Where breast cancer spreads

When breast cancer metastasizes, the cancer cells have traveled through the bloodstream and lymphatic system to nearby lymph nodes and settled to form new tumors in distant areas of your 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 system.

In some cases, breast cancer cells can also get into the bloodstream. In the case of metastasis, the few cancer cells that survive could grow in other parts of the body (brain, liver, lungs, or bones).

Many factors influence if, 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 whether the cancer has biomarkers such as hormone receptors or HER2 that help the cancer grow
• 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.

Here are some common symptoms and tests that can help confirm a diagnosis of metastatic breast cancer:

• Bone metastases can cause bone pain or cause bones to break more easily. Sometimes, they cause the hands, feet, arms, or legs to tingle or go numb. Bone imaging and blood tests may be needed to evaluate these symptoms. If these tests look abnormal, a biopsy may be recommended to look for cancer cells and make the best treatment plan.
• Liver metastases don’t always cause symptoms. Sometimes, they cause stomach or abdominal 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, gastrointestinal tract (colon), heart, pancreas, peritoneal cavity (abdomen), and the pleura (lining) of the lung, skin, or spine.

Another type of metastatic breast cancer is inflammatory breast cancer (IBC). Here are some things to know about symptoms and diagnosis:

• Inflammatory breast cancer has many of the same symptoms as other metastasis to the skin, and can cause redness, swelling, warmth, or pain. Inflammatory breast cancer can be hard to diagnose because these symptoms could be mistaken for an infection.
• One inflammatory breast cancer symptom that stands out is pitting or thickened skin covering the breast. If this happens, the skin looks like an orange peel. However, not all inflammatory breast cancer has an orange-peel appearance.
• Many cases of inflammatory breast cancer 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 were treated for early-stage breast cancer in the past and now have metastatic breast cancer, it’s important to talk with your doctor about having a new biopsy of the cancer to look for any changes in hormone receptor and HER2 status. These and other biomarkers can sometimes change over time. Confirming the cancer’s biomarkers with a biopsy and other tests, such as ctDNA tests, ensures that you and your care team can choose the best treatments for your individual situation.

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 in the past, your doctor may call metastasis 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, chemotherapy, and immunotherapy 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 early-stage breast cancer treatment and hide, in another organ, remaining inactive (dormant) until they begin to grow later.

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.

If you are concerned about recurrence after early-stage breast cancer

If you’ve been treated for early-stage breast cancer and you are concerned about recurrence, you’re not alone. The cancer’s specific stage, grade, lymph node involvement, and other factors help determine the risk of recurrence.

If early-stage breast cancer was hormone receptor-positive:

• Your doctor likely ordered genomic testing on the tumor to help determine your risk of recurrence. Genomic tests such as Oncotype DX Breast Recurrence Score, MammaPrint, EndoPredict, and Prosigna can assess risk of recurrence and whether certain treatments may be helpful in reducing risk.
• The Breast Cancer Index test looks at risk of recurrence after 5 years of hormonal therapy treatment to help you and your doctor decide whether 5 more years of hormonal therapy would be helpful for you.

Talk with your doctor about your individual risk of recurrence and what this means for your treatment options and follow-up care plan.

Treatability after metastasis

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.