Treatment options for metastasis are determined based on individual case and often focus on relieving symptoms.
Depending on the type and extent of the metastases, systemic therapies—such as chemotherapy and hormonal therapy—can be effective in controlling breast cancer metastases. Regardless of where the cancer is now, it is still breast cancer that has spread to other parts of the body.

Breast cancer metastasis can occur in nearly any part of the body, although the most common sites are bone, lung and liver—in that order.

Lung Metastases
The lungs are a primary site for breast cancer spread, second to the bones. Studies show that first metastases go to the lungs (1, 2) in approximately 19 percent of cases.
Symptoms of lung metastases vary. Some patients are diagnosed on a routine checkup, but most do have symptoms. These may include a persistent dry cough not associated with other health issues, unexplained shortness of breath, or a dull pain in the back or side.
Metastases are usually detected through chest X-ray, CT scan or MRI. Surgery is performed when the tumor can be removed. Most patients are treated with chemotherapy, and radiation may be used in some cases.
1. The GIVIO Investigators. (1994). Impact of follow-up testing on survival and health-related quality of life in breast cancer patients. Journal of the American Medical Association, 271(20), 1587-1792.
2. Rosselli Del Turco, M., et al. Intensive diagnostic follow-up after treatment of primary breast cancer. Journal of the American Medical Association, 271(20), 1593-1597.

Cancer in Bones
While bone metastases can be difficult to live with, there are many treatment options available for alleviating pain and treating the cancer itself.
These treatments include:
• Bisphosphonates: When breast cancer has spread to the bone, bisphosphonates are given intravenously to slow abnormal bone destruction and formation, to ease bone metastisis pain, to reduce the risk of fractures and to prevent new lesions. Bisphosphonates are not chemotherapy but must be administered intravenously so they are properly absorbed. Oral bisphosphonates may cause gastrointestinal side effects and are not effective for patients with bone metastases. IV bisphosphonates and conventional treatments (chemotherapy and radiation) complement each other and are often used in combination. Aredia® (pamidronate) is administered over two to four hours to reduce the risk of fractures and other bone complications. There are two kinds of bone mets, osteolytic and osteoblastic – most women with bone mets have osteolytic lesions and this is what Aredia targets. Zometa® (zoledronic acid) is the most widely used bisphosphonate to treat bone metastases. It is administered over 15 minutes to slow abnormal bone destruction and formation, to ease bone metastisis pain and to reduce the risk of fractures. It has been proven effective for women who have osteolytic or osteoblastic bone metastases. It is also used to lower the amount of calcium in patients with hypercalcemia (too much calcium in the blood) caused by tumors.
• Chemotherapy: Various types of chemotherapy are given to treat bone metastases as well as bone pain. Choices in chemotherapy drugs are usually determined by the drugs the patient has previously been given (the doctor would want to try something new), and the potential for side effects (such as low white blood cell count). In addition, an important factor can also be the administration schedule required–if you have to choose between a treatment that would require a visit to your oncologist once a week versus once every three weeks, you might prefer going to the doctor less often (all other considerations being equal).
• Radiation therapy: Many women receive adjuvant radiation therapy at the site of their bone metastases to relieve pain. The relief generated by radiation tends not to last as long, but can be effective for some people.
• Hormone therapy: This is a treatment option that is offered to women whose cancer is estrogen dependent. While it may not seem the most aggressive approach, hormone therapy is a very effective treatment for bone metastases. Many women who are ER+ and have bone mets are given an aromatase inhibitor, such as anastrozole, letrozole, or exemestane (brand name: Aromasin®). An older alternative is tamoxifen, which is another kind of hormone therapy. Tamoxifen blocks estrogen after it is formed and aromatase inhibitors prevent its production. All these can stabilize and even fight the disease in the bone.
• Metastron®: This treatment is a radiopharmaceutical, which cannot be taken while on chemotherapy. Metastron targets osteoblastic lesions, and can be taken in addition to pamidronate. Metastron is administered by certified nuclear medicine technologists in the nuclear medicine department at your treatment facility. It is injected into a vein in your arm — it is possible for one injection to alleviate bone pain for weeks or months. For the first few days after your injection, you will have to take some precautions due to the level of radioactive drug in your system. After this precautionary time period, you can resume your normal activities without concern.
• Quadramet®: This treatment is also a radiopharmaceutical, which is administered by a certified nuclear medicine technologist. Quadramet alleviates bone pain, and targets osteoblastic lesions. An injection of Quadramet can relieve bone pain for weeks or months; it requires the same treatment administration and precautions as other radiopharmaceutical drugs for bone metastases.

Chest Wall/Scarline Recurrence
Chest wall, scar-line or local cancer recurrence after a lumpectomy is treated in several ways. Generally speaking, the typical treatment plan for a recurrence of breast cancer involves a mastectomy or a local resection, possible radiation and chemotherapy. A recurrence to the scar-line or chest wall after a mastectomy is usually treated with radiation (providing none was given previously) and/or systemic therapies.

Liver Metastases
The liver is one site where breast cancer tends to spread, but is less common than the bones or lungs. Studies show that first metastases go to the liver (1, 2) in approximately 10 percent of cases.
Symptoms of liver metastases may include swelling in the upper right abdomen due to an enlarged liver; ache on the right side below the rib cage; occasional sharp pain in the right side; and jaundiced skin and eyes. As always, talk with your doctor if you notice anything that is unusual for you.

Liver metastases are often difficult to detect. Detection methods include scintigraphy (an imaging process using radioactive isotopes tagged to drugs that go to the liver when used intravenously), ultrasound and CT scan. Patients are treated with endocrine (hormone) therapy and chemotherapy; some with limited metastases may be treated with surgery or a process known as radiofrequency energy ablation that uses heat to kill tumor cells.

1. The GIVIO Investigators. (1994). Impact of follow-up testing on survival and health-related quality of life in breast cancer patients. Journal of the American Medical Association, 271(20), 1587-1792.
2. Rosselli Del Turco, M., et al. Intensive diagnostic follow-up after treatment of primary breast cancer. Journal of the American Medical Association, 271(20), 1593-1597.

Brain Metastases
Studies show that 10 to 20 percent of breast cancer that metastasizes goes to the brain (1-3).
Symptoms of brain metastases are headaches, seizures or problems with vision, speech, moving, memory, talking, etc., but some people show no symptoms. Metastases are diagnosed with MRI, CT scan, PET scan or biopsy.
Surgery is often the preferred treatment. Radiation therapy—painless X-rays that damage or destroy tumor cells—can be used locally after surgery to prevent recurrence. When surgery is not an option, radiation can be used locally to relieve symptoms. It can also treat the whole brain.
Stereotactic radiosurgery is another option. Despite the name, it is not surgery, but rather very focused radiation therapy. It is also known by the names of Gamma Knife, XKnife, and Cyberknife. This one-time treatment is delivered to a small area by several beams that are computer guided.
Chemotherapy is another option, but can be a problem due to what is called the blood-brain barrier. Cancer cells can get through this barrier, but chemotherapy is often prevented from reaching the area to be treated. New chemotherapies are being developed to address this problem.
Other treatments include giving steroids to reduce swelling and improve mental functioning, and offering anti-seizure medications. Complementary therapies can also help. Among many others, these therapies include stress management, relaxation training, group support and acupuncture.

1. Lee, Y. T. (1983). Breast carcinoma: Pattern of metastasis at autopsy. Journal of Surgical Oncology, 23, 175–180.
2. DiStefano, A., Yong Yap, Y., Hortobagyi, G. N. et al. (2979). The natural history of breast cancer patients with brain metastases. Cancer, 44, 1913–1918.
3. Posner, J. B. (1987). Back pain and epidural spinal cord compression. Medical Clinics of North America, 71, 185–205.