How is metastatic breast cancer treated?
Treatment for metastatic breast cancer is to control the growth and spread of the cancer rather than cure it. Treatment can also help to relieve your symptoms and improve your quality of life.
Sometimes the cancer and its symptoms can be kept under control for many years. For some women, living with metastatic breast cancer is like living with a chronic (long-term) illness.
A treatment is used until it stops working or side-effects become difficult to control. Then another treatment is started. This can control the disease, sometimes for a long time.
The female hormones oestrogen and progesterone can cause the growth of some breast cancer cells. Changing the level of these hormones in your body can slow down or stop the growth of metastatic breast cancer. Hormone therapy is suitable if you have oestrogen-receptor positive or progesterone-receptor positive cancer. It is usually used as the first treatment for metastatic breast cancer.
You may have hormone therapy alone or in combination with other treatments.
Different targeted therapies work in different ways. The types used for breast cancer target specific genes and proteins that are involved in the growth and survival of cancer cells.
Drugs that kill cancer cells thereby slowing down and controlling cancer growth. You may be offered chemotherapy:
- If your cancer is growing quickly.
- If the cancer is affecting how your liver or lungs are working.
- If you don’t have hormone receptors on your cancer cells or if hormone therapy isn’t working to control your cancer any more.
You may have chemotherapy on its own or together with other treatments.
A medical oncologist is a doctor who specialises in treating cancer with drug treatments. These are often used for advanced (metastatic) cancer.
If the metastatic breast cancer is affecting your bones, you might be given bone strengthening drugs called bisphosphonates. These can slow down or prevent bone damage and may reduce the spread of cancer. These can also be used to lower calcium levels in your blood if you have a condition called hypercalcaemia.
Bisphosphonates can help to strengthen bones weakened by cancer and reduce the risk of fractures. Bone pain can be reduced as well. In fact, the drug can help reduce pain that has not responded well to painkillers or is too widespread for local radiotherapy.
Radiotherapy uses X-rays to destroy cancer cells. The aim of radiotherapy in metastatic breast cancer is to reduce the size of the cancer in some parts of your body and relieve symptoms such as pain. This is called palliative radiotherapy. It's used:
- To improve your mobility, decrease pain, prevent any possible fractures or spinal cord compression with cancer spread to your bones.
- To shrink the tumour and relieve pain or swelling if the cancer has spread to other parts of your body.
- To control the cancer coming back in your skin or armpit.
Radiotherapy is a localised treatment, which means it only treats the area of your body that it is aimed at.
Usually you will only need a short course of radiotherapy. You may have a single dose or a dose divided over a few days. Because metastatic breast cancer usually only needs a short course of radiotherapy most women have few side-effects.
Surgery is rarely an option for people with metastatic breast cancer. It is not likely to remove all the cancer. Drugs tend to be a better option. You may have surgery to:
- To get a sample of tissue to send to the lab. The doctor will use the lab results to decide which treatments options are most suitable for your cancer. How the sample is removed will depend on where the cancer has spread.
- To treat a fracture or replace a damaged joint, if the cancer is affecting your bones.
- To help with lung problems.
- To remove small areas of cancer or drain fluid from your brain, if the cancer has spread there.
- To remove a small cancer in a single area of the liver, if the cancer has spread there.
- To help with cancer that has grown out through your skin, or is pressing on nerves and causing pain or a blocked bowel.
What’s the best treatment for me?
The best treatment for you will depend on:
- Where the secondary cancer is in your body.
- If your breast cancer cells are positive or negative for hormone receptors or HER2.
- Your age and if you have gone through the menopause or not.
- Your previous cancer treatments and response to those treatments.
- How the cancer affects your everyday living and quality of life.
- Your personal preference.
Palliative care doctors and nurses are experts in managing the symptoms of advanced cancer, such as bone pain, tiredness or breathlessness. They are also called the symptom control team. Read more about side-effects and symptoms.
Having palliative care doesn’t mean that you’re at the end of your life. The expertise of the palliative care team means that your symptoms can be better managed and new problems can be spotted and treated early, to help you to feel as well as possible. The palliative care team may be involved in your care at many different times.
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