Where breast cancer spreads

When breast cancer metastasizes, the cancer cells enter the lymphatic system or the bloodstream and spread to lymph nodes or other organs of the body. If you have metastatic breast cancer, it means breast cancer cells spread away, or metastasized, from your breast tissue to other, distant areas of the body.

The lymphatic system is a series of small organs, called lymph nodes, and tissues and vessels that produce, store, and carry the body’s white blood cells and lymphatic fluid. Cancer cells can spread throughout the body through the lymphatic vessels.

Breast cancer cells can also get into the bloodstream fairly easily. But only a few can survive and grow in other organs. Typically, your body will reject or attack things it doesn’t recognize, the same way it attacks germs to keep you from getting sick. But in the case of metastasis, the few cancer cells that can survive in other organs seem familiar enough that different areas of the body allow them to grow.

Whether you’ve been diagnosed with early-stage or metastatic breast cancer, it’s normal to want to know how fast cancer is able to grow or spread. Many factors influence whether, and how fast, one cancer might grow compared to another. These factors include:

• Features of the cancer, such as the tumor grade, lymph node involvement, and subtype of cancer
• Physical factors, such as whether you’ve started menopause

But even with this information available, doctors can only predict — not know for sure — if a given cancer is likely to continue to spread in the body.

We know that wondering if or how breast cancer may spread can trigger many emotions. We’re here for you. Whether you’ve just been diagnosed or you’ve finished primary treatment, this page provides information to help you navigate conversations with your care team about the most effective treatment and follow-up plan for you.

Sites of metastasis

Breast cancer can spread to any part of the body, but the four most common sites are the bones, liver, lungs, and brain. Often, brain metastases are diagnosed after cancer has already been found in other parts of the body.
Here are some common symptoms and tests that can help confirm a diagnosis of bone, liver, lung, or brain metastasis:

• Bone metastases can make bones painful or easier to fracture. Sometimes, they cause the hands, feet, arms, or legs to tingle or go numb. Doctors look for bone metastases with imaging and blood tests. A biopsy may be needed to confirm.
• Liver metastases don’t always cause symptoms. Sometimes, they cause pain or a feeling of fullness in the belly. A blood test showing higher-than-normal levels of certain enzymes, along with imaging tests, help doctors find liver metastases. A biopsy may be needed to confirm.
• Lung metastases don’t always cause symptoms right away, but they can cause shortness of breath, coughing that won’t go away, chest pain, and other breathing-related symptoms. Imaging tests are the most common way for doctors to look for lung metastases. A biopsy may be necessary to confirm. Biopsy methods include CT scan-guided lung biopsy or biopsy that includes bronchoscopy, a procedure in which a lighted tube is inserted in your nose and mouth to take tissue to be analyzed.
• Brain metastases can cause many different symptoms, including dizziness, problems with memory, and blurred vision. Doctors use imaging tests to look for brain metastases. A biopsy may be needed to confirm.

Breast cancer can spread to other organs too, although not as often as the bone, liver, lung, and brain. Less common areas of metastasis include breast cancer in the:

• Bone marrow, a spongy tissue found in the center of most bones that creates the body’s red and white blood cells, and platelets. Symptoms of bone marrow metastasis are typically due to impaired function of bone marrow cells, and can include fatigue, unusual bruising, and low blood cell counts.
• Gastrointestinal (GI) tract, the longest part of the large intestine that includes the stomach. The GI tract removes water, nutrients, and electrolytes from partially digested foods. Symptoms of metastasis to the GI tract include abdominal pain, constipation, and vomiting.
• Heart. Symptoms of metastasis to the heart include difficulty breathing, rapid or irregular heartbeat, chest pain, and swelling of the legs or feet. Metastasis to the heart is extremely rare.
• Pancreas, an organ in the abdomen that breaks down sugar, fats, and starches, and also makes some hormones. Symptoms of pancreatic metastasis include abdominal pain and jaundice, a yellowing of the skin. Breast cancer metastasis to the pancreas is extremely rare.
• Peritoneal cavity, the abdominal space around the stomach, intestines, and liver. Fluid can build up in this space; this is known as malignant pleural effusion.
• Pleura, or membrane, that surrounds the lungs and the chest lining. If breast cancer metastasizes to the pleura, it is called malignant pleural effusion. Fluid can build up in the area. Symptoms include shortness of breath, dry cough, pain, chest tightness or heaviness, and being unable to lie flat.
• Skin. Symptoms of metastasis to the skin can be different from person to person, but may include the appearance of small, raised areas of skin tissue that may be pink, reddish, or brown. Sometimes metastasis to the skin can look like tiny, broken blood vessels or spider veins. Or, skin can take on an orange-peel appearance.
• Spine. Symptoms of metastasis to the spine include pain in the back or neck, which signal spinal cord compression caused by cancer pressing on the spinal cord. Symptoms can also include leg weakness and numbness of the legs or belly.

Another type of metastatic breast cancer is inflammatory breast cancer (IBC). IBC has many of the same symptoms as other metastasis to the skin, but one symptom that stands out is pitting or thickening of the breast skin. If this happens, the skin looks like an orange peel. Not all IBC has an orange-peel appearance, though. IBC is always staged as at least stage III. While stage III is not considered metastatic, IBC can be hard to diagnose. This is why many cases of IBC are already stage IV at diagnosis.

Keep in mind that the symptoms listed above can be symptoms of many kinds of illness we all encounter each day. Having one symptom, or even many symptoms, does not guarantee that you have metastatic breast cancer. The best thing you can do is pay attention to your body and talk to your doctor if you notice symptoms. Many medical oncologists recommend letting your doctor know about a symptom that seems unusual or new if it persists for 2-3 weeks. Still, talk with your care team about when to report a new symptom.

Metastatic breast cancer is still breast cancer

Finding out breast cancer spread to another area of your body does not mean you have an entirely new type of cancer. Your doctors will still treat it as breast cancer. Breast cancer in distant parts of the body will respond best to treatments for breast cancer. Being diagnosed with bone metastasis, for example, is not the same as being diagnosed with bone cancer.

If you had early-stage breast cancer before, your doctors should run tests on the metastatic tumor to make sure that the cancer cells are the same hormone receptor and HER2 receptor status as your first diagnosis. Metastatic tumors can test differently than tumors from an earlier diagnosis. Your care team will adjust your treatments, if needed, for the best results possible.

Metastatic breast cancer vs. locally advanced breast cancer

Metastatic breast cancer is breast cancer that spreads to a distant part of the body. But cancer cells can also spread just beyond the breast to the nearby lymph nodes, to the skin, or to the chest wall. In these cases, the cancer is considered to be locally advanced, because it has spread a small amount, but is not found in other parts of the body. Locally advanced breast cancers are often stage III.

Doctors sometimes have different ways of looking at staging and metastasis. You might hear some doctors say that in stage III, locally advanced breast cancer has metastasized to lymph nodes and other areas near the breast. Stage IV may be referred to as distant metastasis to organs far away from the breast.

De novo metastatic breast cancer

If your first breast cancer diagnosis is metastatic stage IV breast cancer to a distant organ, you may hear the term de novo metastatic breast cancer to describe it. Signs of de novo metastatic breast cancer include a breast lump or mass that you can feel, or a symptom such as pain. De novo metastatic stage IV breast cancer is often confirmed on imaging tests that show cancer spread to a distant organ. Learn more about de novo metastatic breast cancer.

Recurrent disease

If you had breast cancer before, a metastasis may be referred to as recurrent disease. In this case, some of the original cancer cells survived the treatments you had for early-stage breast cancer. Systemic, full-body treatments such as hormonal therapy and chemotherapy aim to kill cancer cells in the breast as well as any cells that may have started spreading to other parts of the body. In some cases, those cells escape the cancer treatment and hide, in another organ, remaining inactive (dormant) until they begin to grow later.

Certain subtypes of breast cancer have higher rates of recurrence than others. For example, a 2017 study found women with hormone receptor-positive, early-stage breast cancer had a 10 to 41 percent risk of developing metastatic breast cancer in the 20 years after their diagnosis, even after standard 5-year hormonal therapy. It can be upsetting to learn that there could still be a risk of the cancer spreading outside the breast and nearby lymph nodes as many as 10 to 15 years after you stop taking hormonal therapy. Doctors are now considering recommendations for longer durations of hormonal therapy because of this. Whatever your individual situation is, this information can help you and your doctor make better treatment decisions and better understand your personal risk of recurrence.

Many researchers have studied the process of metastasis. To date, no one can predict how long cancer cells will be dormant before they begin to grow and can be detected.

Treatability after metastasizing

Thanks to research advances, there are many treatment options available for metastatic breast cancer, no matter where it’s diagnosed in the body. Treatment varies from person to person because your care team will carefully choose each new treatment based on the characteristics of the cancer, whether you’ve had treatments before, and your own unique needs. Treatment may include:

• Hormonal therapy
• Radiation therapy
• Targeted therapy
• Immunotherapy
• Chemotherapy

These same types of treatment are available for other stages of breast cancer. Treatment options, and their likely outcomes, vary by stage. Once breast cancer spreads beyond the breast to other distant organs, it is considered stage IV disease.

You can learn more about treatments for metastatic breast cancer on our metastatic breast cancer treatments page.