What Is It?

Secondary breast cancer, also called metastatic, advanced, or stage 4 breast cancer, occurs when cancer cells spread from the breast to other parts of the body via the blood or lymphatic system. Common sites include bones, lungs, liver, and brain. It can be diagnosed after a primary diagnosis or at the same time (de novo).

Is It Curable?

While secondary breast cancer isn’t curable, it is treatable. The goal is to control the disease, manage symptoms, and maintain quality of life for as long as possible.

Diagnosis and Prognosis

Prognosis varies based on the location and extent of spread, cancer characteristics, past treatments, and overall health. With modern therapies, many people live for several years with metastatic breast cancer.

Testing

• Biopsies may be done to reassess hormone or HER2 receptor status.
• Tumour markers and scans help monitor disease but aren’t always fully reliable alone.

Treatment Options

Treatment is personalized based on cancer type, spread, symptoms, and patient preferences. A multidisciplinary team supports you.

1. Hormone Therapy

For oestrogen receptor-positive (ER+) cancers:

• Drugs: Tamoxifen, letrozole, fulvestrant, anastrozole
• Blocks or reduces oestrogen to slow cancer growth
• Often first-line and taken long-term if effective

2. Chemotherapy

Used when hormone therapy is ineffective or not suitable.

• Drugs: Capecitabine, paclitaxel, carboplatin, eribulin
• Side effects are managed with dose adjustments or supportive care

3. Targeted Therapy

Targets specific cancer traits:

• HER2-positive: Trastuzumab, pertuzumab, Enhertu
• HER2-negative/ER+: CDK4/6 inhibitors (palbociclib, ribociclib)
• Triple-negative: Immunotherapies (atezolizumab, sacituzumab govitecan)

4. Bone-Strengthening Therapy

Used for bone metastases:

• Drugs: Bisphosphonates, denosumab
• Reduce pain, fractures, spinal cord compression, and high calcium levels

5. Radiotherapy

• Localized pain control, especially in bones or brain
• Stereotactic radiotherapy is precise and spares healthy tissue

6. Surgery

Rarely used, but may relieve symptoms or address isolated lesions (e.g., spinal stabilization).

Managing Side Effects

Pain

• Often manageable with a step-up approach using paracetamol, opioids, anti-inflammatories, and nerve pain drugs.
• Complementary therapies like massage and acupuncture may help.

Fatigue

• Common and persistent
• Track energy patterns, prioritize tasks, balance activity and rest, and consider light exercise.

Breathlessness

• Common with lung metastases or infections
• Managed with breathing techniques, physiotherapy, and cooling the face

Digestive Issues

• Nausea: Controlled with anti-sickness medication
• Constipation: Caused by pain meds; managed with diet, fluids, and laxatives
• Diarrhoea: Caused by some chemo; treat with antidiarrheal meds
• Appetite/weight changes: Nutritional supplements or dietitian support may help

Monitoring and Follow-Up

Regular appointments ensure treatment is working and side effects are managed. You’ll discuss symptoms, energy, and mental well-being. Scans are used to assess progression or treatment effect. Blood tests may be used, but tumour markers alone aren’t definitive.

Living with Secondary Breast Cancer

Emotional Support

• Shock, fear, and uncertainty are normal.
• Speak with specialist nurses, therapists, or peer support groups.
• Breast Cancer Now offers: Helpline (0808 800 6000), online forums, and Living with Secondary Breast Cancer groups.

Work, Finances, and Daily Life

• Adjust work schedules or take leave if needed
• Financial advice is available through charities like Macmillan
• Occupational therapists can help with mobility and daily routines

Palliative and Supportive Care

Palliative Care

Supports symptom control and emotional well-being. Offered alongside treatment or when active treatment ends.

Hospices

Offer inpatient, home care, counselling, complementary therapies, and respite care. Not just for end-of-life.

Taking Treatment Breaks or Stopping Treatment

You may choose to pause treatment to recover or attend a personal event. Others decide to stop treatment when side effects outweigh benefits. Support remains available, including palliative care and symptom control.

Clinical Trials and New Treatments

Why Join a Trial?

• Access new therapies
• Closer monitoring and support
• Contribute to future cancer research

Trials test new drugs, combinations, or supportive therapies. Genomic testing may be used to identify eligible participants.

Find trials at:

• Be Part of Research
• Cancer Research UK

Emergencies to Watch For

1. Blood Clots

Symptoms: Leg/arm swelling, chest pain, breathlessness. Immediate medical attention required.

2. Hypercalcaemia

Too much calcium in blood (common in bone metastases). Symptoms: Nausea, fatigue, confusion.

3. Neutropenic Sepsis

Serious infection risk due to low white blood cells. Symptoms: High/low fever, chills, feeling unwell.

4. Spinal Cord Compression

Emergency if cancer affects spine. Symptoms: Severe back pain, numbness, incontinence, leg weakness.

Making the Most of Appointments

• Prepare questions
• Bring someone for support or take notes
• Ask for copies of letters and explanations in plain language
• Express your concerns and priorities

Final Words

Living with metastatic breast cancer can feel overwhelming, but support, treatment, and self-care strategies can help you live well for many years. Stay informed, advocate for your needs, and don’t hesitate to ask for help.

Helpful Contacts:

• Breast Cancer Now Helpline: 0808 800 6000
• Website: breastcancernow.org