The 7 symptoms of breast cancer that metastasizes

Metastatic breast cancer is breast cancer at an advanced stage, where cancer cells have migrated to other parts of the body. Depending on the organs affected, the symptoms are different. What signs in case of liver metastases? On the bones? In the lung? After how long do these symptoms appear?

Metastatic breast cancer is a breast cancer whose cancer cells have colonized other parts of the body. These cancer cells, called “metastases”, usually affect the bones, but can also spread to vital organs such as the lungs, liver, brain or even the skin. “Only 5% of metastatic breast cancers are diagnosed immediately : that is, cancer cells were simultaneously detected in one breast and in another part of the body during the initial diagnosis. In the vast majority of cancers (i.e. 95%), the cancer cells first reached the breast and then moved to other parts of the body“, says Dr. Mahasti Saghatchian, oncologist and practitioner specializing in breast cancer at the Gustave Roussy Institute. Good to know: cancer is always defined by its origin, in other words its starting point. Thus, a breast cancer that has spread to the lung is still breast cancer, even if it has also developed elsewhere. It will be treated as breast cancer, not lung cancer. Also know that metastases are not not operable, it is the original cancerous cells that will have to be treated.

Metastatic or stage 4 breast cancer, which corresponds to cancer that has metastasized to a distance, is the most advanced stage of breast cancer and remains much more difficult to treat, although many treatment options can be considered. Hence the importance of detecting the signs of metastases as early as possible. Issue, the symptoms linked to the presence of metastases are not necessarily painful and can go unnoticed for a long time. “And when symptoms appear, the cancer is usually well advanced“, specifies the oncologist. However, certain symptoms are not to be taken lightly and can give the signal of alarm. In the event of symptoms, it is advisable to consult a doctor, without waiting for the next medical check-up. Depending on the clinical examination, the doctor may prescribe targeted additional examinations (blood test, ultrasound, chest scan, etc.) which will be used to guide the diagnosis.

1. Lymph nodes in the armpit

“In breast cancer, the lymph node is the first relay for the dissemination of cancer cells in the body and thus constitutes the first metastasis“, explains the specialist. It is possible to feel one or more hard lumps in the armpit which is closest to the breast where the tumor is nestled, but also around the collarbone and breastbone. These so-called lymph nodes are painless. In the case of a small infiltrating tumor of the breast and in the absence of malignant adenopathy detected, we use sentinel lymph node technique, in other words the node closest to the tumor in breast cancer and which specifically drains the tumor. This surgery involves removing the first lymph node(s) in the armpit closest to the tumour. To do this, a product emitting radiation (technetium) is injected into the breast, as well as, in some cases, a blue coloring liquid. These two products will go to the breast and lodge in the sentinel lymph node(s). This will allow the surgeon to easily locate them and be able to remove them. However, this technique is only considered for small tumours. “On the other hand, if a lymph node is detected at the level of the other armpit or elsewhere, it is a question of “true metastases” because they are at a distance from the original tumor. They will then have to be removed.“, she underlines.

2. Unusual headaches (metastases to the brain)

“Severe headaches or unusual migraines may be a sign of brain metastases. That is to say, the cancer could potentially spread to the brain (entire brainstem of the cerebellum and the brain). We must remain vigilant. If these pains become frequent and persist, it is advisable to consult a doctor who will perform a physical examination during which he will look for any signs of metastases and will ask you about your medical history, your symptoms and your risk factors. And at the end of this clinical examination, he will be able to prescribe blood tests, as well asbrain MRI“, insists the oncologist. If these headaches are also associated with nausea and vomiting, dizziness, numbness of certain parts of the body, balance and coordination disorders, even speech disorders , it is necessary to consult a health professional, namely that cerebral metastases are more frequent than primary brain cancer.

3. Bone pain

Breast cancer can spread to the bones and form what are called bone metastases. So, “cancer cells will gradually nibble the bone and make it more fragile. Concretely, the patient will feel severe pain, intermittent or continuous, which can for example be silent during the day and very intense at night, localized in a single region or felt throughout the body and above all, which does not pass with conventional pain treatments“, describes Dr. Mahasti Saghatchian. These pains can be accompanied bya broken bonemost often ribs, vertebrae and long bones of the legs.

4. Back pain

If bone metastases form in the spine, tumor cells can put pressure on the spinal cord (called spinal compression), which can lead to significant back pain, neuralgia, loss of balance, weakness or numbness in the legs or arms, inability to urinate and even difficulty walking. In addition to targeted treatments (targeted radiotherapy or targeted drugs such as Trastuzumab or Pertuzumab) which are capable of blocking the specific mechanisms of cancer cells, it is possible to use bisphosphonate drugs, treatments usually prescribed for osteoporosis. These medications help slow bone breakdown, and thus prevent pain and fractures related to weakening of the bone.

5. Hard lumps under the skin

“Skin manifestations are easier to diagnose, as they are visible to the naked eye. Redness in the joints (erythema) or hard lumps under the skin should lead to consultation. Breast cancer can spread to the skin and be associated with other metastases (bone, for example)“, says our interlocutor.

6. Abnormal shortness of breath

A persistent cough, abnormal shortness of breath (excluding effort), frequent bronchopulmonary infections Or blood in the sputum may be signs of lung metastases. It is therefore essential to consult a doctor in order to carry out all the necessary examinations (clinical examination, blood tests, imaging tests, bronchoscopy, etc.) and to draw up a treatment plan if necessary.

Finally, a sudden loss of appetite associated with fatigue, weight loss and nausea, yellowish skin and eyes (jaundice), dark urine or swelling of the abdomen may be characteristic of liver metastases. It is better to talk to your doctor in case of symptoms.

In the vast majority of cases (80 to 90% of breast cancers according to the National Cancer Institute), the tumor is treated in time and the cancerous cells do not develop in any organ other than the breast. However, cancer cells from the breast may travel through the lymph and blood and invade other organs. Generally, these metastases appear within 5 years following the diagnosis of breast cancer. If this period is exceeded, it is very rare for metastases to appear.

Between two medical checks, it is advisable to perform a self-examination of the breasts (ideally just after menstruation). It does not replace the palpation carried out by a health professional, but it allows identify any signs of recurrence. Stand in front of the mirror and look at both of your breasts. Several aspects should attract your attention:

• a change in the shape of the treated breast and the scar,
• the presence of hard nodes or a lump in the breast,
• retraction of the breast or nipple,
• a discharge of liquid from the nipple,
• grainy, swollen, retracted, or peeling breast skin, or visible veins.

If you notice one or more of these symptoms, contact your doctor without waiting for the next check-up.

Thanks to Dr. Mahasti Saghatchian, oncologist and practitioner specializing in breast cancer at the Gustave Roussy Institute