Topic Overview
Is this topic for you?
This topic provides
information about breast cancer that has spread or come back after treatment.
If you are looking for information about first-time diagnosis and treatment of
breast cancer, see the topic
Breast Cancer.
What are metastatic and recurrent breast cancer?
Breast cancer occurs when abnormal cells grow out of
control in one or both breasts.
- Metastatic breast cancer means that cancer has spread to
other parts of the body.
- Recurrent breast cancer means that cancer has come back in or near the
original site or in another part of the body.
For
most women who have had breast cancer, their greatest fear is that the cancer
will come back or spread. Finding out that this has happened can turn your world
upside down. But there is hope. Some recurrent
breast cancers can be successfully treated. Other recurrent breast cancers and metastatic breast cancer usually can't be cured. But with treatment, some women live for many years.
Why does breast cancer come back after treatment?
Even with the best treatment, cancer can come back. If just a few cancer cells remain in your body after your initial treatment, those cells can spread through
the blood or
lymph system and grow. This may happen from a few
months to many years after the first diagnosis.
If your breast
cancer has come back, you may second-guess your previous
treatment choices. But the fact is, there is no guarantee with any
treatment. Now it is time to make new decisions
and explore other treatment options.
What are the symptoms?
The symptoms depend on
where the cancer is and how large it is. The most common places for breast
cancer to spread are within the breast or to the nearby chest wall or to the
liver, lungs, or bones. Common symptoms include a lump in your breast or on
your chest wall, bone pain, and shortness of breath.
Or you may not
have any symptoms. Sometimes recurrent or metastatic breast cancer is found
with an X-ray or a lab test.
How is it treated?
To plan your treatment, your
doctor will consider where the cancer is and what type of treatment you had in
the past. Your wishes and quality of life are also important factors. Treatment
choices may include surgery, medicines like
chemotherapy or
hormone therapy, and
radiation. Sometimes a mix of these treatments is
used.
Treatments for breast cancer can cause side effects. Your
doctor can tell you what problems to expect and help you find ways to manage
them.
Your doctor may recommend that you join a clinical trial if one is available in your area. Clinical trials test new cancer treatments and may be the best choice for you.
If treatments don't work, a time may come when the goal
of your treatment shifts from trying to cure your cancer to keeping you as comfortable as possible. This can allow you to make the most of the time you have left.
How can you handle your feelings about having breast cancer again?
It's common to have a wide range of emotions. It may be
hard to stay hopeful when you are fighting cancer for the second or third time.
These ideas may help:
- Get the
support you need. Spend time with people who care about you, and let them help
you.
- Take good care of yourself. Get plenty of rest, and eat nourishing foods.
- Talk about
your feelings. Find a support group where you can share your experience.
- Stay positive. Do things each day that will help you stay calm and relaxed.
If your emotions are too much to handle, be sure to tell
your doctor. You may be able to get counseling or other types of help.
You may want to think about planning for the future. A
living will lets doctors know what type of
life-support measures you want if your health gets much worse. You can also
choose a
health care agent to make decisions in case you aren't able to. If you put your wishes in writing, you can make it easier for your loved ones and others to know what you want.
Frequently Asked Questions
Learning about metastatic and recurrent breast cancer: | |
Being diagnosed: | |
Getting treatment: | |
Ongoing concerns: | |
Living with breast cancer: | |
End-of-life issues: | |
Cause
The exact cause of
breast cancer is not known. But after you have had breast cancer, it can come back (recur) or spread
(metastasize) to other parts of your body.
Symptoms
The symptoms of
metastatic and recurrent breast cancer depend on how
much the cancer has spread. Some women have symptoms, but many women don't.
Recurrent breast cancer
Cancer that recurs in the same breast or
in your mastectomy scar is called a local recurrence. With local recurrence, you may have symptoms such as:
- A lump or thickening in the breast, chest
wall, or armpit after you have had
breast-conserving surgery or a
mastectomy. You may notice that the skin of your chest
looks or feels different.
- A change in the size or shape of the
breast or a dimple or pucker in the skin of the breast.
- Discharge
or bleeding from the nipple that occurs without squeezing the nipple.
- A change in the nipple, such as a scaly or
crusty look or a nipple that draws inward.
Cancer that recurs in another part of your body, such as your lungs, is called distant recurrence. With distant recurrence, you may have some of the same symptoms as metastatic breast cancer.
Metastatic breast cancer
Symptoms of metastatic
breast cancer will depend on the area affected and how far your breast cancer
has spread. For example:
- If your bones are affected, you may have bone pain. And
your bones may break more easily.
- If your lungs are affected, you may be short of breath.
- If your liver is affected, you may have swelling in your belly
or yellow, itchy skin.
- If cancer spreads to your brain, you may have
confusion, changes in your vision, or seizures.
Inflammatory breast cancer
Symptoms such as changes in the skin of the breast or the nipple may be a sign of inflammatory breast cancer. For more information, see the topic Inflammatory Breast Cancer.
What Happens
Breast cancer occurs when abnormal cells grow out of
control in one or both breasts. Breast cancer can come back in or near the original location after treatment (recur) and affect nearby
lymph nodes.
Cancer cells also can travel from the breast, either through the bloodstream or the
lymph system, to other parts of the body and cause
cancer in a new location (metastasize). Metastatic
breast cancer can be present when a woman is first diagnosed with breast cancer,
or it may occur months to years after treatment.
Your medical team will put together a treatment plan for you. This plan will be based on many things, such as the stage of your cancer, whether the cancer is hormone-receptor positive, and what treatments you may have had in the past.
What Increases Your Risk
You have a risk of having
metastatic or recurrent breast cancer if you have ever
had
breast cancer. Older women have the highest
risk. But no one can say for sure whether breast cancer will come back or metastasize.
When To Call a Doctor
Call your
doctor if you have any symptoms of breast cancer that last for more
than 1 to 2 weeks, such as:
- A lump or sore in your breast or on your chest
wall.
- Swelling in the armpit or neck.
- Swelling of the
arm.
- Bone pain, especially in the back or
hips.
- Shortness of breath or a cough.
- Loss of
appetite.
- Extreme tiredness.
- Nausea or
vomiting.
- Recurrent headaches.
Who to see
If you have received treatment for
breast cancer, health professionals who can evaluate
new problems include a:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
Regular checkups
After you've been treated for breast cancer the first time, you will have regular checkups to be sure that the cancer has not returned. You and your doctor will talk about how often you will need checkups. Your checkups may include a physical exam, a clinical breast exam (CBE), or a mammogram. An
MRI of the breast may also be used.
Diagnostic tests
If your doctor thinks that breast cancer has come back or spread, you may have other tests, including:
- Blood tests, such as a
complete blood count (CBC). These help find the cause of symptoms such as fatigue,
weakness, fever, bruising, or weight loss.
- Tissue tests, such as a biopsy.
- Imaging studies, such as abdominal ultrasound, bone scan, chest X-ray, CT scan, or
MRI.
Treatment Overview
If you
have recently been diagnosed with
metastatic or recurrent breast cancer, you may
have many
emotions. There is no "normal" or "right" way to
react. You may feel angry or frustrated and may second-guess your previous
treatments. Or you may feel hopeless.
But there are treatments that help. Some recurrent
breast cancers can be successfully treated. Other recurrent breast cancers and metastatic breast cancer usually can't be cured. With these cancers, treatment is focused on keeping the cancer from getting worse. This includes helping women live as long as possible and with a good quality of life.
Types of treatment
When making decisions about treatment, you and your doctor will consider many things, such as your age and health, the type of breast cancer you have, where it is, and your
preferences.
For recurrent breast cancer in the breast or chest wall, treatments may include:footnote 1
For recurrent breast cancer in other parts of the body and metastatic breast cancer, treatments may include:footnote 1
- Hormone therapy and/or chemotherapy (with or without trastuzumab).
- Tyrosine kinase inhibitor therapy with lapatinib and capecitabine.
- Monoclonal antibody therapy, such as trastuzumab or trastuzumab and pertuzumab.
- Radiation therapy, surgery, or both for symptoms that may be causing pain or other problems.
- Bisphosphonates or denosumab to
reduce bone pain, fractures, and spinal cord compression caused by cancer in the bones.
- Being in a clinical trial, such as one testing new chemotherapy medicines and hormone therapy.
Side effects of treatment
Cancer and its treatments can be painful, but cancer pain can almost always be controlled. If you are having ongoing problems with managing pain, ask to see a pain specialist.
There are also many
things you can do at home to help manage side
effects of treatment. But talk to your doctor about any bothersome symptoms. Working together with your doctor can help you have the best possible quality of life.
Additional information about breast cancer is provided by the National Cancer Institute at www.cancer.gov/cancertopics/types/breast.
Clinical trials
Clinical trials test new medicines,
combinations of medicines, and other treatments for breast cancer. If you have been
diagnosed with metastatic or recurrent breast cancer, talk with your doctor
about taking part in a clinical trial.
Palliative care
Palliative care is a kind of care for people who have a serious illness. It's different from care to cure your illness. Its goal is to improve your quality of life-not just in your body but also in your mind and spirit.
You can have this care along with treatment to cure your illness.
Palliative care providers will work to help control pain or side effects. They may help you decide what treatment you want or don't want. And they can help your loved ones understand how to support you.
If you're interested in palliative care, talk to your doctor.
For more information, see
the topic
Palliative Care.
End-of-life care
For some people who have advanced cancer, a time comes when treatment to cure the cancer no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the promise of cure or relief. But you can still get treatment to make you as comfortable as possible during the time you have left. You and your doctor can decide when you may be ready for hospice care.
For more information, see
the topics:
Prevention
In some cases, initial treatment of
breast cancer with
chemotherapy or hormone therapy can help prevent
metastatic or recurrent breast cancer.
For women with
estrogen receptor-positive (ER+) breast cancer,
treatment with
tamoxifen, an
aromatase inhibitor, or both can also help prevent
recurrence. For some postmenopausal women who are also ER+, an
aromatase inhibitor such as exemestane (Aromasin) works even better than
tamoxifen alone. Aromatase inhibitors may be taken alone or after
tamoxifen.
Home Treatment
Managing side effects
The side effects of breast cancer treatment can be serious. Healthy habits such as eating a balanced diet and getting enough sleep and exercise may help control your symptoms. Your doctor may also give you medicines to help you with certain side effects, such as
medicines to control and prevent nausea and vomiting.
- Home treatment for fatigue includes tips on how to manage tiredness that doesn't go away with rest or sleep. For example, if taking a shower is a priority, and if mornings are when you have the most energy, take your shower in the morning.
- Home treatment for nausea or vomiting includes watching for and treating early signs of dehydration, such as having a dry mouth or feeling lightheaded when you stand up. Eating smaller meals may help. So can a little bit of ginger candy or ginger tea.
- Home treatment for diarrhea includes resting your stomach and being alert for signs of dehydration. Check with your doctor before using any nonprescription medicines for your diarrhea. Be sure to drink enough fluids.
- Home treatment for constipation includes making sure that you drink enough fluids and eat fruits, vegetables, and fiber in your diet each day. Don't use a laxative without first talking to your doctor.
Other symptoms that can be treated at home include:
- Sleep problems. If you have trouble sleeping, some tips for managing sleep problems may help.
- Hair loss may be unavoidable. But you can decrease irritation of your scalp by using mild shampoos and avoiding hair products that damage hair.
- Stress. Cancer and its treatment can be stressful. But there are many steps you can take to manage stress.
- Pain. Not all forms of cancer or cancer treatment cause pain. But if you do have pain, there are many home treatments that can help.
- Swelling of your arm. You can reduce your risk of this swelling by protecting your arm on the side where you had surgery. Let your doctor know right away if you have swelling or redness in that arm. This swelling is called lymphedema (say "limp-fih-DEE-muh").
- Lymphedema: Managing Lymphedema
Managing stress
Having cancer and being treated for it can be very stressful, especially when it is metastatic or recurrent cancer. There are steps you can take to reduce your stress. Some people find that it helps to talk about their feelings with family and friends. Others find that spending time alone is what they need.
If your emotional reaction to cancer gets in the way of your ability to make decisions about your health, it's important to talk with your doctor. Your cancer treatment center may offer psychological or financial services. And a local chapter of the American Cancer Society can help you find a support group.
Body image
Cancer or cancer treatments can cause changes that may be hard to adjust to, such as changes in your body image or sexual problems. Managing body image issues may involve talking openly about your feelings with your partner and discussing your concerns with your doctor. Your doctor may be able to refer you to groups that can offer support and information.
For more information about learning how to live with metastatic or recurrent cancer, read "Coping With Advanced Cancer" or "When Cancer Returns" from the National Cancer Institute. These booklets are available online at www.cancer.gov/cancertopics/coping/advancedcancer and at www.cancer.gov/cancertopics/coping/when-cancer-returns.
Having cancer can change your life in many ways. For support in managing these changes, see the topic
Getting Support When You Have Cancer.
Medications
Metastatic or recurrent breast cancer is treated with a variety of medicines,
including chemotherapy and hormone therapy.
Medicine choices
Chemotherapy. Medicines may be given by themselves, or in some cases, in a combination. Medicines may also be combined with trastuzumab or lapatinib for HER2-positive cancer. Commonly used medicines include:
- Capecitabine.
- Cyclophosphamide.
- Docetaxel.
- Doxorubicin.
- Epirubicin.
- Gemcitabine.
- Paclitaxel.
- Vinorelbine.
Hormone therapy. Medicines for hormone therapy include aromatase inhibitors, tamoxifen, antiestrogens (such as fulvestrant), or megestrol.
Targeted therapy. This may
include:
- Monoclonal antibodies, such as ado-trastuzumab, pertuzumab, and trastuzumab.
- Tyrosine kinase inhibitors, such as lapatinib.
- PARP inhibitors, which are used to treat triple negative
breast cancer.
Other medicines that may be used include corticosteroids for cancer that has spread to
the brain or spinal cord and bisphosphonates for cancer that has spread to the bones.
Opioid pain relievers are the most common medicines used to treat cancer pain.
Dealing with side effects of medicines
Chemotherapy can often cause nausea and vomiting. To help relieve any nausea that you may have, your
doctor will prescribe medicines to control and prevent nausea and vomiting that you can take along with your treatments.
- Cancer: Controlling Nausea and Vomiting From Chemotherapy
Surgery
Surgery, such as mastectomy, may be used to treat breast cancer that has
recurred in the breast after breast-conserving surgery
and radiation. Or surgery may be
done for metastatic breast cancer to slow the progress of the cancer, relieve
symptoms, and improve quality of life.
Other Treatment
Radiation therapy
Radiation treatments may be a good choice to
treat cancer that has spread to the brain, to relieve bone pain, and to control the spread of the
cancer.
The type and length of radiation therapy depend on the
area of your body
affected, your health, and any other symptoms. Even
though radiation treatments may not cure your cancer, they may improve your
quality of life.
Complementary therapy
People sometimes use complementary therapies
along with medical treatment to help relieve symptoms and side effects of
cancer treatments. Some of the complementary therapies that may be helpful
include:
These mind-body treatments may help you feel better. They can make it easier to cope with treatment. They also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.
Before you try a complementary therapy, talk to your doctor about the possible value and potential side effects. Let your doctor know if you are already using any such therapies. They are not meant to take the place of standard medical treatment.
Other Places To Get Help
Organization
National Cancer Institute (U.S.)
www.cancer.gov (or https://livehelp.cancer.gov/app/chat/chat_launch for live help online)
References
Citations
- National Cancer Institute (2012). Breast Cancer Treatment (PDQ)-Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/breast/Patient.
Other Works Consulted
- American Joint Committee on Cancer (2010). Breast. In AJCC Cancer Staging Manual, 7th ed., pp. 345-376. New York: Springer.
- National Cancer Institute (2011). Lymphedema PDQ-Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/supportivecare/lymphedema/healthprofessional.
- National Cancer Institute (2013). Nausea and Vomiting PDQ-Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/supportivecare/nausea/HealthProfessional.
Credits
ByHealthwise Staff
Primary Medical ReviewerSarah Marshall, MD - Family Medicine
E. Gregory Thompson, MD - Internal Medicine
Kathleen Romito, MD - Family Medicine
Elizabeth T. Russo, MD - Internal Medicine
Specialist Medical ReviewerDouglas A. Stewart, MD - Medical Oncology