Metastatic Breast Cancer

Managing the Symptoms of Metastatic Breast Cancer

Managing the symptoms related to metastases is an important component of care for women with metastatic breast cancer. Your doctor will consider all sites of metastasis before planning a treatment approach.

In general, pain—the leading fear for all people with cancer—is the major symptom associated with most metastases, regardless of location. No one with cancer should expect to endure pain. Several treatments can provide relief, and you should talk to your doctor to ensure that your pain is managed adequately, allowing you to enjoy everyday activities.

The symptoms associated with metastatic breast cancer differ according to the location of the metastatic lesion (Table 1). Bone metastasis and brain metastasis are the two most commonly treated types of lesions. Liver and lung metastases present more of a challenge and symptoms related to metastases in these sites are often alleviated when systemic therapy is effective; that is, when treatment slows or stops the progression of disease. The use of additional local treatments, such as radiation therapy or surgery, depends on many factors, such as the number and location of metastases, the overall control of disease, and the general health of the individual. Most experts agree that surgical removal of a liver or lung metastasis is not beneficial.

Table 1. Symptoms According to Location of Metastasis

Bone Metastasis

Metastasis to the bone most often affects the spine, ribs, pelvis, skull, and the long bones of the arms and legs. Pain is the primary symptom related to bone metastasis, and bones may also fracture easily.

All women with bone metastasis should be treated with a bisphosphonate, a drug that prevents the loss of bone mass (typically used to treat osteoporosis). This treatment will help to prevent bone fractures and can reduce the need for surgery or radiation therapy to alleviate bone pain. These drugs are given with calcium and vitamin D supplements.

Radiation therapy can also help to prevent or treat fractures, especially if the involved bone is a weight-bearing one. Radiation beams are targeted to the area of the metastasis and relief of symptoms is usually immediate and complete.

Brain Metastasis

Systemic chemotherapy is not usually effective for brain metastasis because of the blood-brain barrier (a membrane that protects the brain by preventing substances in blood, such as drugs, from entering the brain). Therefore, local therapies are often used, and the choice of treatment depends on the number and location of the brain lesions (Table 2).

The initial treatment to relieve symptoms related to brain metastasis is usually a corticosteroid, and treatment may be continued for several weeks. However, the longer the treatment lasts, the greater the chance for side effects. An anticonvulsant drug is used for women who have seizures.

Whole brain radiation therapy is the most commonly used treatment for brain metastasis, and about eight out of 10 women will have some improvement or stabilization of symptoms, especially headaches and seizures. Studies have also shown that whole brain radiation therapy extends life and improves the quality of life for women with symptoms. There are several potential side effects, including memory loss, extreme fatigue, temporary baldness, skin rash, and hearing loss. 

Another option is stereotactic radiosurgery, also known as Gammaknife or Cyberknife. Because the radiation is delivered precisely to the lesion, the likelihood of side effects is lower than that for whole brain radiation therapy.

Traditional surgery is done in a limited number of cases. Whole brain radiation therapy is usually given after surgery to prevent recurrence.

It is important to tell your doctor or nurse when symptoms persist despite treatment or if any new symptoms occur. Your health care team will work with you to optimally manage your symptoms, to provide you with greater control over your daily activities and improve your general well-being.

Table 2. Treatment Options for Brain Metastasis

Additional Sources of Information

• American Academy of Pain Management
  • Patient Information
• American Society of Clinical Oncology (patient website)
  • Pain - ASCO Curriculum
• Brainmetsbc.org
  • Current Treatments for Brain Metastases
• Breastcancer.org
  • Day-to-Day Matters: Pain
• National Cancer Institute
  • Pain Control: Support for People with Cancer
• Susan G. Komen for the Cure
  • Management of Pain Related to Metastatic Breast Cancer