Medical News Today: What are the symptoms of stage 4 breast cancer?

If a person has stage 4 breast cancer, this means that the cancer cells have spread to other organs in their body, such as the lungs, lymph nodes, bones, skin, liver, or brain.

Cancer stages range from 1 to 4 and indicate the extent of the disease. A doctor may also refer to stage 4 as advanced or metastatic breast cancer.

Breast cancer is the second most common cancer in women.

In this article, learn about the symptoms of stage 4 breast cancer, as well as the treatment options.

Symptoms

Breast cancer pink ribbon
Stage 4 breast cancer may cause symptoms throughout the body.

A person with stage 4 breast cancer may experience some symptoms specific to the breast, as well as others that affect the whole body.

Breast-related symptoms include:

  • a lump
  • pitted skin (peau d’orange, or skin that looks like orange peel)
  • nipple changes, such as flattening, inversion, and dimpling
  • redness, swelling, and warmth

Other symptoms that may appear throughout the body include:

  • weakness or numbness
  • a consistent dry cough
  • chest pain
  • loss of appetite
  • bloating
  • constant nausea
  • severe headaches
  • jaundice
  • vision problems
  • seizures and confusion
  • loss of balance

When breast cancer cells move to other areas of the body, they remain as breast cancer cells. For example, breast cancer that has spread to the lungs is still breast cancer, not lung cancer.

In stage 4 breast cancer, cancer spreads to different parts of the body in a process called metastasis. It may cause different symptoms depending on the affected parts of the body:

Bone metastasis

When breast cancer cells move into bone, this is called bone metastasis. It is more common for breast cancer to spread to the bones than to any other body part.

The primary symptom of bone metastasis is intermittent bone pain. At times, the pain may become persistent.

Other symptoms may include:

  • Sudden or sharp pain, which may indicate a fracture.
  • Pain in the back and neck, trouble urinating, and weakness. These symptoms can indicate a compressed spinal cord.
  • Fatigue, nausea, dehydration, and loss of appetite, which may indicate high levels of calcium in the blood due to bone breaking down.

Lung metastasis

Lung metastasis does not always cause symptoms, but a doctor may discover it during a CT scan, as the cells will typically form a tumor.

If symptoms do occur, they may include:

  • shortness of breath
  • wheezing
  • discomfort or pain in the lungs
  • a persistent cough
  • coughing up blood and mucus

Although some of the symptoms may resemble those of a common cold, lung metastasis will require treatment. Therefore, it is vital that anyone with stage 4 breast cancer makes their doctor aware of any new symptoms, even if they do not seem severe.

Brain metastasis

The risk of breast cancer spreading to the brain is generally highest in those with HER2-positive or triple-negative breast cancer, which are more aggressive subtypes of this disease.

About 10–15 percent of women with stage 4 breast cancer will develop brain metastasis.

Symptoms include:

  • a headache
  • memory problems
  • vision problems
  • seizures
  • slurred speech
  • balance problems
  • dizziness
  • stroke

If a doctor suspects that the cancer has moved into the brain, they will order an MRI to confirm the diagnosis.

Liver metastasis

Stage 4 breast cancer showing lymph node and liver tumors in anatomy model.
Stage 4 breast cancer may spread to the liver or lymph nodes.

Breast cancer that spreads to the liver does not always cause symptoms.

A doctor may be able to diagnose liver metastasis with a blood test that measures specific enzymes and proteins in the blood.

If symptoms do occur, they may include:

  • fatigue and weakness
  • discomfort and pain in the upper abdomen
  • weight loss and poor appetite
  • bloating
  • fever
  • swelling in the legs
  • a yellow tint to the skin and eyes, called jaundice

In addition to a blood test, a doctor may use imaging tests, such as an MRI, CT scan, or ultrasound to help them make a diagnosis.

Lymph node metastasis

Lymph nodes are part of a network of tubes and glands that play an important role in the body’s immune system. The lymph system filters waste material and harmful substances from the body. It also helps to fight infections.

When cancer spreads, it can travel through either the bloodstream or the lymph system. If cancer starts to grow inside the lymph nodes, they may begin to feel hard or swollen.

Symptoms of lymph node metastasis can include a lump or swelling in the following areas of the body:

  • under the armpit
  • in the arm or hand
  • in the breastbone or collarbone area

If the lymph nodes are producing uncomfortable symptoms, a doctor can provide treatment.

Other symptoms

In one study, people with stage 4 breast cancer reported feeling frustrated as a result of symptoms restricting their activity. These symptoms included depression, anxiety, sleep problems, fatigue, and sadness.

It is vital to address the mental health issues that a stage 4 breast cancer diagnosis may cause.

To manage these symptoms, people can try yoga, meditation, and other stress-relieving techniques.


Treatment

Treatment for stage 4 breast cancer can include surgery, radiation, and chemotherapy.

If doctors believe that stage 4 breast cancer will be terminal, they will focus on trying to alleviate painful or uncomfortable symptoms to help a person have a better quality of life.

If a breast cancer tumor is hormone receptor-positive, the doctor may suggest using hormonal therapy.

Hormonal therapy includes the use of tamoxifen, aromatase inhibitors, and other therapies to reduce estrogen production. This is because estrogen contributes to breast cancer growth.

In some cases, a doctor may also remove a person’s ovaries to reduce the amount of estrogen in their body.

Other targeted therapy treatments identify and attack specific cancer cells. These include:

  • monoclonal antibodies
  • tyrosine kinase inhibitors
  • cyclin-dependent kinase inhibitors
  • PARP inhibitors

Treatment for bone metastasis may include bisphosphonates or denosumab to alleviate pain and reduce the risk of bone disease.

When to see a doctor

A person who suspects they may have breast cancer should see a doctor immediately.
A person who suspects that they may have breast cancer should see a doctor immediately.

If a person is experiencing any symptoms of breast cancer, they should visit a doctor immediately.

Screening is essential for catching and treating breast cancer during the early stages.

Screening involves:

  • self-examination
  • blood tests
  • imaging procedures, such as a mammogram
  • genetic testing for at-risk groups

Regular screening is especially vital if a person has certain genetic mutations or a personal or family history of cancer.

A person with stage 4 breast cancer will usually already have a team of doctors working to treat the disease and reduce symptoms. They should report any new symptoms to a doctor as soon as possible.


Outlook

The 5-year relative survival rate for stage 4 breast cancer is 22 percent, which means that 22 percent of people will live for at least 5 years after diagnosis.

However, many factors influence survival rates, including:

  • the subtype of breast cancer
  • how fast the tumor is growing
  • how likely the cancer is to come back
  • the person’s age
  • whether it is a new diagnosis or a recurring cancer
  • estrogen receptor and progesterone receptor levels in the tumor tissue
  • HER2/neu levels in the tumor tissue
  • whether or not the tumor tissue is triple negative

HER2 and triple-negative cancers are more aggressive and may have a lower survival rate.

A doctor that specializes in cancer, called an oncologist, will be able to provide a clear individual prognosis based on a person’s test results and personal medical history.

A person with stage 4 breast cancer can also seek support from family, friends, and support groups for people with a similar diagnosis.

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