Stage IV breast cancer can't be cured, but you still have options to treat your cancer

• If you have stage IV breast cancer, the cancer has spread to areas like your bones, lungs, or liver.
• This cancer can't be cured, but many women live for five to 10 years after receiving this diagnosis.

If you or a loved one have received a diagnosis of stage IV breast cancer, this means the cancer cells have spread to other parts of the body beyond the breast.

This migration is called metastasis, which is why this stage also goes by the name metastatic breast cancer. Stage IV is breast cancer's most severe and life-threatening form.

It's natural to feel sad, angry, or frightened after receiving such a serious diagnosis. But while there's no cure for stage IV breast cancer, you could still have a few years ahead of you. Roughly 13% of women with this type of cancer survive at least a decade after their diagnosis.

Understanding more about your condition can help you get a sense of your current situation and what to expect going forward.

Note: Most breast cancer statistics focus on people assigned female at birth, but people of any gender can get this type of cancer. That said, men get it much more rarely, since they typically don't have much breast tissue. The odds of a man getting breast cancer in his lifetime are 1 in 833, compared to 1 in 8 for women.

Symptoms

Although stage IV breast cancer has spread beyond the breast, you may still experience breast cancer signs and symptoms like:

• A new lump in your breast: Cancerous tumors are often hard and bumpy but otherwise painless.
• Swelling in nearby lymph nodes: The lymph nodes near your armpit and collarbone may swell, even before the tumor becomes large enough to feel.
• Skin changes: Your nipple or breast skin may become darker, thicken, or flake.
• Skin dimpling: Your skin may pucker, as if you poked it and the tissue stayed bent.
• Nipple retraction: Your nipple may turn inside out.
• Nipple discharge: Your nipple may leak clear or bloody liquid, even though you aren't breastfeeding.

Additional symptoms in stage IV breast cancer depend a lot on where else the cancer cells have spread. According to one study, the most common sites for breast cancer metastasis are:

• Bones: 39.8%
• Lungs: 10.9%
• Liver: 7.3%
• Brain: 1.5%

These symptoms of breast cancer and metastasis are the same regardless of sex, according to Dr. Lauren Carcas, a cancer doctor at Miami Cancer Institute who specializes in breast cancer care.

About a third of people with stage IV breast cancer will experience multiple metastasis, where the cancer spreads to multiple sites across the body. Multiple metastasis can cause more symptoms and a lower survival rate.

Here is a list of potential cancer symptoms associated with each site:

• Bones: Breast cancer cells are most likely to invade the bones near your breasts, like your ribs, spine, and pelvis. You may also get cancer in the long bones of your arms and legs. Cancer in your bones can cause bone fractures, spinal cord compression, and high calcium levels. You may experience numbness and muscle weakness and have difficulty passing urine or stool. Other symptoms include fatigue, nausea, and loss of appetite.
• Lungs: Breast cancer cells almost always invade one lung at a time. Some people have no symptoms, but you may experience symptoms that resemble respiratory conditions like the common cold. For instance, you may develop a cough that won't go away or brings up bloody mucus. Other signs include shortness of breath and pain or discomfort in your lungs.
• Liver: Generally, liver metastasis doesn't cause symptoms. When issues do occur, they may include pain on the right side of your abdomen, yellowing eyes or skin ( jaundice), muscle weakness, and a poor appetite.
• Brain: Cancers that migrate to the brain can cause a wide range of health issues, including headaches, nausea and vomiting, weakness on one side of the body, and seizures. You may also notice your vision getting blurrier.

Outlook

The prognosis for stage IV breast cancer varies widely from person to person. The median survival time is 26 months after diagnosis. This means that of all the different life expectancies, 26 months falls in the middle. Some people may live for a much shorter or longer period.

Certain factors may improve your prognosis, including:

• Being female: Women have higher five-year survival rates for all stages of breast cancer. Among people with metastasis beyond the immediate chest area, women have a five-year survival rate of 29%, compared to 19% for men.
• Younger age: The vast majority of women with breast cancer get diagnosed after age 45. Those on the younger side of the age range have a better chance of long-term survival after a stage IV diagnosis. Women between ages 41 and 50 have a 10-year survival rate of 14.9%. Meanwhile, women between ages 51 and 70 have a 10-year survival rate of 11.7%.
• Hormone-positive subtype: Some types of breast cancer cells have hormone receptors, or little gates that allow them to interact with estrogen and progesterone hormones. Hormone-positive cancer cells grow more slowly and respond to more treatments than hormone-negative cells..
• Bone metastasis: According to research comparing survival odds three years after diagnosis, people with bone metastasis have a 50.5% survival rate, while people with brain metastasis have a 19.9% survival rate. Those with multiple metastasis sites have an average three-year survival rate of 27.4%.

Recurrent versus new diagnosis

Three out of four people with a diagnosis of stage IV breast cancer have recurrent cancer, or cancer that returned.

For instance, you may have received treatment for a milder form of cancer and stopped having symptoms for a time. However, some cancer cells could have survived treatment and quietly "escaped" to regrow in other parts of the body months or years later.

Research suggests the odds of survival for recurrent stage IV breast cancer are equal to those of de novo — aka newly discovered — stage IV breast cancer.

In other words, drugs or therapies you received for cancer in the past likely won't improve the outcome of your current case. That said, your response to those treatments could give you a head start in figuring out which drugs or therapies you'll respond best to.

Treatment options

Although stage IV breast cancer isn't curable, treatment can still offer a lot of benefits, including:

• Shrinking tumors or slowing their growth
• Reducing symptoms like nausea and pain
• Increasing your life expectancy

Options for managing your symptoms include:

Systemic treatments

Because stage IV breast cancer has spread beyond your breast, systemic drug therapies are often the main approach. These treatments address your whole body rather than one specific area. They include:

• Chemotherapy: These drugs kill tumor cells directly. They're the preferred treatment for hormone-negative breast cancers.
• Hormone therapy: These treatments stop estrogen and progesterone from bonding to cancer cells, which slows the cancer's growth. They work well for hormone-positive breast cancers.
• Immunotherapy: These medicines coach your immune system to recognize and destroy breast cancer cells more effectively.
• Targeted therapy: These drugs target a specific protein on breast cancer cells to slow their growth or kill them. Targeted therapy is helpful for breast cancers caused by certain gene mutations.

People with hormone-positive tumors will receive the same hormone therapies, regardless of gender, according to Carcas.

"Treatment decisions for metastatic breast cancer are based on the characteristics of the tumor itself and not based on the sex of the patient," Carcas says.

Local treatments

Local treatments focus on a specific area to offer symptom relief or address complications. For example, if cancer is pressing on your spinal cord, doctors may want to address your pain and nerve damage right away rather than waiting for systemic drugs to take effect.

Examples of local treatments include:

• Surgery to physically cut the tumor out of your body
• Radiation therapy, which uses high-energy rays to kill tumor cells
• Regional chemotherapy to deliver chemo drugs to a limited area, like the fluid around your brain

End-of-life care

Treatments may work for a time, but breast cancer is a stubborn disease, and it often finds ways to progress.

When typical treatments no longer work, you have two options:

• You can pursue more intensive treatment that may come with more severe side effects.
• You can quit treatment and focus on managing your symptoms as the cancer progresses.

Choosing to stop treatment for cancer and focus on managing your symptoms of the disease is a personal and often difficult decision, according to Dr. Lindsay Peterson, a doctor on the breast cancer specialist team at Siteman Cancer Center.

It often comes down to choosing quality of life over quantity of life, Peterson says. This decision is entirely yours — there's no "correct" choice.

You and your care team may believe further treatment will cause more harm than benefit. Or, you may want to prioritize your remaining time by spending it with family and friends rather than doctor appointments, she says.

If you do choose to end cancer treatment, you can still receive medical support as you transition to this new stage. Hospice care can support you in your final days, weeks, or months by:

• Helping you get support with daily tasks like bathing and cooking
• Managing symptoms such as pain, fatigue, and nausea
• Providing psychological and spiritual counseling for you and your loved ones

Depending on your situation, you can receive hospice care at a center or in your own home. Most health insurance companies cover hospice care for the last six months of life.

Insider's takeaway

A diagnosis of stage IV breast cancer means your cancer has spread, or metastasized, to other parts of the body besides the breast. Your bones, lungs, liver, and brain are the most common sites. Your symptoms and life expectancy can vary widely depending on where the cancer appears in your body.

After a diagnosis of stage IV breast cancer, the median life expectancy is between 2-3 years, although some people live for a decade after diagnosis, if not longer. Breast cancer treatments are constantly evolving, and you may have the opportunity to participate in clinical trials for experimental treatments.

Your doctor can always offer more personalized guidance on the best way to treat your cancer.