Overview

Secondary breast cancer, also known as metastatic or stage 4 breast cancer, occurs when breast cancer cells spread beyond the breast and nearby lymph nodes to other parts of the body. Although it cannot be cured, it can be treated to control the disease, relieve symptoms, and maintain quality of life.

This guide explains the nature of secondary breast cancer, available treatments, symptom management, emotional support, and how to navigate life with the disease.

Understanding Secondary Breast Cancer

What It Is

Secondary breast cancer happens when cancer cells spread through the bloodstream or lymphatic system from the primary tumor to distant organs. Common sites include:

• Bones
• Lungs
• Liver
• Brain

In some cases, secondary breast cancer is diagnosed at the same time as the primary cancer, known as de novo metastatic breast cancer.

Prognosis

While outcomes vary significantly, many people live for years with metastatic breast cancer. Prognosis depends on factors like where the cancer has spread, how extensive it is, previous treatments, and overall health.

Treatment Approach

Goals of Treatment

• Slow or stop the spread of cancer
• Relieve symptoms
• Prolong and maintain quality of life

Treatment decisions are made collaboratively with the care team, factoring in the location and extent of disease, personal preferences, and health status.

Common Treatments

1. Hormone Therapy

For oestrogen receptor-positive (ER+) cancers:

• Blocks the cancer’s ability to use oestrogen.
• Often first-line treatment.
• Drugs include tamoxifen, letrozole, fulvestrant, and goserelin.

2. Chemotherapy

• Used when hormone therapy is unsuitable or no longer effective.
• Aims to control spread and relieve symptoms.
• Drugs include capecitabine, paclitaxel, carboplatin, and eribulin.

3. Targeted Therapy

Targets specific cancer features like HER2 or mutations.

• HER2-positive: trastuzumab, pertuzumab, T-DM1, Enhertu.
• ER+ and HER2-negative: CDK4/6 inhibitors (palbociclib, ribociclib, abemaciclib), everolimus.
• Triple-negative: Immunotherapy like atezolizumab or sacituzumab govitecan.

4. Radiotherapy

• Used to relieve pain or pressure.
• Especially helpful in bone or brain metastases.
• May be external beam or stereotactic radiotherapy.

5. Bone-Strengthening Treatments

• Bisphosphonates or denosumab reduce bone complications and pain from bone metastases.

6. Surgery

Rare for metastatic disease but may help in specific cases (e.g., spinal cord compression or isolated bone lesions).

Symptom Management

Pain

Pain is a common concern but is manageable. Options include:

• Mild to strong painkillers (including morphine).
• Adjuvant drugs (anti-inflammatories, antidepressants for nerve pain).
• Radiotherapy, bisphosphonates or denosumab for bone-related pain.

Fatigue

Cancer-related fatigue is debilitating and differs from regular tiredness. Management tips:

• Prioritize activities
• Maintain rest-activity balance
• Gentle exercise can help
• Seek help for treatable causes (e.g., anemia)

Breathlessness

Can result from lung metastases or infections. Strategies:

• Breathing exercises
• Physiotherapy
• Fan or cool air
• Medications for inflammation or anxiety

Nausea and Vomiting

May be due to treatment or cancer itself. Anti-sickness medications are effective.

Bowel Issues

• Constipation: Often from pain medication. Manage with diet, fluids, laxatives.
• Diarrhoea: May result from drugs like abemaciclib or radiotherapy. Treated with antidiarrheal medication and dietary adjustments.

Appetite & Weight Changes

• Poor appetite: Eat small, frequent meals; high-calorie snacks; consider supplements.
• Weight gain: Can result from steroids or less activity. Diet and exercise support may help.

Monitoring and Appointments

Regular Check-Ups

• Track symptoms and treatment effectiveness.
• Discuss side effects and overall well-being.

Tumor Markers and Scans

• Tumor marker tests may support monitoring but are not always reliable.
• Scans (CT, bone, MRI) assess disease progression or treatment response.

Emotional and Psychological Support

A secondary diagnosis can bring shock, fear, and uncertainty. It helps to:

• Talk to specialist nurses or counsellors
• Join peer support groups (e.g., Living with Secondary Breast Cancer)
• Use resources like Breast Cancer Now’s forum or Helpline (0808 800 6000)

Daily Life and Practical Matters

Managing Energy

• Keep a diary of energy levels and side effects.
• Use tools like a personal organiser to track patterns and inform discussions with your team.

Work and Finances

• Consider flexible work arrangements or stopping work.
• Seek advice on benefits, insurance, and grants from advisors or Macmillan Cancer Support.

Diet and Exercise

• Eat well to maintain strength and support treatment.
• Physical activity can help manage fatigue and improve mental health.

Access to Treatment and Clinical Trials

Availability of New Treatments

Some treatments are not routinely funded by the NHS. Access may be possible through:

• Individual funding requests
• Cancer Drugs Fund (in England)
• Paying privately (discuss first with your specialist)

Clinical Trials

Trials offer access to new drugs or strategies. Benefits include:

• Extra monitoring
• Cutting-edge treatment
• Contributing to future cancer care

Discuss with your specialist or search:

• Be Part of Research
• Cancer Research UK

Palliative and Supportive Care

Palliative care focuses on:

• Managing symptoms like pain or breathlessness
• Emotional and psychological support
• Enhancing quality of life

It’s not just for end-of-life care and can be accessed early during treatment.

Hospices offer services including:

• Symptom control
• Counselling
• Complementary therapies
• Respite care

Treatment Breaks and Stopping Treatment

Some people take breaks from treatment for recovery or special occasions. Others choose to stop treatment when side effects outweigh benefits.

Stopping treatment is a personal decision and doesn’t mean care ends. Palliative support remains available.

Emergencies to Watch For

Report these symptoms immediately:

1. Blood Clots

• Swelling, redness, pain in legs or arms
• Shortness of breath or chest pain

2. Hypercalcaemia (high calcium)

• Nausea, vomiting
• Thirst, confusion, fatigue

3. Neutropenic Sepsis

• Fever (above 37.5°C or below 36°C)
• Feeling unwell, chills, or infection signs

4. Spinal Cord Compression

• New or worsening back pain
• Numbness or tingling in limbs
• Difficulty walking or controlling bladder/bowel

Making the Most of Appointments

Before

• Write down symptoms, concerns, and questions.
• Use a diary to track side effects.

During

• Take a trusted person for support or record the session.
• Speak openly about what matters to you.

After

• Ask for copies of clinic letters if helpful.
• Discuss unclear information or next steps.

Final Thoughts

Living with secondary breast cancer is challenging but manageable. With the right treatment, support, and self-care, many people live fulfilling lives for years.

Accessing the right care, managing side effects, seeking emotional support, and staying informed empowers you to live well with secondary breast cancer.

For more resources and guidance:

• Visit breastcancernow.org
• Call the free Helpline: 0808 800 6000