Symptoms and diagnosis

Symptoms of advanced breast cancer vary depending on where the cancer has metastasised. If there is suspicion of ABC, refer the patient directly to their medical oncology team (if they have one), or to the local diagnostic breast service at your district hospital. You can review the referral pathways for each region here.

Diagnosing ABC

The following tests are used to determine the presence of ABC:

• Blood tests
• Bone scans and/ or x-rays 
• MRI scans
• CT scans
• PET scan
• Imaging of the abdomen or chest
• Tissue biopsy
• Bronchoscopy (if patient has a persistent cough or difficulty breathing)
• Fluid samples from the lungs or around the spinal cord.

A biopsy should be taken from areas of concern, even if the original tumour has been biopsied, in case the hormone receptor status may have changed. As with early breast cancer, test results for ABC should be discussed at a multi-disciplinary meeting to determine the appropriate treatment, but this practice is variable.

Cancer that has metastasised to the bones:

• Bone pain (e.g. in the back, hips, ribs, or long bones of the arms and legs) that lasts for more than one or two weeks, doesn’t improve with pain relief or is worse at night.
• Pathological fracture.
• Hypercalcaemia - symptoms include fatigue, nausea, constipation, irritability, thirst and confusion.
• Spinal cord compression - symptoms include unresolved localised back pain(/stiffness), weakness, or paraesthesia in the legs and/or incontinence.

Cancer that has metastasised to the liver:

• Fatigue.
• Localised or referred discomfort, pain or swelling.
• Nausea.
• Loss of appetite.
• Jaundice.

Cancer that has metastasised to the lungs:

• Persistent cough, unresolved over three weeks (new or changed).
• Dyspnoea.
• Recurrent chest infections.
• Haemoptysis.
• Pleural effusion.

Cancer that has metastasised to the brain:

• Severe or ongoing headaches, especially at night.
• Loss of balance or co-ordination.
• Seizures.
• Altered vision, speech or behaviour.
• Memory problems.
• Weakness or paraesthesia in limbs.

Cancer that has metastasised to local lymph nodes:

Local recurrence of breast cancer is when cancer returns in the same breast or chest area as the original tumour. Occasionally, this recurrence is the first sign of metastatic spread, which is characterised by swelling in axillary, mediastinal or supraclavicular lymph nodes.