What is secondary breast cancer?
Secondary breast cancer is breast cancer that has spread from the breast to other parts of the body.
Secondary breast cancer is also called metastatic breast cancer or advanced breast cancer. Many women diagnosed with secondary breast cancer have been diagnosed with breast cancer before. For some women a diagnosis of secondary breast cancer may be their first diagnosis of cancer.
How does secondary breast cancer develop?
In some women with breast cancer, cancer cells break away from the cancer in the breast. The cancer cells spread to other parts of the body via the blood vessels or lymphatic vessels and form a new cancer deposit. This can happen before or after treatment for breast cancer. The original cancer in the breast is called the primary cancer. If breast cancer develops in another part of the body, it is called a secondary breast cancer or a metastasis.
Why did my breast cancer spread?
We do not know what causes breast cancer to spread in some women and not in others. If you have previously been diagnosed and treated for early breast cancer, it is important to remember that you and your doctors made the best decisions about your previous treatment with the information available at the time.
Is secondary breast cancer painful?
Secondary breast cancer affects different people in different ways. The type and level of pain experienced by one person may not be the same as that for another person with cancer in the same parts of the body. Not everyone with secondary breast cancer finds it painful. Some people have no pain; others find that pain affects them at certain times of the day or night or while doing different activities. Pain caused by secondary breast cancer does not always get worse with time. Cancer pain can be controlled. It is very rare to have cancer pain that cannot be lessened, changed or controlled.
Should I have been having regular scans or blood tests after my first breast cancer diagnosis?
Some people who have been diagnosed and treated for early breast cancer assume that they should have regular scans and blood tests after treatment. However, studies have shown that having more tests does not improve the length or quality of life for women who have been treated for breast cancer, unless they have symptoms which suggest that cancer has spread outside the breast.
How often should I be tested to see if the cancer is under control or continuing to grow?
The type and frequency of scans or other tests used to check whether your cancer is responding to treatment will depend on where the cancer is and the type of treatment(s) you receive. Tests might be less frequent if your cancer has been controlled for some time. Ask your Doctor or Nurse Specialist about what tests you might have and when these might be needed.
If cancer spreads to the brain, will this cause changes to my personality or mental function?
Secondary breast cancer that spreads to the brain does not cause mental illness. People may experience different symptoms depending on which part of the brain is affected by the cancer. The most common symptom is headache that does not go away. Some people have difficulty concentrating or reading difficult text. A small number of people may experience changes in their mood, personality or mobility. It is important that this is assessed by a health professional to make sure the changes are not due to other things, such as depression.
If secondary breast cancer is my first diagnosis of breast cancer, why is surgery to the breast usually not recommended?
When cancer is confined to the breast, the priority for treatment is to remove the cancer and stop cancer cells from spreading to other parts of the body. Once cancer has spread outside the breast, the priority becomes controlling the cancer in the different parts of the body that are affected and slowing the further spread of the cancer. For many people with secondary breast cancer, the cancer in the breast does not cause major symptoms or health problems. Surgery to the breast will not usually help to treat the cancer overall and may actually delay the other more useful treatments such as chemotherapy. However, in certain specific circumstances, surgery to remove the cancer in the breast may be recommended.
Should I worry about taking strong painkillers?
No. Pain is a warning system to alert health professionals to a problem. Once the problem has been identified, is it most important to relieve the pain. This is why stronger painkillers might be given to you. If pain is not relieved it can interfere with your ability to move freely and interact with others. This can often be worse than the possible side effects of the painkillers.
Should I expect to have many unrelieved symptoms as part of having secondary cancer?
Like pain, it is possible to manage or relieve other symptoms of secondary breast cancer. In most cases, adequate symptom relief can easily be achieved.
Will I be distracting my doctors and nurses from their job of treating my cancer by telling them about my symptoms?
No. Uncontrolled symptoms are a burden and may interfere with your ability to tolerate cancer treatments. It is important that you tell the people looking after you about any symptoms or side affects you experience so that solutions can be sought to ensure you feel as comfortable as possible, regardless of where you are in your cancer journey.
What happens if my painkiller becomes less effective?
There are many different drugs that can be used to manage pain. If the painkiller you are taking stops working, or if your pain gets worse, your doctor can recommend whether to increase the dose or try another drug. Do not stop taking your painkillers without talking to your doctor first.
How do I know if I am hormone receptor positive?
If secondary breast cancer is your first diagnosis of breast cancer, your surgeon will probably do a biopsy to see whether there are hormone receptors on your cancer cells.
If you have been diagnosed with early or locally advanced breast cancer before, your pathology report will show whether your breast cancer was hormone receptor positive. However your surgeon may decide to do another biopsy to see whether there has been any change in the receptors on your cancer cells.
If I have side effects, can I lower my dose of hormonal therapy?
The recommended doses of hormonal therapies are the ones that have been shown to be beneficial in clinical trials. Taking lower doses or less frequent doses is not a good idea. If you have side effects that are concerning you, it is important that you discuss them with your Oncologist or Specialist Nurse.
If I run out of my hormone therapy, can my GP renew it?
Your GP can renew most hormonal therapy prescriptions.
What if I can’t remember what the doctor says?
A diagnosis of secondary breast cancer can be overwhelming. You will be given a lot of information and you may find it difficult to remember everything. You can always have someone come in with you who can take notes. You can ask your doctor to repeat things or write them down for you. You will get a copy of the clinic letter which will help. You can also contact your Specialist Nurse for support at this time, if they are unable to come into the consultation with you they will be able to discuss the outcomes of you appointment with you.
How will I know what treatment to choose?
Your doctor will explain your treatment options. Ask your doctor about the possible benefits and side effects of each treatment. You may need time to read about different treatments or to talk to family and friends. After weighing up the benefits and side effects, you may decide not to have a particular treatment. Discuss your decision with member of your healthcare team.
How do I decide whether to have chemotherapy?
Your doctor will talk to you whether chemotherapy is recommended for you. Ask your doctor about the possible benefits and side effects of treatment. You might find it helpful to talk to other women who have had chemotherapy to find out what is involved.
What should I do if I want a second opinion?
You have the right to have a second opinion at any time. If you want a second opinion you can ask your Oncologist or GP to refer you to someone else. You may decide after seeing another doctor that you would like to stay with the original team. The fact that you have seen someone else will not affect how the first doctor manages your treatment.
Can I decide not to have treatment?
You may decide after talking to members of your healthcare team that you do not want to have a particular treatment. Weigh up the possible benefits and side effects of the treatment and talk to your doctor about what might happen with or without treatment. If you decide not to have a particular treatment, discuss your decision with your doctor and with those close to you.
Will chemotherapy make me lose my hair?
Some people who have chemotherapy lose their hair. The chance of you losing your hair will depend on which drugs you receive. Talk to your doctor or specialist nurse about whether hair loss is likely with the treatments that are recommended for you.
Will having a higher dose of chemotherapy increase the chance of it working?
The doses of chemotherapy recommended are the ones that have been shown in clinical trials to be most effective with manageable side effects. In general, higher than recommended doses do not improve the overall response to treatment and can cause increased side effects.
How do I know if targeted therapies will be of benefit to me?
Targeted therapies will only be suitable for you if your breast cancer cells have particular characteristics. For example, Herceptin and Pertuzamab are only suitable for women who have HER2 positive breast cancer. About one in five people with breast cancer have HER2 positive breast cancer.
Am I at a disadvantage if my breast cancer cells are HER2 negative?
Some people who have HER2 negative breast cancer are concerned that they are not suitable for treatment withHerceptin or another targeted therapy. However, it is important to realise that HER2 negative breast cancer is often a less aggressive form of breast cancer than HER2 positive breast cancer. Research into new targeted agents that could be used in HER2 negative cancers is on-going.
How long will targeted therapies be of benefit to me?
There is no easy answer to this question. It depends on you as an individual. Some women use targeted therapies for many years. For others, targeted therapies only work for a few months. Treatment will usually be given until the disease progresses.
Can I take complementary therapies at the same time as my conventional treatments?
Some complementary therapies are encouraged by health professionals. These include relaxation therapy, guided imagery, medication and gentle exercise. Some complementary therapies may be harmful if taken at the same time as conventional treatments, such as some vitamins. It is important that you tell the health professionals managing your care about any treatments you are taking or involved in.
Where can I access Complementary therapies?
The Fountain Centre is a charity for cancer patients, their families and carers located in the St Luke’s cancer unit at the Royal Surrey County Hospital, Guildford. They offer advice, counseling and a huge range of complementary therapies, in a calming and relaxed atmosphere.
If you are accessing Complementary therapies elsewhere you may be asked to provide a letter from your specialist confirming it is safe for you to have certain treatments.
What is the difference between complementary and alternative therapies?
Complementary therapies are therapies or treatments that are used alongside conventional medicine. Alternative therapies are therapies or treatments that are used instead of conventional medicine.
Can complementary or alternative therapies be used to treat or prevent breast cancer?
There is no evidence that complementary or alternative therapies can treat breast cancer, stop it from coming back or stop it from spreading to other parts of the body.
Do I have to be in a hospice or hospital to have palliative care?
No. Palliative care can be provided for you as an outpatient in clinic, at home or in a hospital or hospice.
Does palliative care mean I am dying?
No. Palliative care can be provided to anyone who has a life limiting illness.
If I have palliative care, does that mean that my other treatments will stop?
No. Palliative care is available throughout your cancer journey. It is used to help you cope physically and emotionally with your cancer and its treatments
What role will my GP play in my care?
Your GP can help to coordinate your care and provide you and your family with support and information to help you to make informed choices about treatment. Your GP can help you and those close to you to manage your physical and emotional health need thought out the cancer journey including palliative care.
Where can I get some counselling?
You can ask your GP to refer you to a Counsellor or a talking therapy.
You can refer yourself to the Fountain Centre for counselling. The Fountain Centre is a charity for cancer patients, their families and carers located in the St Luke’s cancer unit at the Royal Surrey County Hospital, Guildford. They offer advice, counseling and a huge range of complementary therapies, in a calming and relaxed atmosphere.
The Community Palliative Care Teams provide counselling and you can be referred to them by your GP, Consultant or Specialist Nurse
Where can I find answers to questions not covered here?
You can contact your Specialist Nurse.
For Frimley Park Hospital phone: 01276 604945.
For Heatherwood and Wexham phone: 01753636281
You can contact one of the Charities that provide additional support:
Breast Cancer Care: 0808 800 6000 www.breastcancercare.org.uk
Macmillan Cancer Support: 0808 808 0121 www.macmillan.org.uk