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 occurs when abnormal cells grow out of
control in one or both breasts.
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.
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.
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.
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
hormone therapy, and
radiation. Sometimes a mix of these treatments is
Treatments for breast cancer can cause side effects. Your
doctor can tell you what problems to expect and help you find ways to manage
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.
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:
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
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.
Learning about metastatic and recurrent breast cancer:
Living with breast cancer:
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.
After you have had breast
cancer, you have a higher-than-average risk of having cancer again. If cancer does come back, it often shows up within 10 years after a first diagnosis.1
To learn more about the risk of breast cancer coming back or spreading, see What Increases Your Risk.
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.
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:
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.
Symptoms of metastatic
breast cancer will depend on the area affected and how far your breast cancer
has spread. For example:
Symptoms such as changes in the skin of the breast or the nipple may be a sign of inflammatory breast cancer. For more information, see the topic 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
Cancer cells also can travel from the breast, either through the bloodstream or the
lymphatic 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.
To learn more about treatment, see Treatment Overview.
You have a risk of having
metastatic or recurrent breast cancer if you have ever
breast cancer. Older women have the highest
risk. But no one can say for sure whether breast cancer will come back or metastasize.
doctor if you have any symptoms of breast cancer that last for more
than 1 to 2 weeks, such as:
If you have received treatment for
breast cancer, health professionals who can evaluate
new problems include a:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
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:
For more information on exams and tests, see the topic
have recently been diagnosed with
metastatic or recurrent breast cancer, you may
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.
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
For recurrent breast cancer in the breast or chest wall, treatments may include:2
For recurrent breast cancer in other parts of the body and metastatic breast cancer, treatments may include:2
Cancer and its treatments can be painful, but cancer pain can almost always be controlled. If you are having ongoing problems with managing pain, ask to see a pain specialist.
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.
Cancer treatment has two main goals: curing cancer and making your quality of life as good as possible. Palliative care can improve your quality of life by helping you manage your symptoms. It can also help you with other concerns that you may have when you are living with a serious illness.
For some people who have advanced cancer, a time comes when treatment to cure 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 this isn't the end of treatment. You and your doctor can decide when you may be ready for hospice care.
It can be hard to decide when to stop treatment aimed at prolonging your life and to shift the focus to end-of-life 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,
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
For more information, see the topic
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.
Other symptoms that can be treated at home include:
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. 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. Commonly used medicines include:
Hormone therapy. Medicines for hormone therapy include aromatase inhibitors, tamoxifen, antiestrogens (such as fulvestrant), or megestrol.
Other medicines may be used. For example, tyrosine kinase inhibitors may be given with lapatinib and capecitabine. And corticosteroids or bisphosphonates may be used if cancer has spread to the brain or spinal cord.
Opiate pain relievers are the most common medicines used to treat cancer pain. If your doctor isn't able to help you get relief from your pain, ask to see a pain specialist. Cancer pain can be complicated and may require a doctor who has had specialized training.
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
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
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.
FORCE is an organization that provides educational and emotional support for women who are making decisions about surgery to prevent breast or ovarian cancer because they are at high risk. This website also has resources for women who have cancer and are concerned about their cancer coming back. There are online resources as well as a helpline, newsletters, and information on local groups and annual conferences.
The American Cancer Society (ACS) conducts educational
programs and offers many services to people with cancer and to their families.
Staff at the toll-free number have information about services and activities
in local areas and can provide referrals to local ACS divisions.
Breastcancer.org is a website dedicated to helping women
understand breast cancer and make good decisions about their treatment. This
site provides information from medical professionals on all aspects of
breast cancer, from screening and surgery to sex and intimacy. The site also offers links
to chat rooms, discussion boards, and "Ask the Expert" online conferences.
The National Breast Cancer Coalition (NBCC)
asks the government for increased funding for breast cancer research. The NBCC
also works with researchers to advance the science of breast cancer research
and to improve access to high-quality health care and breast cancer clinical
trials for women. This website offers news and research on breast cancer. It also has information about current controversies in breast cancer and provides expert opinions.
The NBCC has a sister organization, the National Breast
Cancer Coalition Fund (NBCCF). Together these two groups help women take a leadership role
among government leaders, scientists, and doctors.
The National Cancer Institute (NCI) is a U.S. government
agency that provides up-to-date information about the prevention, detection,
and treatment of cancer. NCI also offers supportive care to people who have cancer
and to their families. NCI information is also available to doctors, nurses,
and other health professionals. NCI provides the latest information about
clinical trials. The Cancer Information Service, a service of NCI, has trained
staff members available to answer questions and send free publications.
Spanish-speaking staff members are also available.
The National Lymphedema Network (NLN) provides education and
guidance to people with lymphedema, health professionals, and the general
public. The NLN provides information on the prevention and management of
primary and secondary lymphedema and supports research to find causes and
treatments for lymphedema.
CitationsEllis MJ, et al. (2004). Treatment of metastatic
breast cancer. In JR Harris et al., eds., Diseases of the Breast, 3rd ed., pp. 1101–1159. Philadelphia: Lippincott Williams and
Wilkins. National Cancer Institute (2011). Breast Cancer PDQ: Treatment—Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/breast/Patient.Other Works ConsultedAmerican Joint Committee on Cancer (2010). Breast. In AJCC Cancer Staging Manual, 7th ed., pp. 345–376. New York: Springer.Blanchard EM, Hesketh PJ (2008). Nausea and vomiting. In VT DeVita Jr et al., eds., DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology, 8th ed., vol. 2, pp. 2639–2646. Philadelphia: Lippincott Williams and Wilkins.Dizon DS, et al. (2009). Breast cancer. In RR Barakat et al., eds., Principles and Practice of Gynecologic Oncology, 5th ed., pp. 897–945. Philadelphia: Lippincott Williams and Wilkins.Howell SJ, Howell A (2010). Treatment of metastatic breast cancer: Endocrine therapy. In JR Harris et al., eds., Diseases of the Breast, 4th ed., pp. 856–876. Philadelphia: Lippincott Williams and Wilkins.National Cancer Institute (2010). Lymphedema PDQ: Treatment—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/supportivecare/lymphedema/healthprofessional.National Cancer Institute (2011). Breast Cancer PDQ: Treatment – Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/breast/HealthProfessional.National Cancer Institute (2011). Breast Cancer PDQ: Treatment—Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/breast/Patient.National Cancer Institute (2011). Nausea and Vomiting PDQ—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/supportivecare/nausea/HealthProfessional.Tan S, Wolff AC (2010). Treatment of metastatic breast cancer: Chemotherapy. In JR Harris et al., eds., Diseases of the Breast, 4th ed., pp. 877–919. Philadelphia: Lippincott Williams and Wilkins.
October 22, 2012
Sarah Marshall, MD - Family Medicine & Douglas A. Stewart, MD - Medical Oncology
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