Patients with metastatic breast cancer may have elevated levels of the tumor markers CA 27.29 and 15-3, though higher levels are not necessarily linked with metastatic disease — or even a diagnosis of breast cancer. These tumor markers can also be used to monitor response to therapy, though they are not necessarily the best predictor of clinical outcomes.6

In addition to elevated tumor markers, there may be other evidence of metastasis on labs and imaging. Lung metastases can be detected on plain chest radiograph, although a computed tomography (CT) of the chest may be more specific. Patients with bone metastases may have elevated alkaline phosphatase levels and an abnormal bone scan and/or magnetic resonance imaging (MRI). Patients with liver metastases may have elevated liver function tests (LFTs), which should prompt additional imaging of the liver and biliary system.

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When reviewing the abdominal imaging studies in the setting of possible biliary obstruction secondary to metastases, it is important to note whether there are focal lesions affecting the bile ducts, which have the potential for an endoscopic intervention.

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The workup for potential metastatic disease with bloodwork and imaging must be individualized for each patient. The individual’s unique symptoms and physical exam findings are critical factors for decision-making.


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