Table of ContentsView AllTable of ContentsBone MetastasesLung MetastasesLiver MetastasesBrain MetastasesRare ComplicationsNext in Metastatic Breast Cancer Guide GuideEnd of Life Concerns With Metastatic Breast Cancer
Table of ContentsView All
View All
Table of Contents
Bone Metastases
Lung Metastases
Liver Metastases
Brain Metastases
Rare Complications
Next in Metastatic Breast Cancer Guide Guide
The complications of metastatic breast cancer, also known as stage 4 breast cancer, can vary based on which organ (or organs) the cancer has spread to. The four most common sites formetastasesare the bones, lungs, liver, and brain.
Metastases can complicate the systemic symptoms of advanced breast cancer, including fatigue, nausea, loss of appetite, and weight loss. While most complications are treatable,survival ratescan vary based on the location, size, and number of tumors you have.Stage 4 breast canceris treatable but not curable.
Verywell / Brianna Gilmartin
Around 70% of people diagnosed with stage 4 breast cancer will experiencemetastasis to the bonesfirst.When cancer invades the bones, it interferes with a process called boneremodeling(in which bones are continuously broken down and renewed with new bone cells to keep them healthy).
This can cause two different types of bone metastasis:
These two types of metastasis can occur independently or with each other, leading to potentially serious complications like:
For people with bone metastases,bone-modifying drugssuch asbisphosphonatesand Prolia (denosumab) may reduce the risk of pathologic fractures.Radiation therapyis often effective in reducing pain due to bone metastases.
Correct TerminologyBreast cancer that has spread to the bones is called bone metastases, not bone cancer. Although there is cancer in the bone, it is still regarded as breast cancer and treated with breast cancer drugs, not bone cancer drugs.Metastasis is the singular form of metastases.
Correct Terminology
Breast cancer that has spread to the bones is called bone metastases, not bone cancer. Although there is cancer in the bone, it is still regarded as breast cancer and treated with breast cancer drugs, not bone cancer drugs.Metastasis is the singular form of metastases.
Breast cancer that has spread to the bones is called bone metastases, not bone cancer. Although there is cancer in the bone, it is still regarded as breast cancer and treated with breast cancer drugs, not bone cancer drugs.
Metastasis is the singular form of metastases.
The lungs are the second most common site of metastasis in people with stage 4 breast cancer, affecting roughly 60% of diagnosed people.
Metastasis can occur when cancer cells from the primary tumor spread into the fluid-filled space between the lungs and chest wall, called thepleural cavity.
Around 40% of cases involve a single lung tumor, while the rest involve multiple tumors. Cigarette smoking adds to the risk.
Lung metastases are oftenasymptomatic(without symptoms) and typically found during a chest X-ray or some other imaging test.
When symptoms occur, they may include:
Complications of lung metastases include:
Chemotherapy is the most common treatment for lung metastases, involving systemic and inhaled drugs.Chemotherapy is sometimes used with surgery andtargeted drug therapy.
Pleural effusion can be treated withthoracentesisin which a needle is inserted through the chest wall to extract fluid.Pleurodesisis a procedure used to stick together pleural tissues to prevent the re-accumulation of fluid.
The liver is a common site of metastasis, affecting roughly 50% of people with stage 4 breast cancer. The invasion occurs when cancer cells inlymph nodesbreak free and circulate through thelymphatic systemto the liver.
Many cases are asymptomatic and will only manifest with symptoms when a person developsacute hepatitis(liver inflammation).
Symptoms of liver metastases include:
In severe cases, liver metastases can cause acuteliver failureand death.
In addition to standardchemotherapy, localized chemotherapy may be used to treat the metastases specifically. This includeshepatic arterial infusion (HAI)in which chemotherapy drugs are delivered to the main artery of the liver, or transarterial chemoembolization (TACE) in which microbeads of chemotherapy drugs are placed in the liver tumors.
Brain metastasesare also common, affecting 20% to 40% of people with stage 4 breast cancer. It mainly affects those with aggressive forms of breast cancer, includingHER2-positiveortriple-negative breast cancer.
To access the brain, the cancer must infiltrate the blood-brain barrier which isolates the brain from the rest of the body.These metastases are often the first or sole site of metastasis in the body. At other times, it may be a sign of disease progression, occurring four to five years after the initial diagnosis.
Brain metastases may cause neurological and psychiatric symptoms depending on which part of the brain is affected. These may include:
Stroke is a possible complication of brain metastases caused either when a weakened blood vessel ruptures (hemorrhagic stroke) or a tumor directly or indirectly cuts off blood supply to the brain (ischemic stroke).
Left untreated, brain metastases secondary to brain cancer have a survival time of roughly one month.
On rare occasions, breast cancer can spread to the lining of the heart and causepericardial effusion. When fluid builds up between the membranes lining the heart, your heart has to work harder. The heart rate usually speeds up to make up for the smaller volume the heart is pumping out.
If the fluid builds up quickly or is extensive, it can lead to a condition known aspericardial tamponadein which the heart is unable to beat. When this occurs due to cancer metastases, a third of people die before it can be diagnosed and treated.
Summary
Complications of metastatic brain cancer vary based on whether the cancer has spread to the bones, lungs, liver, or brain. Treatments are available for stage 4 breast cancer, ranging from chemotherapy to radiation and surgery. While these cannot cure cancer, they may extend disease-free survival.
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15 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Penn Medicine.Metastatic (stage 4) breast cancer.National Breast Cancer Foundation.Stage 4 breast cancer overview.Pang L, Gan C, Xu J, et al.Bone metastasis of breast cancer: molecular mechanisms and therapeutic strategies.Cancers (Basel). 2022 Nov 22;14(23):5727. doi:10.3390/cancers14235727Kang J, Formenti SC.Metastatic osseous pain control: radiation therapy.Semin Intervent Radiol. 2017;34(4):322-327. doi:10.1055/s-0037-1608703Susan G. Komen.Bone metastases and metastatic breast cancer.Breastcancer.org.Lung metastasis.Jin L, Han B, Siegel E, Ciu Y, Giuliano A, Cui X.Breast cancer lung metastasis: molecular biology and therapeutic implications.Cancer Biol Ther. 2018 Apr 30;19(10):858–868. doi:10.1080/15384047.2018.1456599Zhou H, Dong D, Chen B, et al.Diagnosis of distant metastasis of lung cancer: based on clinical and radiomic features.Transl Oncol. 2018;11(1):31-36. doi:10.1016/j.tranon.2017.10.010Rosière R, Berghmans T, De Vuyst P, Amighi K, Wauthoz N.The position of inhaled chemotherapy in the care of patients with lung tumors: clinical feasibility and indications according to recent pharmaceutical progresses.Cancers(Basel). 2019;11(3). doi:10.3390/cancers11030329American Cancer Society.Lung metastases.Breastcancer.org.Liver metastasis.Liu C, Mohan SC, Wei J, et al.Breast cancer liver metastasis: pathogenesis and clinical implications.Front Oncol.2022 Oct 25;12:1043771. doi:10.3389/fonc.2022.1043771Raghavendra AS, Ibrahim NK.Breast cancer brain metastasis: a comprehensive review.JCO Oncol Prac.2024;20(10). doi:10.1200/OP.23.00794Martin AM, Cagney DN, Catalano PJ, et al.Brain metastases in newly diagnosed breast cancer: a population-based study.JAMA Oncol. 2017;3(8):1069-1077. doi:10.1001/jamaoncol.2017.0001Aleman BM, Moser EC, Nuver J, et al.Cardiovascular disease after cancer therapy.EJC Suppl. 2014;12(1):18-28. doi:10.1016/j.ejcsup.2014.03.002
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Penn Medicine.Metastatic (stage 4) breast cancer.National Breast Cancer Foundation.Stage 4 breast cancer overview.Pang L, Gan C, Xu J, et al.Bone metastasis of breast cancer: molecular mechanisms and therapeutic strategies.Cancers (Basel). 2022 Nov 22;14(23):5727. doi:10.3390/cancers14235727Kang J, Formenti SC.Metastatic osseous pain control: radiation therapy.Semin Intervent Radiol. 2017;34(4):322-327. doi:10.1055/s-0037-1608703Susan G. Komen.Bone metastases and metastatic breast cancer.Breastcancer.org.Lung metastasis.Jin L, Han B, Siegel E, Ciu Y, Giuliano A, Cui X.Breast cancer lung metastasis: molecular biology and therapeutic implications.Cancer Biol Ther. 2018 Apr 30;19(10):858–868. doi:10.1080/15384047.2018.1456599Zhou H, Dong D, Chen B, et al.Diagnosis of distant metastasis of lung cancer: based on clinical and radiomic features.Transl Oncol. 2018;11(1):31-36. doi:10.1016/j.tranon.2017.10.010Rosière R, Berghmans T, De Vuyst P, Amighi K, Wauthoz N.The position of inhaled chemotherapy in the care of patients with lung tumors: clinical feasibility and indications according to recent pharmaceutical progresses.Cancers(Basel). 2019;11(3). doi:10.3390/cancers11030329American Cancer Society.Lung metastases.Breastcancer.org.Liver metastasis.Liu C, Mohan SC, Wei J, et al.Breast cancer liver metastasis: pathogenesis and clinical implications.Front Oncol.2022 Oct 25;12:1043771. doi:10.3389/fonc.2022.1043771Raghavendra AS, Ibrahim NK.Breast cancer brain metastasis: a comprehensive review.JCO Oncol Prac.2024;20(10). doi:10.1200/OP.23.00794Martin AM, Cagney DN, Catalano PJ, et al.Brain metastases in newly diagnosed breast cancer: a population-based study.JAMA Oncol. 2017;3(8):1069-1077. doi:10.1001/jamaoncol.2017.0001Aleman BM, Moser EC, Nuver J, et al.Cardiovascular disease after cancer therapy.EJC Suppl. 2014;12(1):18-28. doi:10.1016/j.ejcsup.2014.03.002
Penn Medicine.Metastatic (stage 4) breast cancer.
National Breast Cancer Foundation.Stage 4 breast cancer overview.
Pang L, Gan C, Xu J, et al.Bone metastasis of breast cancer: molecular mechanisms and therapeutic strategies.Cancers (Basel). 2022 Nov 22;14(23):5727. doi:10.3390/cancers14235727
Kang J, Formenti SC.Metastatic osseous pain control: radiation therapy.Semin Intervent Radiol. 2017;34(4):322-327. doi:10.1055/s-0037-1608703
Susan G. Komen.Bone metastases and metastatic breast cancer.
Breastcancer.org.Lung metastasis.
Jin L, Han B, Siegel E, Ciu Y, Giuliano A, Cui X.Breast cancer lung metastasis: molecular biology and therapeutic implications.Cancer Biol Ther. 2018 Apr 30;19(10):858–868. doi:10.1080/15384047.2018.1456599
Zhou H, Dong D, Chen B, et al.Diagnosis of distant metastasis of lung cancer: based on clinical and radiomic features.Transl Oncol. 2018;11(1):31-36. doi:10.1016/j.tranon.2017.10.010
Rosière R, Berghmans T, De Vuyst P, Amighi K, Wauthoz N.The position of inhaled chemotherapy in the care of patients with lung tumors: clinical feasibility and indications according to recent pharmaceutical progresses.Cancers(Basel). 2019;11(3). doi:10.3390/cancers11030329
American Cancer Society.Lung metastases.
Breastcancer.org.Liver metastasis.
Liu C, Mohan SC, Wei J, et al.Breast cancer liver metastasis: pathogenesis and clinical implications.Front Oncol.2022 Oct 25;12:1043771. doi:10.3389/fonc.2022.1043771
Raghavendra AS, Ibrahim NK.Breast cancer brain metastasis: a comprehensive review.JCO Oncol Prac.2024;20(10). doi:10.1200/OP.23.00794
Martin AM, Cagney DN, Catalano PJ, et al.Brain metastases in newly diagnosed breast cancer: a population-based study.JAMA Oncol. 2017;3(8):1069-1077. doi:10.1001/jamaoncol.2017.0001
Aleman BM, Moser EC, Nuver J, et al.Cardiovascular disease after cancer therapy.EJC Suppl. 2014;12(1):18-28. doi:10.1016/j.ejcsup.2014.03.002
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