware that they have bone metastases until they experience a fracture with minimal trauma. Fractures which occur through bones to which cancer has spread are referred to as pathologic fractures.

Liver metastases: Liver metastases are often first suspected when blood tests show an elevated levels of liver enzymes. When breast cancer spreads to the liver it is common for women (and men) to experience generalized itching, which can be intense. Jaundice (a yellowing of the skin and the whites of the eyes) may occur, as well as abdominal discomfort, nausea, and vomiting.

Lung metastases: Lung metastases from breast cancer may cause a chronic cough and progressive shortness of breath, often first occurring only with activity. A buildup of fluid between the membranes lining the lungs (pleural effusion) is also common and is usually heralded by rapidly increasing shortness of breath.

Brain metastases: Breast cancer spreads to the brain less often than the bones, liver, and lungs, but can be very frightening. You may notice progressively worsening headaches, visual changes, dizziness, personality changes, or even seizures. Brain metastases occur more commonly in people who have HER2 positive breast cancer.

Breast Symptoms

You may or may not have breast symptoms related to your cancer, and this will depend on whether your cancer is metastatic when first discovered (“de novo” breast cancer) or if it is a recurrence after treatment of an earlier breast cancer.

Breast symptoms with recurrent metastatic breast cancer: For the majority of people with metastatic breast cancer, the metastases represent a recurrence of a breast cancer which you had in the past. What, if any, breast symptoms you have will depend on what led you to find your diagnosis, and the methods used to treat your original cancer.

If you had a mastectomy, for example, a cancer may recur in the liver without any symptoms related to your breast or chest wall.

Breast symptoms with primary metastatic breast cancer: If you are diagnosed with metastatic breast cancer without a prior history of breast cancer (de novo breast cancer), there are many possible symptoms which you may have.

Some people see their doctors with a breast lump or abnormal mammogram, and are found to have metastases while staging with a CT scan, bone scan, or PET scan is done. In contrast, metastatic cancer is sometimes found when a biopsy of a site, such as the liver, reveals breast cancer cells. Further workup will then often find the original tumor in the breast. Some cancers, such as inflammatory breast cancer, are often metastatic at the time of the original diagnosis.

Recurrence vs. second primary: If a lump occurs in your breast after a lumpectomy, it may be difficult at first to know whether it is a recurrence of your original cancer or a second primary cancer. Molecular testing of the tumor can be used to figure this out.

Symptoms of Complications

Symptoms related to metastatic breast cancer may include not only those due to the cancer itself, but complications caused by the cancer. While these symptoms sound frightening, they are not all that common. We list them here because they may indicate an emergency, and early treatment of emergencies is important both for quality of life and survival for those with metastatic breast cancer.

Spinal Cord Compression: When cancer spreads to the lower spine it can result in compression of vertebrae and the nerves that emerge between vertebrae. When this occurs in the lower spine it may rapidly compress nerves going to the legs, bowel, and bladder.

This emergency usually includes symptoms of lower back pain with or without radiation into the legs and loss of bowel and bladder control. Rapid treatment is needed to preserve function of the nerves.

Pleural Effusion: A pleural effusion, often referred to as “a buildup of fluid on the lungs,” is a common complication for people with metastatic breast cancer. The space between the linings of the lungs (the pleura) is ordinarily small, containing only three to four teaspoons of fluid.

With metastatic cancer, a large amount of fluid (a liter or more) may accumulate in this space, which, in turn, compresses the lungs. Symptoms may include rapidly progressive shortness of breath, and chest pain (often sharp) with inspiration. Treatment (discussed later) includes inserting a needle to drain the fluid.

Pericardial Effusion: Just as fluid can build up between the membranes lining the lungs, fluid may accumulate in the tissues lining the heart (the pericardial space), causing compression of the heart. Symptoms may include chest pain (often sharp or stabbing), shortness of breath, palpitations, and eventually, loss of consciousness.

Hypercalcemia: The breakdown of bone due to bone metastases can lead to an increased level of calcium in the blood. This hypercalcemia can, in turn, lead to kidney stones, kidney damage with decreased urination, nausea and vomiting, and confusion, among other symptoms. This condition is treatable, but prompt medical attention is necessary.

Febrile Neutropenia: Those who are receiving chemotherapy are more likely to develop infections, and these infections are often difficult to treat. Symptoms may include a high fever, chills, confusion, cough, or pain with urination. Treatment of chemotherapy associated infections has improved substantially in the recent past, but requires prompt medical attention.

Talking to Your Doctor

It is crucial that you talk to your oncologist and health care team about any and all symptoms you are experiencing. Some of these symptoms, such as pain, are under-treated in people with metastatic cancer. This is not because physicians fail to treat the symptoms, but because they are simply unaware that a person is coping with them.

With all of the talk about people with cancer being “brave” or “strong,” you might hesitate to share symptoms that could make you appear “frightened” or “weak.” Yet facing metastatic cancer is frightening, and being able to share your concerns is a sign of strength, not weakness. There is a lot that can be done to ease most of the symptoms of metastatic breast cancer, but the only way that your oncologist can know what you are feeling is if you are “brave” enough to speak up.

In addition, sharing your symptoms, even if they may seem of little consequence to you, may help your oncologist better recognize the extent of your disease, anticipate potential complications, and suggest the best possible treatments for your disease.

Sources:

DeVita, Vincent., et al. Cancer: Principles & Practice of Oncology. Cancer of the Breast. Wolters Kluwer, 2016.

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