Understanding Stage 4 Breast Cancer: A Guide to Its Symptoms

Receiving a breast cancer diagnosis is difficult, and hearing the words “stage 4” or “metastatic” can be overwhelming.

This advanced stage of the disease means the cancer has spread beyond the breast and nearby lymph nodes to other parts of the body. 

Naturally, you will have many questions about what this means for you or your loved one.

This guide is here to provide clear, reliable information. We understand that you are looking for answers during a time of uncertainty. 

We will walk through the symptoms of stage 4 breast cancer, explaining what they are, why they happen, and how they relate to the parts of the body the cancer has spread to.

In this article, we will cover the general symptoms of metastatic breast cancer and then look at specific signs related to where it commonly spreads, such as the bones, brain, lungs, and liver. 

We will also answer frequently asked questions to give you a comprehensive understanding of this complex condition.

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Stage 4 breast cancer, also known as metastatic breast cancer, is the most advanced stage of the disease. “Metastatic” means the cancer cells have travelled from the original tumour in the breast through the bloodstream or lymphatic system to form new tumours in distant organs.

It is important to understand that stage 4 breast cancer is not a separate type of cancer. It is still breast cancer, but it is now located in another part of the body.

 For example, if breast cancer spreads to the bones, it is not bone cancer; it is metastatic breast cancer in the bones. Treatment is focused on managing the cancer, controlling symptoms, and improving quality of life.

General Symptoms of Advanced Cancer

While many symptoms are specific to where the cancer has spread, some general signs can affect the whole body. These symptoms often result from the cancer cells consuming the body’s energy and resources, or from the body’s response to the cancer.

Common systemic symptoms include:

• Persistent fatigue: This is an extreme tiredness that does not improve with rest. It is one of the most common symptoms reported by people with advanced cancer.
• Unexplained weight loss: Losing a significant amount of weight without trying can be a sign that the cancer is affecting your metabolism.
• Loss of appetite: You may feel full quickly or have no desire to eat.
• Nausea or vomiting: This can be a side effect of the cancer itself or its treatment.
• General feeling of being unwell: Often described as malaise, this is a vague sense of discomfort or illness.

The symptoms of stage 4 breast cancer largely depend on which organs are affected. The most common sites for breast cancer to metastasise are the bones, lungs, liver, and brain.

When Breast Cancer Spreads to the Bones (Bone Metastases)

The bones are the most common site of metastasis for breast cancer. When cancer cells settle in the bones, they can disrupt the normal process of bone renewal, leading to specific symptoms.

⇒What are the symptoms of bone metastases?

• Bone Pain: The most common symptom is a new, persistent pain in a bone, often described as a dull ache. It may be worse at night and might not go away with standard pain relievers.
• Increased Risk of Fractures: The cancer can weaken the bones, making them more likely to break (fracture) from a minor injury or sometimes for no clear reason. These are known as pathological fractures.
• Spinal Cord Compression: If the cancer spreads to the spine, it can put pressure on the spinal cord. This is a medical emergency and can cause back pain, numbness in the legs or abdomen, and difficulty controlling your bladder or bowels.
• High Blood Calcium (Hypercalcaemia): As cancer damages bones, calcium can be released into the bloodstream. High levels of calcium can cause constipation, nausea, extreme thirst, confusion, and fatigue.

When Breast Cancer Spreads to the Lungs (Pulmonary Metastases)

The lungs are another common site for breast cancer to spread. The symptoms can sometimes be mistaken for other conditions like a common cold or asthma.

⇒What are the symptoms of lung metastases?

• Persistent Cough: A dry cough that does not go away is a frequent sign.
• Shortness of Breath (Dyspnoea): You might feel breathless during daily activities or even while resting.
• Chest Pain: This can feel like a sharp pain or a constant ache in the chest, shoulder, or back.
• Wheezing: A whistling sound when you breathe.
• Coughing up Blood (Haemoptysis): Even a small amount of blood should be reported to your doctor immediately.
• Pleural Effusion: This is a build-up of fluid in the space between the lung and the chest wall, which can increase shortness of breath and cause discomfort.

When Breast Cancer Spreads to the Liver (Hepatic Metastases)

When breast cancer spreads to the liver, it can interfere with the liver’s ability to perform its essential functions, such as filtering toxins from the blood and producing bile.

⇒What are the symptoms of liver metastases?

• Pain or Discomfort in the Abdomen: This is often felt in the upper right side of the abdomen, just below the ribs.
• Jaundice: A yellowing of the skin and the whites of the eyes. This happens when the liver cannot process bilirubin, a yellow substance in the blood. Jaundice can also cause dark urine and pale stools.
• Itchy Skin (Pruritus): This is caused by a build-up of bile salts in the skin.
• Bloating and Swelling: Fluid build-up in the abdomen (ascites) can cause swelling and a feeling of fullness.
• Loss of Appetite and Nausea: These symptoms are common as the liver struggles to function.

When Breast Cancer Spreads to the Brain (Brain Metastases)

Brain metastases occur when breast cancer cells travel to the brain. The symptoms are caused by the tumour putting pressure on the brain or interfering with its functions.

⇒What are the symptoms of brain metastases?

• Persistent Headaches: These headaches are often worse in the morning and may not improve with typical pain relief. They can be accompanied by nausea or vomiting.
• Seizures: This is one of the more dramatic and serious symptoms.
• Neurological Changes: These can vary widely depending on the location of the tumour in the brain.
• Weakness or numbness: Often on one side of the body.
• Balance problems: Difficulty walking or feeling unsteady.
• Vision changes: Blurred vision, double vision, or loss of vision.
• Speech difficulties: Slurring words or having trouble finding the right words.
• Cognitive or Personality Changes: This can include memory problems, confusion, or changes in mood and behaviour.

Q1: Can you feel a lump if breast cancer has spread?
A: Sometimes. If cancer spreads to lymph nodes in the armpit, neck, or above the collarbone, you might feel a lump or swelling in those areas. However, tumours in internal organs like the liver or lungs cannot be felt from the outside.

Q2: How quickly do symptoms of stage 4 breast cancer appear?
A: The speed at which symptoms appear varies greatly from person to person. Some people may develop symptoms quickly, while others may live for months or even years without noticeable signs of metastasis. Symptoms often develop gradually as the tumours grow.

Q3: Can you have stage 4 breast cancer with no symptoms?
A: Yes, it is possible to have metastatic breast cancer without any symptoms, especially in the early stages of metastasis. It is sometimes discovered during routine follow-up scans after an initial breast cancer diagnosis.

Q4: Is stage 4 breast cancer always terminal?
A: While stage 4 breast cancer is considered incurable, it is treatable. Many people live for years with metastatic breast cancer, managing it as a chronic disease with ongoing treatment. Advances in therapy continue to improve survival rates and quality of life.

Q5: What are the first signs of breast cancer spreading?
A: The very first signs depend entirely on where the cancer has spread. A new, persistent pain in a bone (like the back or hips), a dry cough that won’t go away, or a constant headache are all possible first signs. Any new and persistent symptom should be discussed with your healthcare team.