Breast Cancer Awareness Month: What Are The Metastatic Breast Cancer Complications

Metastatic breast cancer (advanced breast cancer or Stage IV breast cancer) is that which has spread from the breast to other areas of the body. It is the most prevalent form of malignant cancer among women globally. From being fourth most common cancer in India during the 1990s, it is now the first.

Increase in breast cancer cases

In 2018, 162,468 new cases of breast cancer were diagnosed, representing 27.7% of all new cancers among Indian women and 11.1% of all cancer deaths. Notably, the epidemiological characteristics of breast cancer among Indian women differ markedly when compared to the Western population. In the United States, a striking 60% to 70% of breast cancer cases are detected at stage 1, whereas merely 1% to 8% of Indian women present with breast cancer at this early stage.

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In the United States, roughly 10% of women are diagnosed with stage IV breast cancer, while in India, this percentage ranges from approximately 6% to 24%, with roughly 29% to 52% of Indian women being diagnosed at stage III. Furthermore, although the incidence of breast cancer is on the rise worldwide, mortality associated with this condition is decreasing in the Western world but is on an upward trajectory in India.

Complications which arise from metastatic breast cancer depend on its spread in the body.

- Extreme fatigue

- Organ Dysfunction: Cancer which has spread to vital organs, such as the lungs, liver, bones, or brain, can lead to impaired organ function and associated symptoms. For example, lung metastasis can cause breathing difficulties, liver metastasis can lead to jaundice, and bone metastasis can result in pain and fractures.

- Pain: Bone metastasis can be particularly painful, causing discomfort, reduced mobility, and an increased risk of fractures.

- Neurological Symptoms: If metastatic breast cancer reaches the brain, it can lead to symptoms like headaches, seizures, confusion, and other neurological issues.

- Compression of Structures: Tumours can press on or compress nearby structures, leading to complications such as compression of the spinal cord, which can cause pain, weakness, or loss of function in the affected area.

- Lymphedema: In some cases, metastatic breast cancer can affect the lymphatic system, causing lymphedema, which results in swelling, pain, and decreased range of motion in the affected limb.

- Compromised Immune System: The presence of cancer can weaken the immune system, making the body more susceptible to infections and other illnesses.

- Cancer-Related Fatigue: Metastatic breast cancer and its treatments can lead to severe fatigue, which can significantly impact a person's daily life.

- Emotional and Psychological Impact: The emotional and psychological toll of living with advanced cancer can be substantial, leading to anxiety, depression, and decreased quality of life.

- Medication Side Effects: The treatments used for metastatic breast cancer can have their own side effects, including nausea, hair loss, anaemia, and immune system suppression.

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What is metastatic breast cancer

Metastatic breast cancer is categorized as a ¡®recurrent¡¯ cancer, meaning it is cancer that reappears after initial treatment and spreads to tissues and organs located at a considerable distance from the original site of the breast cancer. Typically, breast cancer recurs when the initial treatment fails to completely eliminate all cancer cells. Treatments may reduce tumour size to the extent that they become undetectable in tests. However, even surgical removal of a cancerous tumour is not always 100% effective, as cancer cells can infiltrate nearby tissues, lymph nodes, or the bloodstream before the surgery takes place. These cancer cells persist in the body following treatment.

Gradually, they regain their strength and begin to grow and replicate. They subsequently traverse the bloodstream and utilize the lymph nodes and blood vessels as conduits to reach different parts of the body. Since the lymph nodes and blood vessels transport fluids throughout the body, breast cancer cells easily locate new sites to settle and establish new tumours. At times, these malignant cells remain in a state of dormancy, neither growing nor spreading, for months or even years after the completion of treatment. This is why metastatic breast cancer can become apparent long after the conclusion of treatment.

Metastatic breast cancer care

It's essential for individuals with metastatic breast cancer to work closely with their healthcare team to manage these complications and maintain the best possible quality of life. Palliative care and support from a multidisciplinary team can help address the physical, emotional, and practical challenges associated with advanced breast cancer.

About the Author: Dr. Kunjahari Medhi is the Senior Director Medical Oncology and Hemato-Oncology, Cancer Institute, Medanta, Gurugram. All views/opinions expressed in the article are of the author.