Metastatic Breast Cancer

De novo Stage IV breast cancer compromises 5–6% of woman with breast cancer. Systemic staging at the time of initial presentation is recommended for patients with clinical Stage IIIA disease or patients who have symptoms concerning for metastatic disease. Patients were suspected to have metastatic disease should be referred to medical oncology. A biopsy of the metastatic focus should be performed to confirm the diagnosis and tumor markers including ER, PR, and HER-2/neu should be tested. Surgery has limited role in metastatic breast cancer. After excellent response to systemic therapy resection of single metastatic, focus in lung or liver may be considered. Resection of the primary breast lesion may also be considered in selected patients with well-controlled oligometastatic disease. These patients should be discussed in a multidisciplinary setting with the input of medical oncology, surgery, radiation oncology, and pathology. Surgery may be necessary for palliation in the setting of infection, bleeding, or unrelenting pain.