| Secondary
Lung Cancer
This section is for those who have been diagnosed with
secondary cancer in the lungs that has spread from the breast.
It describes what secondary lung cancer is, what the symptoms are
and the treatments used. We hope it answers some of your questions
and helps you to discuss your options with your specialist team.
Page Contents
What is secondary lung cancer?
How do the lungs work?
What symptoms might I have?
What investigations will I need?
What treatments might I be offered?
Living with secondary lung cancer
Help from Action Breast Cancer
What is secondary lung cancer?
Secondary lung cancer occurs when cancer cells spread from the
breast through the bloodstream and settle in the lungs. You may
hear this type of spread described as metastases, recurrence
of the cancer, secondary tumours or secondaries. The cells in
the lungs are breast cancer cells. It is not the same as having
a cancer that starts in the lungs (primary lung cancer).
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How do the lungs work?
To understand some of the symptoms described in this section
it may help to look at how the lungs work. The lungs sit on either
side of the chest and are protected by the rib cage. The lungs
are lined with two layers of thin tissue called the pleura. The
inner layer is attached to the outside of the lungs and the outer
layer lines the inside of the chest wall. There is a small space
(the pleural space) between the two layers of tissue that is filled
with a small amount of fluid. The fluid stops the two layers of
tissue from rubbing together when we breathe. Each lung is made
up of sections called lobes. The air we breathe is carried to the
lungs via two tubes known as the left and right bronchus that divide
into smaller tubes called bronchioles. At the end of the bronchioles
are millions of tiny air sacs (alveoli). It is here that the oxygen
from the air we breathe in is taken into the bloodstream (in order
to make energy) and carbon dioxide is passed from the bloodstream
into the air we breathe out.
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What symptoms might I have?
If you have developed secondary lung cancer you may have a number
of different symptoms. They can range from mild to severe, depending
on how advanced the secondary lung cancer is.
Shortness of breath
The most common symptom of secondary lung cancer is shortness of
breath which can be distressing. The medical term for this is dyspnoea.
You may find breathing is uncomfortable, or feel that you can’t
get enough air into your lungs. Not being able to breathe properly
can make you anxious. This can lead to you feeling panicky, which
can make your symptoms worse. You may find that you can learn to
manage the problem yourself through exercises to control your breathing.
Relaxation techniques can also be very helpful in reducing anxiety.
If necessary, your doctors can give you medicines to help ease
the feeling of breathlessness and the anxiety that it can cause.
Breathlessness can happen for different reasons. The tumour can
narrow or block the airways (bronchial tubes). Sometimes the tumour
may cause swelling or inflammation that can add to the difficulty
in breathing. Steroid drugs such as dexamethasone and prednisolone
can help reduce this swelling. Antibiotics may be helpful if you
have a chest infection. In some circumstances oxygen can help relieve
breathlessness. Your doctor will be able to tell you if it will
be useful for you.
Cough
A cough that does not clear is another common symptom that
can be distressing. It may be caused by the cancer itself, or an
infection. Phlegm may build up in the chest and throat and can
be difficult to bring up. Cough medicine may help to control coughing
and loosen the phlegm. Breathing salt water through a nebuliser
can also help to loosen the phlegm, making it easier to bring up.
If the cough is very difficult to control your doctors may prescribe
drugs such as morphine. Gentle physiotherapy may also help.
Pain
Most pain can be successfully treated. If you have pain your doctors
will ask you to describe where the pain is, how it feels, how strong
it is and what makes it better or worse. This will help them decide
what to do to control your pain.
Pleural effusion
A pleural effusion is a build up of extra fluid in the pleural
space. It may make you feel even more breathless and this can be
eased by drawing off the extra fluid. This is done by inserting
a narrow tube into the pleural space. If there is a lot of fluid
the tube can be attached to a drainage bottle and left in place
until it has all drained off. Sometimes the specialist will inject
a drug through the tube, which can help to stop the fluid from
building up. You will need to go into hospital or a hospice to
have this done.
Loss of appetite and weight loss
You may lose your appetite because of the cancer, your symptoms
or the side effects of treatment. Nutritional supplements may be
useful to you if you feel you are not managing to eat enough. Your
GP or specialist can prescribe these or can refer you to a dietician
for advice.
Tiredness
Tiredness can be due to a number of things, such as your treatment,
poor appetite, anxiety or because you have secondary lung cancer.
Some causes such as anaemia (lack of red blood cells) are treatable
so tell your GP or specialist how you feel. Try to have a balance
of rest and exercise and if you have things you must do or you
enjoy doing, try to pace yourself and expect to take longer to
do them. Sometimes your doctor may prescribe steroids as they can
work like a tonic and boost your energy.
Call the National
Cancer Helpline on Freefone 1800 200 700 to ask for our booklet
on Understanding Fatigue.
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What investigations will I need?
Chest x-ray
A chest x-ray is usually the first investigation that will be done.
If a tumour is small it may not always show up on an x-ray.
CT
scan (computerised tomography)
If the x rays are not clear you
may need a CT scan. This is a type of x-ray that creates a three-dimensional
picture of the lungs. The scan is completely painless but you will
have to lie still for about half an hour.
MRI (magnetic resonance imaging)
This scan uses magnetic waves instead of x-rays. It is usually
used if the CT scan pictures are not clear. It is not painful but
you will have to lie still for up to an hour.
Biopsy
A biopsy of the lungs may be needed if your specialist is uncertain
about the diagnosis. Under local anaesthetic a tube (called a bronchoscope)
is passed into the mouth and down into the lungs. A small piece
of lung tissue can then be removed and examined under a microscope.
You will be given medication to make you relaxed before the procedure.
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What treatments might I be offered?
Surgery to remove secondary lung cancer may be possible for a small
number of people. Secondary lung cancer can be treated although
it cannot be cured in the long term. The aim is to relieve your
symptoms and improve your quality of life by slowing down the growth
of the cancer. You may be offered treatments such as chemotherapy,
hormone therapy and radiotherapy, either alone or in combination.
Chemotherapy
If you had chemotherapy when your breast cancer was first treated
you may be given a similar combination of drugs, or you may be
offered different ones. For more information, call the National
Cancer Freefone Helpline on
1800 200 700.
Hormone therapy
Hormone therapies are usually used to treat cancers that are sensitive
to hormones such as oestrogen. There are a number of different
hormone drugs and your specialist will decide which one is right
for you.
Monoclonal antibodies
Monoclonal antibodies are a new group of drugs used to treat secondary
breast cancer. An example of a drug used is Herceptin (trastuzumab).
In 25-30% of breast cancers, cells become overloaded with a protein
called HER2 and grow and divide uncontrollably. Monoclonal antibodies
aim to stop the cells growing and dividing. For more information,
see our section
on Herceptin.
Radiotherapy
Radiotherapy is sometimes used to treat secondary lung
cancer. It can be given as a single dose or divided doses over
a few days. Internal radiotherapy or brachytherapy may be given
when the tumour is blocking one of the airways. A thin tube (catheter)
containing radioactive material is placed close to the tumour using
a bronchoscope (a thin flexible tube used to examine the inside
of the airways). Usually only one treatment is required. For more
general information, please contact the National Cancer Freefone
Helpline on 1800 200 700 or see the section on Radiotherapy.
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Living with secondary lung cancer
Knowing that your cancer has spread to your lungs may leave you
feeling a variety of emotions similar to when you were first diagnosed,
only this time they may be stronger. There may be times when you
feel overcome by fear, anxiety, sadness, depression or anger. The
uncertainty of living with secondary lung cancer can sometimes
contribute to you feeling emotionally up and down. You may be able
to cope with these feelings on your own or with the support of
those closest to you such as your family and friends. If you find
you need extra support, you can talk to your breast care nurse,
or home care nurse. A social worker may be able to offer more practical
support. A councillor or psychotherapist may be more appropriate
if you need more long-term professional help. The Irish Cancer
Society funds a counselling service which may help you to see things
differently and help you through a difficult patch. You may be
able to express worries or concerns to a counsellor that you do
not wish to discuss with others. For more information, call the
National Cancer Freefone Helpline on 1800 200 700.
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Help from Action Breast Cancer
Action Breast Cancer is a national project established by the Irish Cancer Society
to provide breast cancer information and support and to fund breast cancer research.
Its services are free, confidential and accessible. For more information call
the National Cancer Helpline on Freefone 1800 200 700 or visit www.cancer.ie
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ABC would like to thank Breast Cancer Care in the UK for their permission
to adapt the text in this factsheet from their series of factsheets.
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