When someone has gone through breast cancer treatment, it's natural to hope the cancer is gone for good. But sometimes, breast cancer can come back. This is called a recurrence. When breast cancer recurs, it can be local, regional, or distant and the signs and symptoms of a breast cancer recurrence vary, depending on where it comes back. When the cancer spreads to other parts of the body, it’s a distant recurrence and it’s known as metastatic or stage IV breast cancer.
Metastatic breast cancer may come back months or even years after the original diagnosis and treatment. Even after successful treatment, some cancer cells may stay in the body without being detected. This can be a scary and overwhelming experience but understanding what’s happening and what to expect can help you make informed decisions about your health.
How is a Metastatic Recurrence Different?
If the cancer spreads beyond the breast and nearby lymph nodes to distant parts of the body, it's considered metastatic—even if it’s the first time it’s come back. This kind of recurrence isn’t a new cancer; it’s the same breast cancer cells that have now traveled to other parts of the body through the blood or lymphatic system. Most often, these areas are the bones, liver, lungs, or brain.
Even though the cancer cells in a metastatic recurrence are from the original tumour, sometimes the characteristics of the recurring cancer can be different. Breastcancer.org explains that although it seems logical that a metastatic recurrence would be the same subtype as the original diagnosis, it can differ in its HER2 and hormone receptor status. These differences can affect your treatment options, so your care team will likely test your cancer to determine its biomarker status.
What Are the Signs to Watch For?
Metastatic breast cancer symptoms can present in different ways, depending on where it spreads. For example:
- if it spreads to the bones, it may cause pain or fractures
- in the lungs, it might cause a cough or trouble breathing
- in the liver, it could lead to fatigue, pain, jaundice or digestive issues
- in the brain, it might cause headaches, dizziness, changes to your vision or confusion
Other symptoms like unexplained weight loss, ongoing fatigue, or a loss of appetite, may signal that something isn’t right. These symptoms don’t always mean your cancer has returned, but it’s important to speak to your doctor if you notice anything unusual or persistent.
For people originally diagnosed with lobular breast cancer, it’s helpful to know that this type may be more likely than ductal breast cancer to spread to less common areas, such as the gastrointestinal tract, ovaries, or peritoneum (the abdominal lining). While lobular breast cancer can still spread to the common sites mentioned earlier, if it spreads elsewhere, symptoms like digestive issues, bloating or pelvic discomfort may be important signs to discuss with your doctor.
How Is Metastatic Recurrence Treated?
While metastatic breast cancer is not considered curable, it is treatable. The goal of treatment is to control the cancer, relieve symptoms, and help you live as well as possible for as long as possible.
Your care team will consider several factors when recommending treatment including your overall health, where the cancer has spread, and how it responded to previous treatments. The primary treatment option is systemic therapy, which may include hormone therapy, chemotherapy, targeted therapy, or immunotherapy. Radiation may also be used to treat certain areas, like brain metastases, or to relieve pain caused by cancer in the bones.
Metastatic breast cancer is treated using lines of therapy, meaning you may start on one treatment and move to another if it stops working. It’s common for people to get multiple lines of treatment (first, second, third, or even later lines over time).
Your care team will monitor how the cancer responds to each treatment by taking routine blood tests or scans. They may use terms like:
- Regression: the cancer is shrinking
- Stable disease: the cancer is not growing but not shrinking either
- Progression: the cancer is growing or spreading
If the cancer is progressing, this is usually a sign that you’ll need to explore other treatment options.
Living With Metastatic Breast Cancer
A metastatic breast cancer recurrence can be emotionally and physically challenging. But many people live full lives for years after this diagnosis. Support from your healthcare team, counselors, support groups, and loved ones can help you cope and make informed decisions.
It’s important to keep asking questions, staying updated, and taking care of yourself. Advances in treatment continue to offer hope, and ongoing research is leading to new breakthroughs in how this disease is treated.
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