Treatments can slow the progress of secondary breast cancer and lower the chances of it spreading further (metastasising). Treatments you might be offered include hormone therapy, radiotherapy, chemotherapy, targeted therapy and surgery. If you have secondary breast cancer, your cancer specialist (oncologist) will explain your treatment options. They will work out the best options for you taking into account:
- the characteristics of your breast cancer
- where and how far it has spread
- the treatment you've had so far
- your general health
Your feelings and preferences are also important in the decision, including how much more treatment you want and how you feel you will cope with the possible side effects.
The female hormones oestrogen and progesterone can make some breast cancers grow faster (these are known as ‘hormone positive’ or ‘hormone sensitive’ breast cancers). Hormone therapy tablets such as tamoxifen and aromatase inhibitors (anastrozole, letrozole and exemestane) block the production or action of these female hormones on breast cancer cells, slowing the cancer’s growth or spread.
If tests show that your breast cancer is hormone positive, then hormone therapy may be an option for you.
Less commonly, your ovaries can be treated to stop them producing female hormones if you have not been through the menopause. This is known as ovarian ablation. It is usually carried out using the drug therapy goserelin (Zoladex), but radiotherapy or surgery are sometimes used.
Radiotherapy can help to slow the growth of secondary breast cancers and relieve symptoms. Common areas where radiotherapy is used to treat secondary breast cancer include the bone, skin and brain.
Radiotherapy courses for secondary breast cancer are usually shorter than for early breast cancer and some women experience milder side effects. They are usually given at an outpatient clinic and require regular visits to hospital for a week or more, although they can sometimes be given as a single treatment.
Chemotherapy with one or more cytotoxic (anti-cancer) drug may be used to treat secondary breast cancer, especially where it is hormone negative, where hormone therapy is not working well, or where tumours are in internal organs (such as the lung and liver). Treatment aims to slow the growth of secondary tumours and to prevent further spread to new areas.
Chemotherapy is usually given intravenously (into a vein) in an outpatient clinic as a course of treatment broken up into smaller cycles. Each cycle lasts about three weeks, with a complete course taking a few months.
Different cytotoxic drugs work in different ways, but all aim to prevent cancer cells from dividing and growing. Unfortunately, they also target other dividing cells in the body which can lead to side effects such as hair loss, nausea and diarrhoea. Your cancer specialist may be able to offer you treatments, care or practical advice to help relieve these.
Chemotherapy drugs called anthracyclines (doxorubicin, epirubicin) are quite often used to treat secondary breast cancer. If you’ve not had these before, you’ll probably be offered them at this stage if they are suitable for you. Other chemotherapies recommended for secondary breast cancer include:
- taxanes (docetaxel; paclitaxel)
- capecitabine (Xeloda)
- vinorelbine (Navelbine)
- gemcitabine (Gemzar)
- carboplatin (Paraplatin)
Targeted (biological) therapies are drugs that attack breast cancer cells directly and so can be used to help slow the growth or spread of secondary breast cancer. Some can help to relieve symptoms too. The targeted therapy available on the NHS is called Herceptin (trastuzumab), which may be given alone or in combination with hormone therapy or chemotherapy (commonly a taxane).
Herceptin works by attacking cancer cells that produce high levels of a protein called HER2 (called HER2 positive breast cancers). If your cancer has tested positive for HER2, Herceptin may work for you and you may have received it for your primary cancer. If you have HER2 positive secondary breast cancer and have been receiving Herceptin but it has stopped working, you may be offered another targeted therapy. However, other targeted therapies have not yet been approved for NHS use, so their availability can be limited. Some may be available through clinical trials only.
Surgery is not frequently used to treat secondary breast cancers. However, surgery is sometimes possible for the removal of small tumours in operable areas, such as the brain and liver – in this case your cancer specialist will refer you to a specialist surgeon.
Relieving symptoms and preventing complications
The effects of secondary breast cancer differ from person to person and depend where the cancer has spread. Some more common effects are:
- lymphoedema (swelling of the arm or nearby areas caused by removal of armpit lymph nodes or presence of cancer in this area)
- cancer-related fatigue (ongoing tiredness that affects much of your everyday life)
- feeling anxious, stressed or depressed
Treatments, psychological support and practical advice can help with these issues and some women find complementary therapies useful too. So, if you experience any of these symptoms, or others, let your cancer specialist, GP or others involved in your care know. Breast cancer treatments can also cause side effects, for example nausea and vomiting, weight gain or menopausal symptoms. Your cancer specialist can let you know about the possible side effects of each treatment and may well be able to offer you additional treatments, care or practical advice to help relieve them.
If you have secondary breast cancer that has spread to the bone and this has weakened the bone, you may be able to have surgery to prevent it fracturing. This will depend where the weakened bone is. You may also be recommended to use bone-strengthening drugs called bisphosphonates. These help to reduce bone pain and reduce fracture risk. They are given as tablets (daily) or an injection (every three to four weeks).
For more detail about secondary breast cancer treatments visit Breast Cancer Care’s website or call them on 0808 800 6000. If you’d like emotional support or financial advice you may wish to visit the Macmillan Cancer Support website or call them on 0808 808 0000.
Information last reviewed: 17 December 2012