After breast cancer treatment, becoming obsessed with symptoms and worrying that every twinge or cough might be a sign of metastasized cancer is all too easy.  A few women go to the other extreme and live in denial despite clear warnings from their body that something is wrong.  The bone, lungs, liver and central nervous system are the most common places for cancer to spread, and each has its own symptoms.  Research has shown that scans usually cannot catch metastases (mets) before the patient feels symptoms, so each woman needs to be alert and notify her doctor when something is wrong.  Here are the most common types of mets, their symptoms, and current treatments.

Bone  The bones are the most frequent place to which breast cancer travels.  Up to 70% of breast cancer patients with mets will have them in their bones.  Bone pain is the most frequent indication of bone mets.  Changes in blood work can also alert your doctor to the possibility.  Because exercise, medications, and/or arthritis can also cause bone pain, see a doctor for any pain that lasts longer than a week or two, especially if the pain is constant.  Bone mets pain does not "come and go" like a strain from exercise might, and it is not likely to be in the joints like arthritis pain.  A bone scan is often the first test a doctor will order, but depending on the location and pattern of pain, the doctor may also use X-rays, MRI's, and PET scans to diagnose bone mets.

Fortunately, bone mets respond better to treatment than some of the other forms of breast cancer metastasis.  Bisphosphonates like pamidronate (Aredia) and zolendronic (Fosamax) help patients by strengthening the bone to make it harder for cancer cells to spread and by preventing the bone fractures that sometimes occur when cancer weakens the bones.   Radiation, chemo, targeted therapies like Herceptin, and/or hormonal treatments may also be used to treat bone mets. Although doctors do not typically use surgery to remove a bone mets lesion, they may need it to stabilize bones and prevent fractures.  Long-term Stage IV survivors like Katherine Russell Rich often have bone mets.

Lung.  The lungs are the second most common place for breast cancer mets.  In Dr. Susan Love's Breast Book 4th edition, Dr. Love says that the lungs are the only place of metastasis for 21% of patients, and that of patients who eventually die of breast cancer, 60-70% will have it in their lungs.  (Keep in mind that many people will have metastases to more than one location, so the percentages can add up to more than 100%.)  Symptoms you should bring to your doctor's attention include shortness of breath, chest pain, or a cough.  If you just climbed a mountain or a cough is making the rounds in your community, don't be alarmed.  But if these symptoms have no logical explanation and don't get better, see your doctor.  Because the breast cancer cells are gradually displacing healthy lung cells, the symptoms may progress slowly.