Metastatic breast cancer in lungs

When breast cancer cells spread to distant parts of the body, it’s called stage IV metastatic breast cancer. If it spreads to the lungs, it’s called lung metastasis, or lung mets. More than one area of metastasis is called metastases. Breast cancer can spread anywhere in the body, but the most common sites are the bones, liver, lungs, and brain.

If breast cancer cells reach the lungs, they can multiply and create tumors that can affect how your lungs work. It’s possible to have just one tumor in the lungs, but most people who get lung metastases develop more than one tumor there.

Metastatic breast cancer can develop months to years after treatment for early-stage breast cancer ends. Doctors don’t know why some people develop metastases and others don’t, but treatment for early-stage breast cancer aims to reduce the risk of developing metastatic disease. Lung metastases can be found when a doctor orders chest imaging to evaluate a symptom such as cough or shortness of breath. Other times, lung metastases are discovered incidentally when chest imaging is performed for another reason.

We know a metastatic breast cancer diagnosis can trigger many intense feelings for you and your loved ones. We’re here for you. Having more information about diagnosis, treatment, and emotional support can help you focus on next steps. Below, we’ll share more details about who gets lung mets, what symptoms might signal lung mets have developed, and supportive resources available to you.

About the lungs

Your lungs are located in your upper body, beneath the ribcage, with one lung on each side of your heart. Healthy lungs supply the body with oxygen on the in-breath. They release carbon dioxide on the out-breath. Together, they help you take thousands of breaths every day.

Who gets lung metastases?

The lungs are the second most common place for breast cancer to spread, after the bones. People diagnosed with triple-negative breast cancer are more likely to be diagnosed with lung mets. Still, it’s possible for people diagnosed with any type of breast cancer, of any background, and any age to develop lung metastases.

What are the symptoms of lung metastases?

Sometimes lung metastases are found during routine imaging tests. Other times, they cause symptoms that prompt you to go to the doctor. Symptoms that can signal lung metastases include:

• Coughing, with or without blood
• Shortness of breath
• Chest pressure or discomfort

The symptoms listed above are not specific to lung metastases. These can happen with common health issues we encounter each day, such as coughing due to a cold or flu, or chest pressure related to heart problems.

It’s important to tell your cancer care team about any new or worsening symptoms, even if you believe they may be caused by something else. Finding lung metastases earlier means starting treatment to manage them earlier. If you have chest pain; are coughing up blood; or have sudden, severe shortness of breath, call 911 or tell your doctor right away. These can be symptoms of more serious problems, such as a heart attack or blood clot, which require urgent attention.

Complications of lung metastases

A possible complication of breast cancer spreading into the lungs is fluid accumulation in the pleural space, or lining of the lung. The pleural space is the area between the outside of the lung and the inside of the ribcage. Fluid accumulation there is called pleural effusion. If cancer cells spread to the pleural space, fluid can be drawn into the space. If enough fluid accumulates, the lung will be compressed and cause symptoms such as shortness of breath, coughing, and chest pressure. Pleural effusion does not happen to every person diagnosed with lung metastases.

A pleural effusion can be drained with a procedure known as a thoracentesis, where a needle is placed through the skin of your back, through the ribs and into the pleural space.

How are lung metastases diagnosed?

Your doctors will most likely use imaging tests to create pictures of the lungs to learn whether cancer is present. These imaging tests can include:

• CT scans
• PET scans
• PET-CT scans, which are a combination of a CT scan and PET scan
• Chest x-rays
• MRIs

CT scans and PET-CT scans are most often used to diagnose lung metastases.

If a scan shows a suspicious finding such as nodules (abnormal growths) in the lung or enlarged lymph nodes in the chest, the next step is a biopsy to remove tissue for examination. There are two ways to perform a biopsy of suspected cancer in the lung:

• Bronchoscopy: To perform a bronchoscopy, your doctor inserts a thin, lighted tube into your nose or mouth and through your airways to look at your lungs. This allows your doctor to look for tumors and obtain a biopsy internally, through your airway.
• Percutaneous needle biopsy: In this type of biopsy, a needle is placed through the skin and into the lung. During a lung biopsy, a surgeon removes a small piece of suspicious-looking lung tissue so it can be tested for breast cancer cells.

More and more, doctors are using CT scans to guide the bronchoscopy or biopsy, which makes the procedure more likely to be successful.

Monitoring lung metastases

If you are diagnosed with lung metastases, you and your care team will decide on a treatment plan. That plan will also include regular tests to show your doctors how treatments are working and if the tumors are shrinking, growing, or staying the same size. Knowing this allows you and your doctor to continue making treatment decisions and managing side effects.

Tests to monitor a lung metastasis

Your doctor may use blood and imaging tests to monitor lung metastases:

• Oxygen saturation can be measured using a technique called pulse oximetry, in which a device with a sensor is clipped onto part of the body, such as a fingertip. This test uses light to the calculate oxygen saturation of the blood, and can show how well your lungs are sending oxygen into your blood.
• Blood tests can also be done to monitor protein levels from cells that have broken away from tumors and entered the blood.
• Imaging tests, such as CT scans or MRIs, create pictures of your lungs. If cancer is present in the lungs, these tests can show where it’s located. By comparing the pictures over time, doctors can see whether lung metastases are growing, shrinking, or changing in other ways. Imaging tests your doctor may order include:

How often you need testing

How often you get which tests depends on the specifics of your diagnosis, your treatment, and your doctor’s recommendations. But it’s common for doctors to recommend imaging tests every 2-6 months. Your doctor may also recommend additional tests if you experience new or more serious symptoms or side effects. Ask your doctor how often they recommend you have certain tests, and how the tests can help guide your treatment plan.

How are lung metastases treated?

Lung metastases are typically treated with systemic treatments that work against cancer cells throughout the body. Systemic treatments include:

• Chemotherapy
• Hormonal therapy
• Targeted therapy
• Immunotherapy

The systemic treatment options offered to you will depend on many things, including specific features of the cancer (such as hormone and HER2 expression), your symptom history, and what kinds of cancer treatment you’ve had in the past. Your care team will work with you to find the most effective plan for you. Other factors that impact your treatment plan are:

• Symptoms you’re currently experiencing
• Whether or not you’ve started menopause
• How healthy you are, aside from cancer

Your doctor will schedule regular imaging tests of your lungs to see how well treatments are working. If the tests show the cancer is growing or spreading, your doctor will likely recommend a change of systemic therapy. Local therapies, such as surgery and radiation, are rarely done for people with lung metastases, and surgery is generally not recommended. Radiation therapy can be given in very specific situations to try to improve symptoms, such as:

• To help stop a tumor in the lung from bleeding into an airway (this is rare)
• To try to shrink a tumor that may be obstructing an airway

You may also receive treatment for other symptoms caused by lung metastases. For example, if pleural effusion starts to occur, it can leave you feeling short of breath. Pleural effusion can be treated with a drainage needle or catheter to reduce the fluid. You may need other local treatments if you experience certain symptoms:

• Shortness of breath can be treated with opioids or anti-anxiety medicines.
• Pain can be eased with prescription pain medicine and supportive care.
• Low oxygen levels can be addressed with supplemental oxygen.

Clinical trials

In addition to receiving standard treatments for lung metastasis, you may also be eligible to join a clinical trial looking at new, promising medicines, or at new ways of delivering treatments. Joining a clinical trial may seem like an uncertain way to treat cancer. However, clinical trials are how new drugs get developed — and how breast cancer treatment can improve over time. Participation in a clinical trial allows you to receive a medication, such as a new targeted therapy, before it gets approved. Clinical trials also allow you to be closely monitored by a research team.

To learn more about clinical trial eligibility and safety, or to search for trials you might be able to join, visit our Clinical Trials Resource Center, presented in partnership with CenterWatch.com.

Emotional support

Lung metastases can make it harder to breathe comfortably. Even though you may be getting enough oxygen, the feeling of breathlessness can be overwhelming. Many people feel scared when they can’t take a full breath. It’s normal to feel worried or panicked. Relaxation techniques, such as hypnosis or guided imagery, have helped some people manage the anxiety that can happen with breathing difficulties.

If you’re feeling anxious or depressed after a metastatic breast cancer diagnosis, it’s important to know that you’re not alone. We have resources to help.

We know that even if you are not having breathing difficulty, coping with cancer can be emotionally draining. Many people find some relief from talking about their experience, either with a licensed professional therapist or with a peer support group. If you’re interested in either of these, talk with a social worker or patient navigator from your healthcare team. These professionals are tuned in to the local cancer support landscape and should be able to recommend support groups or counselors who meet at your cancer treatment center or nearby.

You may also find that it helps to:

• Talk with other women diagnosed with lung mets in online groups.
• Meet up with others diagnosed with lung mets in your community or in organized support groups.
• Get insights from others in text or phone conversations through professional helplines. We encourage you to reach out to our Breast Cancer Helpline to be matched with a trained volunteer who has been diagnosed with metastatic breast cancer and is living with a similar experience.

Living with lung metastases can mean living with extra challenges — emotionally and physically. Below, you’ll find articles, personal stories, and downloadable resources to help you make sense of the basics of your diagnosis, manage lifestyle changes, and connect with the stories of others.