Treatment for Symptoms of Breast Cancer Metastasis

Metastatic breast cancer (MBC) is breast cancer that has spread to other parts of the body. The most common sites where breast cancer metastasizes to are the bones, brain, liver, and lungs. Because breast cancer is in multiple places in the body, systemic treatments are often recommended for women with MBC, as systemic treatments go throughout the body to treat cancer cells wherever they may be. Systemic treatments used to treat MBC include hormone therapy, chemotherapy, targeted therapy and immunotherapy.1

In addition to systemic treatments, other treatments may be used to treat the symptoms of MBC. The treatments recommended will be based on several factors, including the individual’s area(s) of metastases, their symptoms, and their general health. Treatment that focuses on relieving the symptoms is palliative care, also sometimes referred to as supportive care or symptom management. While palliative care does not focus on curing the disease or prolonging life, it can help improve a person’s quality of life and can be used in combination with other breast cancer treatments.1,2

Treatment for symptoms from bone metastases

Bones are the most common site that breast cancer metastasizes to, with an estimated 70-80% of patients with metastatic breast cancer having bone metastases. When breast cancer spreads to the bone, it can cause bone pain, hypercalcemia (too much calcium in the blood), and bone fractures. Depending on where it spreads, metastatic breast cancer may also result in spinal cord compression.3 Some treatments used for bone metastases relieve symptoms by shrinking or slowing the growth of the tumors. Systemic treatments (like chemotherapy, hormone therapy, targeted therapy, and immunotherapy) can potentially help slow tumor growth or shrink the tumors. Additional treatments used to reduce or relieve symptoms from bone metastases include4:

  • Bisphosphonates – Osteoclasts are a type of bone cell that normally absorb bone tissue during growth and healing. Osteoclasts can become overactive when breast cancer spreads to the bones, causing bones to become more easily fractured. Bisphosphonates are a type of medication that slow down osteoclasts and can help ease the symptoms of bone metastases. Bisphosphonates used for bone metastases include pamidronate and zoledronic acid. Common side effects with bisphosphonates include fatigue, fever, nausea, vomiting, anemia, and bone or joint pain.4
  • RANKL inhibitor – Receptor activator of nuclear factor kappa-B ligand (RANKL) is a protein that can trigger osteoclasts to absorb bone. RANKL inhibitors, such as denosumab block this protein and can decrease the bone loss that can occur with bone metastases. Common side effects with RANKL inhibitors include nausea, diarrhea, fatigue, and muscle weakness.4,5
  • Radiation therapy – Radiation therapy uses high doses of radiation to kill cancer cells in a specific area. Radiation therapy can be directed to help relieve pain from bone metastases. Common side effects with radiation therapy include fatigue and redness, blistering or peeling of the skin where the radiation is directed.4,6
  • Radiopharmaceuticals – Radiopharmaceuticals are medications that have radioactive components. The radioactive materials are drawn to places in the body that have cells with high turnover, such as areas of bone metastases, where they give off radiation that kills breast cancer cells. Radiopharmaceuticals are administered by intravenous (IV) injection, and the patient may be in the hospital for a couple days during treatment. Because these medications go throughout the body and radiation may be secreted through sweat, saliva, blood, and/or urine, safety measures are needed to protect others for the first few days after receiving the injection.4,7
  • Ablation – Ablation is the use of a needle or probe to deliver heat, cold, electricity, or a chemical to destroy cancer cells. Examples of ablation include radiofrequency ablation, which uses an electric current, and cryoablation, which freezes the cells.4
  • Bone cement – Bone cement may be used to strengthen or stabilize a bone that is weakened from bone metastases. Strengthening the bones can often also reduce the pain caused by bone metastases.4
  • Surgery – In certain cases, surgery may be used to stabilize bones and prevent fractures, or in some cases, stabilize a bone that has fractured. Surgery to a bone with metastases may use screws, rods, plates, or other devices.4

Treatment for symptoms from brain metastases

When breast cancer spreads to the brain, it can cause swelling (edema) which can lead to symptoms such as headaches, nausea, seizures, and/or neurologic complications. Treatment for brain metastases may include pain relief, anti-nausea medications, or anticonvulsants for those who experience seizures. Other therapies that may be used include radiation therapy or surgery to remove a tumor in the brain.3

Treatment for symptoms from liver metastases

Metastasis to the liver can cause pain, jaundice (yellowing of the skin or whites of the eyes), nausea, and/or itching. Anti-nausea medications or antihistamines may be used to relieve nausea or itching, respectively. Other treatments that may help ease symptoms from liver metastases include surgery or embolization, which cuts off the blood supply to a tumor.3

Treatment for symptoms from lung metastases

When breast cancer spreads to the lungs, symptoms include shortness of breath, difficulty breathing, chest pain, cough, fluid build-up around the lungs (pleural effusion), or airway blockages. Treatment for symptoms from lung metastases may include medications (such as pain relievers, steroids, or anti-anxiety medications), oxygen, removal of fluid build-up, surgery, and radiation therapy.3

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Written by: Emily Downward | Last reviewed: October 2020.