Breast Cancer, Metastatic or Recurrent
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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.
Health Tools help you make wise health decisions or take action to improve your health.
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.
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
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 should you call your 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:
Exams and Tests
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.
If your doctor thinks that breast cancer has come back or spread, you may have other tests, including:
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
- Surgery (mastectomy), radiation therapy, or both.
- Chemotherapy or hormone therapy.
- Being in a clinical trial, such as one where you have trastuzumab (Herceptin) and chemotherapy.
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
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 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 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.
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:
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.
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").
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.
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.
Metastatic or recurrent breast cancer is treated with a variety of medicines, including chemotherapy and hormone therapy.
Chemotherapy . This may include medicines like capecitabine, doxorubicin, and gemcitabine. 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.
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.
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.
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.
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.
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:
- Acupuncture to relieve pain.
- Meditation or yoga to relieve stress.
- Massage or biofeedback to reduce pain and ease tension.
- Breathing exercises for relaxation.
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.
- 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.
Current as of: April 29, 2020
Author: Healthwise Staff
Sarah Marshall MD - Family Medicine
E. Gregory Thompson MD - Internal Medicine
Kathleen Romito MD - Family Medicine
Elizabeth T. Russo MD - Internal Medicine
Douglas A. Stewart MD - Medical Oncology
Current as of: April 29, 2020