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Diagnosing Metastatic Breast Cancer

Finding Breast Cancer Metastases

Metastatic Breast Cancer (MBC) is often found by a symptom—perhaps a recurring pain or cough, shortness of breath, lack of appetite, headaches or an injury. It is also possible to learn of metastases through routine scans.

If possible, your suspected metastasis should be biopsied for two reasons. First, to determine if the abnormality is MBC. Physical exam and imaging can show that something abnormal is present, but a biopsy is the only sure way to know whether the problem is MBC. A biopsy is surgical removal of all or part of a suspected tumor/metastasis for examination under a microscope to check for cancer cells. Second, if a diagnosis of MBC is confirmed, the biopsy will determine tumor characteristics, which will aid in making treatment decisions. While metastases often have the same characteristics as the initial breast cancer, they don’t always.

Studies show that finding metastases early does not create better outcomes or lengthen survival. Don’t blame yourself for not finding your recurrence early if you missed a scan or test or put off getting something checked out.

Diagnostic scans are performed to find out if you have MBC and to measure response to treatment or progression of metastatic tumors. No matter how many times you have been through a scan, there is often anxiety involved in either the process itself or waiting for results. This is normal.

The most typical scans are:

Bone Scans

Bone scans reveal if cancer has spread to the bones. In most MBC cases, metastases first occur in the bones. These scans look at the bones for “hot spots” that may reveal cancer. To conduct a bone scan, your healthcare provider injects dye, then waits a few hours for it to move through the bloodstream so it can be visible in the scan.

Chest X-Ray

A chest x-ray may reveal if breast cancer has spread to the lungs. Metastases in the lungs rarely cause pain, but they can cause shortness of breath or a cough that won’t go away.

CT/CAT Scan (Computerized Tomography or Computerized Axial Tomography)

This scan provides a more-detailed x-ray of the body, usually in order to look for metastases in the brain, lungs and/or liver. Before the scan, you will either ingest a contrast dye and/or have it injected into a vein. The dye highlights specific areas of the body more clearly. A computer rotates around the body, creating a three-dimensional image.

Liver Scan

A liver scan involves having a contrast dye injected into the vein. The dye will collect in areas where there is activity that could indicate cancer growth.

MRI (Magnetic Resonance Imaging)

Before an MRI, you will receive an injection of a contrast dye, then lie down inside a tube-like machine that uses radio waves and a powerful magnet linked to a computer to take three-dimensional pictures of your body.

PET Scan (Positron-Emission Tomography)

This scan works by monitoring the use of glucose (a source of energy) throughout the body. Cancer cells use more glucose than normal cells do. Before the scan, you will have some radioactive glucose called a “tracer” injected into a vein. A computer then takes images and looks for the areas using the most glucose. The PET scan can sometimes find cancer that other tests miss.


A combination of the PET and CT Scans, performed at the same time, can present a more detailed image of the presence or extent of cancer in the body.

Metastatic Breast Cancer Blood Tests

Different blood tests may be used to detect breast cancer:

  • The CA 27.29 blood test measures the level of a protein called the CA 27.29 antigen. In theory, the level rises as there is more breast cancer in the body. This test can, in some patients, help determine if cancer is growing in the body, or whether treatments are working. Similar tests include the CA-15-3 and CEA.
  • Circulating tumor cells (CTCs) may also be measured through a blood test. CTCs are extremely rare in healthy individuals and patients with nonmalignant diseases but are often present in people with metastatic cancer. Some clinical studies indicate the assessment of CTCs can assist doctors in monitoring and predicting cancer progression and in evaluating a patient’s response to therapy. CTC testing and use is still in the experimental stage.

For more detailed information on MBC treatment and resources, download or order a free copy of our Metastatic Navigator.