Cancer Breast Cancer Metastatic Breast Cancer Complications of Advanced (Metastatic) Breast Cancer Potential Problems Resulting From Stage 4 Breast Cancer By Lynne Eldridge, MD facebook Lynne Eldrige, MD, is a lung cancer physician, patient advocate, and award-winning author of "Avoiding Cancer One Day at a Time." Learn about our editorial process Lynne Eldridge, MD Medically reviewed by Medically reviewed by Doru Paul, MD on July 13, 2019 Doru Paul, MD, is board-certified in internal medicine, medical oncology, and hematology. Learn about our Medical Review Board Doru Paul, MD Updated on October 20, 2019 Print Table of Contents View All Table of Contents General Complications Bone Lung Liver Brain Other Treatment-Related Psychological Advanced (stage 4) breast cancer involves metastases, or the spread of the cancer to other parts of the body, which can cause several complications. These issues can vary depending on the sites affected and treatment used, but include a range of concerns from blood clots and muscle wasting to shortness of breath and seizures. Fortunately, unlike common side effects, these potential complications are much less common, and you may not experience many or any of these problems. Many of the possible complications of advanced breast cancer are treatable, and treatments are most effective when they are started sooner rather than later. In some cases, recognizing a complication ahead of time can prevent serious problems, including paralysis or even death. Verywell / Brianna Gilmartin General Complications Some general complications associated with metastatic breast cancer are possible no matter where your cancer has spread or the type of treatments you've received or are receiving now. Blood Clots Risk factors for blood clots include having metastatic cancer, undergoing some of the treatments for the disease (such as chemotherapy), and bed rest. Blood clots with cancer are extremely common, cause considerable illness, and can be fatal. These blood clots often begin in the legs or pelvis (deep vein thrombosis) and can break off and travel to the lungs (pulmonary embolism). Symptoms to be aware of include: Redness Swelling Tenderness of your legs Sudden shortness of breath Sudden severe chest pain Lightheadedness Unconsciousness When caught in time, blood thinners can be used to resolve the clots. Pain Pain with metastatic cancer can be variable and often depends on the location of metastases. Pain can interfere with your quality of life, and keeping that high is a primary goal in treating stage 4 cancer. Talk to your doctor about pain control for people with cancer. Many options are available, and most people, even with severe end-stage disease, can be comfortable. Cachexia Cancer cachexia is a challenging issue with advanced cancer. It's a syndrome of involuntary weight loss, muscle wasting, and reduced appetite. It reduces quality of life and is felt to be the direct cause of death for 20 percent of people with cancer. If you're struggling with loss of appetite or have lost weight, bring it up with your doctor. While weight loss is what gets noticed, cachexia appears to begin before weight loss starts. Significant research looking at ways to prevent and treat this problem is ongoing. While it sounds counterintuitive, exercise is helpful. Medical Marijuana and Where It's Legal Complications Related to Bone Metastases The bones are the most common site to which breast cancer spreads. Progress is being made not only in treating these metastases but looking at ways to prevent them in the first place. For those who have breast cancer with bone metastases, the newer bone-modifying drugs, such as bisphosphonates and denosumab, may reduce the risk of complications such as fractures. Multiple complications may result from bone metastases. Pain The pain due to bone metastases can be excruciating, which can vastly decrease quality of life. However, many of the medications for severe pain cause fatigue and drowsiness. Radiation therapy is very effective at reducing pain due to these metastases. Bone-modifying drugs don't reduce pain to the same degree, but they can be helpful in combination with these other treatments. Pathological Fractures A pathological fracture occurs when a bone breaks through a weakened area. Depending on the location, a fracture of this sort can greatly decrease mobility. Spinal Cord Compression Spinal cord compression due to cancer is a medical emergency. When bone metastases occur in the lower spine, they can cause the spine to compress and press on nerves that are important in helping you walk, urinate, and have bowel movements. A very serious form of microfracture in the spine can lead to vertebrae in the back collapsing down on themselves, which is called a compression fracture. When cancer cells in this region result in nerve compression, a medical emergency known as cauda equina syndrome may occur. Without prompt treatment to stabilize the spinal cord, a person may end up paralyzed in the lower extremities in addition to not being able to control her bladder or bowels. Hypercalcemia When tumor breaks down bone, it results in the release of calcium into the bloodstream, a condition called hypercalcemia of malignancy. (There are other mechanisms in cancer that can increase calcium in the blood as well.) Early on, this may cause: Nausea and vomiting Increased thirst Weakness Muscle aches It can progress to serious symptoms, including: Confusion Abnormal heart rhythms Coma Death When Cancer Spreads to Your Bones Complications Related to Lung Metastases The lungs are the second most common site to which breast cancer spreads, with lung metastases occurring at some point in roughly a third of people with metastatic breast cancer. The symptoms can vary from none (when lung metastases are found on a scan alone) to significant shortness of breath. In addition to regular treatments for metastatic lung cancer, local treatments are now being used for some people who only have a few lung metastases, and this appears to improve life expectancy. Lung metastases are related to several possible complications. Shortness of Breath Shortness of breath can often be controlled with medications such as morphine. If it's caused by an obstruction, a stent may be placed. Surprisingly, oxygen doesn't seem to be very helpful in reducing the sensation of shortness of breath. Pneumonia The presence of metastases in the lungs, especially near the airways, can result in the accumulation of fluid and bacteria deep in the lungs. With the narrowing of the airways, people may develop recurrent pneumonia. This can be more serious if your white blood cell count is reduced due to chemotherapy, and it often requires hospitalization and intravenous antibiotics. Coughing Up Blood Coughing up blood may occur, especially when metastases are near the large airways. Even a small amount—like a teaspoon—is considered a medical emergency. Coughing up a third of a cup of blood has a mortality rate of around 30 percent. Don't ever ignore it if you cough up blood, even if it doesn't seem like much. When diagnosed promptly, a procedure can often stop the bleeding, whether mild or severe. Malignant Pleural Effusion A malignant pleural effusion is a condition in which fluid and cancer cells build up between the membranes (the pleura) that line the lung. The severity varies depending on the amount of fluid present, as well as how rapidly it accumulates. A small pleural effusion may not need any treatment. A large pleural effusion, though, can compress the lungs and lead to severe pain and shortness of breath. The first step in treatment is usually a thoracentesis, in which a needle is inserted through the chest wall into the pleural space to drain the fluid. Unfortunately, the fluid often recurs. Options then include: Recurrent draining Inserting a stent so effusions can be drained at home A procedure called pleurodesis, in which a chemical that causes inflammation is inserted into the pleural space, which results in "gluing" of the membranes together so that fluid may not re-accumulate Pulmonary Hemorrhage Pulmonary hemorrhage, or bleeding into the lungs, isn't common but may occur. This is a medical emergency and may be fatal without prompt treatment. Be sure to get immediate medical attention for symptoms that may be related to pulmonary hemorrhage, which include: Difficult or labored breathing Cough Fever Acute respiratory failure Treatment depends on whether the bleeding is localized (coming from one place) or diffuse (coming from numerous places.) Obstruction of the Airways When metastases grow near or into the airways, they may cause an obstruction. This can lead to: Shortness of breath Infections such as pneumonia If an obstruction is severe, doctors can place a stent in the airway to hold it open. Complications Related to Liver Metastases Liver metastases may not cause any symptoms unless the metastases are near the major vessels and ducts of the liver. If you have symptoms, you may notice: Jaundice (yellowing of the skin and whites of the eyes ) Abdominal pain Shoulder pain Hiccups Often, a large part of the liver needs to be replaced by the tumor to cause significant symptoms. When this happens, several complications may arise. Ascites With liver dysfunction, fluid can build up in the peritoneal cavity, causing ascites. If your abdomen becomes very distended, it can be painful and cause shortness of breath (especially if you also have lung metastases). Doctors may do a procedure called a paracentesis in which a needle is inserted through the skin and into the abdominal cavity to drain off the fluid. Confusion With extensive metastases, confusion and lethargy may result due to the build-up of toxins in the body. Get medical attention if this happens. Bleeding The liver is responsible for making clotting factors for the blood. If this organ is largely non-functioning, the result can be an insufficient amount of clotting factors, which can lead to bleeding and anemia. In case of an injury that won't stop bleeding, get medical attention right away. Itching You may not think of itching as a serious complication, but the itching that can accompany liver metastases can be severe. It occurs due to the build-up of bile acids in the blood and skin. Ask your doctor about medications to reduce this symptom. Complications Related to Brain Metastases Brain metastases are also common in breast cancer and may result in any number of symptoms, some which can be life-threatening. You may experience a complication of brain metastases before knowing that cancer has spread to your brain. Seizures You may be familiar with generalized tonic-clonic (formerly called) grand mal seizures, or tonic-clonic, in which a person becomes unconscious and shakes violently. These are possible with brain metastases. Seizures can cause a variety of symptoms based on the type, ranging from muscle stiffness to the appearance of not being aware of surroundings and more. Symptoms and Types of Seizures Falls Brain metastases can lead to: Weakness Numbness Loss of balance Any of those symptoms can contribute to the risk of falls, which can result in serious injury and disability. If brain metastases are present, it's important to be extra careful about fall prevention. Other complications of brain metastases may include: Visual problems, such as double vision or loss of vision Sudden changes in mental status or personality Loss of consciousness The treatment for complications of brain metastases is often radiation. If only one or a few metastases are present, a specialized form of radiation therapy called stereotactic body radiotherapy (SBRT) may be used in an attempt to eradicate the metastasis. Complications Due to Other Metastases Breast cancer can spread to nearly any region of the body. If you have symptoms, even if they're seemingly unrelated to your cancer, make sure to talk to your oncologist. Other common metastases complications include kidney failure, pericardial effusion, and brachial plexus injury. Kidney Failure Kidney failure may occur not only due to metastases to the kidneys (not an uncommon site) but due to medications you are taking, dehydration, and more. Symptoms of kidney failure include: Decreased urine output Fluid retention/puffiness of the legs, ankles, or feet Shortness of breath Fatigue Confusion Nausea Weakness Irregular heartbeat Chest pain or pressure And in severe cases: Seizures Coma Get immediate medical care for symptoms of kidney failure. Understanding Kidney Failure Pericardial Effusion Just as breast cancer can spread to the lining of the lungs, it can spread to the lining of the heart and cause pericardial effusion. When fluid builds up between the membranes lining the heart, your heart has to work harder. The heart rate usually speeds up to make up for the smaller volume it's pumping out. If the fluid builds up fast or is extensive, it can lead to a condition known as pericardial tamponade, basically restricting the heart so much that it is unable to beat. When this condition occurs due to cancer metastases, a third of people die before it can be diagnosed and treated. Fortunately, this complication isn't common. Be certain you talk to your doctor if you note any increased shortness of breath or a rapid heart rate. Pericardial Effusion in People With Cancer Brachial Plexus Injury When cancer spreads into the tissues under the arm, it may damage a group of nerve fibers known as the brachial plexus. This can cause weakness or paralysis in the arm on that side. Brachial plexopathy due to breast cancer affects only 1 in 200 women, but is often a very frustrating complication when it occurs. Complications Due to Treatment Other serious complications that may occur are similar to those that can happen to people with early-stage breast cancer. These can happen during and after treatment. Heart Disease Both chemotherapy and radiation therapy can damage the heart. Heart disease may appear many years after the initial treatment and can range from coronary artery disease to heart failure to valve problems. Most common is heart failure, which often declares itself with symptoms of shortness of breath, swelling of the extremities, and coughing up pink, frothy sputum. Always get medical help if you have symptoms of heart disease. Infections If you are on chemotherapy, your doctor has likely warned you about developing a fever (fever of neutropenia). A fever that wouldn't be alarming in someone else could be life-threatening in you. When your immune system is suppressed, you are not only more susceptible to infections, but your ability to fight off an infection is compromised. Even mild infections may require hospitalization and intravenous antibiotics. If you believe you may have an infection, don't wait. Call your oncologist. Allergic Reactions When you're living with stage 4 breast cancer, you may be using several medications, including cancer treatments and medications to manage your symptoms. Even if you've taken a medication 100 times, the next dose could result in a severe allergic reaction. Ideally, everyone should be aware of the symptoms of anaphylaxis, a severe allergic reaction, as this can be life-threatening. If you notice any swelling of your neck, tongue, or face, the development of hives, or lightheadedness, seek medical attention. Psychological Complications As with some of the "milder" symptoms above, you may not think of depression as a complication of metastatic cancer, but it is a very important. This battle is a tough one that can affect the mental health of any person, whether they come across as a "fighter" or not. While the risk of suicide is lower in breast cancer than with some other cancers, it is something that, unfortunately, still occurs. The goal of treatment is to extend your years while giving you the best quality of life possible. If anything is interfering with your ability to enjoy your family and friends, it should be addressed, either by your oncologist, a palliative care specialist, or a cancer therapist. The Risk of Suicide in People With Cancer A Word From Verywell These are some of the potential complications that may accompany a diagnosis of metastatic breast cancer, but you may face other, less common issues as well. But also know that many people do not experience complications at all. The important thing is to be aware of your body and talk to your oncologist about any concerns. Frequently, serious complications can be treated if they're found in a timely manner. Was this page helpful? Thanks for your feedback! Get honest information, the latest research, and support for you or a loved one with breast cancer right to your inbox. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Maltser S, Cristian A, Silver JK, Morris GS, Stout NL. A Focused Review of Safety Considerations in Cancer Rehabilitation. PM R. 2017;9(9S2):S415-S428. doi:10.1016/j.pmrj.2017.08.403 Abdol Razak NB, Jones G, Bhandari M, Berndt MC, Metharom P. Cancer-Associated Thrombosis: An Overview of Mechanisms, Risk Factors, and Treatment. Cancers (Basel). 2018;10(10). doi:10.3390/cancers10100380 American Heart Association. Symptoms and Diagnosis of Venous Thromboembolism (VTE). Updated March 30, 2017. Aoyagi T, Terracina KP, Raza A, Matsubara H, Takabe K. Cancer cachexia, mechanism and treatment. World J Gastrointest Oncol. 2015;7(4):17-29. doi:10.4251/wjgo.v7.i4.17 Steger GG, Bartsch R. Denosumab for the treatment of bone metastases in breast cancer: evidence and opinion. Ther Adv Med Oncol. 2011;3(5):233-43. doi:10.1177/1758834011412656 Kang J, Formenti SC. Metastatic Osseous Pain Control: Radiation Therapy. Semin Intervent Radiol. 2017;34(4):322-327. doi:10.1055/s-0037-1608703 Willeumier JJ, Van der linden YM, Van de sande MAJ, Dijkstra PDS. Treatment of pathological fractures of the long bones. EFORT Open Rev. 2016;1(5):136-145. doi:10.1302/2058-5241.1.000008 Delank KS, Wendtner C, Eich HT, Eysel P. The treatment of spinal metastases. Dtsch Arztebl Int. 2011;108(5):71-9. doi:10.3238/arztebl.2011.0071 American Society of Clinical Oncology (ASCO). High Calcium Levels or Hypercalcemia. Published July 2018. Desai NR, Lee HJ. Diagnosis and management of malignant pleural effusions: state of the art in 2017. J Thorac Dis. 2017;9(Suppl 10):S1111-S1122. doi:10.21037/jtd.2017.07.79 Farbicka P, Nowicki A. Palliative care in patients with lung cancer. Contemp Oncol (Pozn). 2013;17(3):238–245. doi:10.5114/wo.2013.35033 Stukan M. Drainage of malignant ascites: patient selection and perspectives. Cancer Manag Res. 2017;9:115–130. Published 2017 Apr 12. doi:10.2147/CMAR.S100210. doi:10.2147/CMAR.S100210 Larson VA, Tang O, Ständer S, Kang S, Kwatra SG. Association between itch and cancer in 16,925 patients with pruritus: Experience at a tertiary care center. J Am Acad Dermatol. 2019;80(4):931-937. doi:10.1016/j.jaad.2018.08.044 Martin AM, Cagney DN, Catalano PJ, et al. Brain Metastases in Newly Diagnosed Breast Cancer: A Population-Based Study. JAMA Oncol. 2017;3(8):1069-1077. doi:10.1001/jamaoncol.2017.0001 American Society of Clinical Oncology (ASCO). Meningioma: Symptoms and Signs. Published November 2018. National institute of Neurological Disorder and Stroke. Brain and Spinal Cord Tumors: Hope Through Research. Updated August 13, 2019. National Institute of Diabetes and Digestive and Kidney Diseases. Kidney Disease Education Lesson Builder, Lesson 3: What Happens when Kidney Disease Gets Worse. Published March 2012. Gandhi SJ, Rabadiya B. Metastatic Brachial Plexopathy with Brain and Spinal Metastasis in a Case of Recurrent Breast Carcinoma Demonstrated on F-FDG PET/CT. Indian J Nucl Med. 2017;32(2):118-121. doi:10.4103/0972-3919.202252 Aleman BM, Moser EC, Nuver J, et al. Cardiovascular disease after cancer therapy. EJC Suppl. 2014;12(1):18-28. doi:10.1016/j.ejcsup.2014.03.002 Do Nascimento TG, De Andrade M, De Oliveira RA, De Almeida AM, Gozzo Tde O. Neutropenia: occurrence and management in women with breast cancer receiving chemotherapy. Rev Lat Am Enfermagem. 2014;22(2):301-8. doi:10.1590/0104-1169.3305.2416 Castells M. Drug Hypersensitivity and Anaphylaxis in Cancer and Chronic Inflammatory Diseases: The Role of Desensitizations. Front Immunol. 2017;8:1472. doi:10.3389/fimmu.2017.01472 Zaorsky NG, Zhang Y, Tuanquin L, Bluethmann SM, Park HS, Chinchilli VM. Suicide among cancer patients. Nat Commun. 2019;10(1):207. doi:10.1038/s41467-018-08170-1