Treatment options for secondary breast cancer

Secondary breast cancer means that a cancer that began in the breast has spread to another part of the body. It is also called advanced or metastatic breast cancer.

When breast cancer is advanced, it usually means it can no longer be cured. Treatment can help to:

• slow down the spread of the cancer

• reduce your symptoms

• make you feel better

Many people with secondary breast cancer can live a normal life for a number of years.

Deciding which treatment you need

A team of doctors and other professionals recommend the best treatment and care for you. They are called a multidisciplinary team (MDT). The team might include:

• medical cancer specialist or oncologist

• specialist nurse or clinical nurse specialist (CNS)

• symptom control or palliative care team

Your team reviews your scans and tests and recommends the best treatment for you.

You can ask your doctor and clinical nurse specialist questions. It helps to understand:

• how treatment can help you

• what are the possible side effects

• how it might affect your quality of life

• how long will you have treatment for

Types of treatment

It can be difficult to choose the best treatment for you. Treatment depends on:

• the size of the cancer and where it is in the body

• the treatment you have already had

• your symptoms

• your general health

• other medical conditions you might have

There are a number of treatments for secondary breast cancer. You might have a type of treatment on its own or a combination of these treatments:

• hormone therapy

• chemotherapy

• radiotherapy

• targeted and immunotherapy drugs

• drugs that strengthen the bones called bisphosphonates and denosumab

• medicines to control symptoms

• surgery to help relieve symptoms

Hormone therapy

Hormone therapy works by lowering the levels of oestrogen or progesterone in the body, or blocking their effects.

Hormone therapy is only likely to work if the breast cancer cells have proteins (receptors) for oestrogen or progesterone. These are called hormone positive breast cancers.

You usually have hormone therapy when secondary breast cancer is first diagnosed. Or after you have had treatment with chemotherapy.

You may also have hormone therapy in combination with targeted drugs called CDK4/6 inhibitors such as abemaciclib.

Chemotherapy

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream. You may have one drug or a combination of drugs.

Radiotherapy

Radiotherapy uses high energy x-rays to kill cancer cells. You usually have a type of radiotherapy called external beam radiotherapy.

The most common way to have radiotherapy for secondary breast cancer is to areas of the bone where the breast cancer has spread. You may also have radiotherapy to the brain if you have breast cancer that has spread to the brain.

Targeted and immunotherapy drugs

Targeted cancer drugs work by targeting the differences in cancer cells that help them to grow and survive. Immunotherapy works by helping our immune system recognise and attack cancer cells.

There are a number of targeted drugs but not all will be suitable for you. Some only work if your breast cancer cells have certain receptors. Your doctor does various tests on the cancer cells to find this out.

Treatment to strengthen the bones (bisphosphonates)

Bisphosphonates are drugs that help prevent or slow down bone thinning (osteoporosis). They can help to strengthen the bones and reduce the risk of bones breaking (fractures).

You might have bisphosphonates if you have breast cancer spread in the bones.

Medicines to control symptoms

The treatment you need depends on what symptoms you have. This might include medicines to help with pain or relieve constipation. 

Surgery to control symptoms

Surgery is not usually an option for treating secondary breast cancer. But in some situations, surgery can help to relieve symptoms. For example, you might have surgery to remove a small cancer that has spread to the brain. 

This type of surgery will not be suitable for everyone. The cancer needs to be small and you also have to be fit enough to have surgery.

Having treatment as part of a clinical trial

Doctors are always trying to improve treatments, reduce side effects and improve your quality of life. Your doctor might ask you to participate in a clinical trial as part of your treatment. This might be to investigate a new test, a new cancer treatment or to look at different combinations of existing treatments.

Your doctor will tell you if there are any trials that you can enter.

Your choices

Your doctor might offer you a choice of treatments. Discuss each treatment with them and ask how they can control any side effects. This helps you make the right decision for you. You also need to think about the other factors involved in each treatment, such as:

• whether you need extra appointments
• if you need more tests
• the distance you need to travel to and from hospital

You might have to make further choices as your situation changes. It helps to find out as much as possible each time. You can stop a treatment whenever you want to if you find it too much to cope with.

If you decide not to have treatment

You may decide not to have cancer treatments, such as chemotherapy. But you can still have medicines to help control symptoms, such as sickness or pain.

Your doctor or nurse will explain what could help you. You can also ask them to refer you to a local symptom control team to give you support at home.

Coping with secondary breast cancer

Finding out cancer has spread can be a big shock. It might help to talk to a close friend or relative about how you feel.