If you’ve been diagnosed with metastatic (stage 4) breast cancer, you may be wondering where the cancer can spread. You may also have concerns about recurrence if you’ve been treated for early-stage breast cancer. The lungs are one of the common sites where breast cancer can metastasize (spread).

“I finally had a PET scan, and the tumors lit up like a Christmas tree,” wrote one MyBCTeam member. “It’s spread to both lungs and the lining of the lungs.”

🗳️ If you’ve experienced lung metastasis with breast cancer, which symptom has affected you most?

Coughing

Chest pain

Shortness of breath

Wheezing

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Potential Symptoms of Lung Metastasis in Breast Cancer

Breast cancer lung metastasis may not cause symptoms. If you do notice symptoms that may be associated with lung metastasis of breast cancer, don’t panic, but report them to your breast cancer care team right away. Your doctor can rule out or diagnose lung metastasis and ensure you receive proper treatment.

Here are four potential symptoms of lung metastasis:

Coughing is common with lung metastases and can occur with or without blood. Coughing without blood is also common with many other conditions, such as the flu or other upper respiratory infections.

If you have severe or prolonged coughing or are coughing up blood, get medical care right away because it could indicate a serious health condition.

Sometimes, lung metastasis causes chest pain. As with coughing, chest pain can also be caused by other health conditions ranging from relatively mild, such as asthma, to life-threatening, such as a heart attack.

Tell your doctor if you develop new or persistent chest pain. Seek emergency medical care for sudden or severe chest pain, especially if it occurs with shortness of breath.

If you’ve had radiation therapy as part of your breast cancer treatment, you may later develop lung problems such as pneumonitis (lung inflammation) or pulmonary fibrosis (lung scarring).

Feeling short of breath with or without coughing may indicate that your breast cancer has spread to your lungs. Cancer cells can spread to a part of your lungs called the pleura.

The pleura is a double-layered membrane that surrounds the lungs and helps your lungs expand and contract when you breathe. The space between the two layers (the pleural cavity) is filled with a small amount of fluid.

Cancer cell growth within the pleural cavity can cause an excess buildup of fluid called pleural effusion. This keeps your lungs from fully expanding and can make it harder to breathe.

Cancer in general is the third most common cause of pleural effusion. Pleural effusion caused by cancer is called malignant pleural effusion.

Other causes could be heart failure or pneumonia. Call your doctor so they can rule out any other potential causes of fluid buildup or difficulty breathing.

Breathlessness can also be completely unrelated to cancer. It can be caused by other conditions like:

• Pneumonia
• Chronic obstructive pulmonary disease (COPD)
• Congestive heart failure
• Gastroesophageal reflux disease (GERD)

If you’re experiencing shortness of breath, make sure to tell your doctor so they can rule out any other potential causes.

Breast cancer metastasis to the lung may cause wheezing. However, wheezing can also be a common symptom of asthma, COPD, postnasal drip caused by allergies, or respiratory infections.

Still, it’s best to report wheezing to your oncologist if you notice it.

Treating Breast Cancer That’s Spread to the Lungs

When breast cancer spreads to the lungs or other parts of the body, treatment focuses on controlling the cancer and managing symptoms. The treatment options your doctor may recommend will depend on the type of breast cancer you have.

The growth rate and outlook for metastatic breast cancer vary based on several factors, including the cancer subtype, where it’s spread, previous treatments, and a person’s overall health.

Treating breast cancer that has spread to the lungs will vary for each person. Treatment goals include controlling the cancer while considering potential side effects and quality of life.

Generally, your doctor will recommend systemic therapy, which uses medications to treat cancer throughout the body.

Your doctor may recommend radiation therapy or surgery to treat lung metastases in selected cases.

Chemotherapy Treatments

Chemotherapy is one treatment option for TNBC with lung metastases. It kills rapidly dividing cells (healthy or not), such as cancer cells. People with other types of breast cancer can also be treated with chemotherapy or therapies designed to attack specific targets on cancer cells.

Your doctor may recommend an antibody-drug conjugate for metastatic TNBC. Antibody-drug conjugates combine a targeted antibody with a cancer-killing drug. They bind to a specific protein on cancer cells and deliver the drug to those cells. Whether this treatment is an option depends on your type of breast cancer and the treatments you’ve already had.

Hormone Therapies and Targeted Treatments

If you have hormone receptor-positive (HR-positive) breast cancer, the cancer cells have estrogen receptors (ERs), progesterone receptors (PRs), or both. Your doctor may recommend hormone therapy.

If your breast cancer cells are positive for human epidermal growth factor receptor 2 (HER2), your doctor may recommend HER2-targeted therapies. These drugs target the HER2 protein on cancer cells. If your breast cancer is HER2-negative, other targeted therapies may be options depending on the cancer subtype and other test results.

Immunotherapy

Immunotherapies are a newer type of cancer treatment that helps the immune system better fight cancer cells.

If you have TNBC, your doctor may prescribe chemotherapy with an immunotherapy drug called pembrolizumab (Keytruda). Pembrolizumab helps activate the immune response against breast cancer cells. However, it’s not used in every case of metastatic TNBC.

Your healthcare team may recommend pembrolizumab with chemotherapy based on the results of a PD-L1 test. This test measures PD-L1 expression and helps determine whether pembrolizumab may be an appropriate treatment.

More effective treatments for metastatic breast cancer are under development. There are also many clinical trials that are studying better treatment options for people with metastatic breast cancer.

Treating Symptoms of Lung Metastasis

Metastatic breast cancer usually can’t be cured, but treatment can help control the cancer, prolong life, relieve symptoms, and improve quality of life. Palliative care focuses on relieving symptoms and improving quality of life and can be given alongside cancer treatment.

Shortness of breath can be one of the most challenging symptoms of lung metastasis. Depending on the cause, your doctor may recommend treatments to ease shortness of breath.

Opioid medications can sometimes help relieve breathlessness, and anti-anxiety medications may help when anxiety or panic makes breathing difficulties worse.

If you develop a pleural effusion, your doctor can remove the extra fluid with a needle in a process known as thoracentesis. They may place a drainage catheter if the pleural effusion persists. Your doctor may prescribe antibiotics if the fluid becomes infected.

Your oncology team can recommend a combination of cancer treatments and supportive care to help manage metastatic breast cancer symptoms and improve your quality of life.