Secondary breast cancer in the brain

1. What is secondary breast cancer in the brain?
2. What’s my outlook?
3. Newly diagnosed or worried about a symptom?
4. What is leptomeningeal metastases?
5. How is secondary breast cancer in the brain treated?
6. Palliative and supportive care
7. How to manage the symptoms of secondary breast cancer in the brain
8. Fatigue (extreme tiredness)
9. Blood clots
10. Can I drive if I have secondary breast cancer in the brain?
11. Support for living with secondary breast cancer in the brain

1. What is secondary breast cancer in the brain?

Secondary breast cancer in the brain happens when breast cancer cells spread to the brain. It can also be known as brain metastases. You may also hear this type of spread described as metastatic breast cancer, metastases, advanced breast cancer, secondary tumours, secondaries or stage 4 breast cancer.

When breast cancer spreads to the brain, it can be treated but cannot be cured.

Treatment aims to control and slow down the spread of the cancer, relieve symptoms and give you the best quality of life for as long as possible.

Secondary breast cancer in the brain in not the same as cancer that started in the brain.

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2. What’s my outlook?

Many people want to know how long they’ve got to live when told they have secondary breast cancer in the brain.

As treatments have improved, more and more people are living longer after a diagnosis of secondary breast cancer. However, life expectancy is difficult to predict as each person’s case is different and no two cancers are the same.

Your specialist can talk to you about the likely progression of your secondary breast cancer. You may worry if their answers are vague, but it isn’t possible to accurately predict how each person’s illness will respond to treatment.

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3. Newly diagnosed or worried about a symptom?

In the days or weeks after a diagnosis of secondary breast cancer, you may feel in turmoil and find it hard to think clearly.

You can read our information for people newly diagnosed with secondary breast cancer, including where to find support.

If you haven’t been diagnosed but are worried about a symptom, find out more about the signs and symptoms of secondary breast cancer.

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4. What is leptomeningeal metastases?

Leptomeningeal metastases (also known as carcinomatous meningitis) develop when secondary breast cancer spreads to the membranes (tissues) surrounding the brain and spinal cord. The leptomeninges are the two innermost layers.

Symptoms of leptomeningeal metastases are similar to those of secondary breast cancer in the brain, but may be less obvious and more difficult to diagnose. It’s usually diagnosed following an MRI scan, but you may also have a lumbar puncture (a needle inserted into the spine) to obtain a sample of fluid for examination under a microscope. This fluid is cerebrospinal fluid (CSF), a clear fluid that surrounds and supports the brain and spinal cord.

Treatment usually includes steroids, radiotherapy and/or chemotherapy. Chemotherapy may be given using a technique called intrathecal chemotherapy. This treatment delivers drugs directly into the fluid surrounding the brain and spinal cord to treat the cancer.

Like secondary breast cancer that occurs in other parts of the brain, supportive and palliative care is an extremely important part of treatment and can significantly improve quality of life for patients and their families.

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5. How is secondary breast cancer in the brain treated?

Treatments for secondary breast cancer in the brain can be given alone or in combination. 

When making decisions about how best to treat you, your specialist team will consider:

  • how many tumours you have
  • which parts of the brain are affected
  • whether the cancer has spread elsewhere in the body
  • any symptoms you have
  • what treatment you’ve had in the past
  • the features of the cancer
  • whether you’ve been through the menopause
  • your general health

Your specialist should discuss any recommendations with you and take into account your wishes. They’ll talk with you about your options, explain the aim of treatment and help you weigh up the potential benefits against the possible side effects.

Find out more about treatments for secondary breast cancer.

Radiotherapy

This is the most commonly used treatment for secondary breast cancer in the brain. It involves the use of high energy x-rays to destroy cancer cells.

Whole brain radiotherapy

Radiotherapy may be given to the whole brain if there are multiple areas of secondary breast cancer in different areas of the brain, or if there is disease involving the meninges (the covering of the brain).

Stereotactic radiosurgery (also known as stereotactic radiotherapy)

Very precise radiotherapy may be considered for people with a single or limited number of small secondary cancers in the brain. This treatment allows high doses of radiation to be delivered with extreme accuracy and minimal damage to the surrounding tissue. It may also be given in combination with surgery or whole brain radiotherapy.

Stereotactic radiotherapy may also be called CyberKnife or GammaKnife, which are the names of the radiotherapy machines. These are specialist treatments that are only available in some centres. Your specialist team can tell you if it may be suitable for you.

Surgery

Although surgery won’t cure secondary breast cancer in the brain, occasionally your specialist may ask the opinion of a surgeon.

Surgery is more likely if there is a single or very few areas of secondary breast cancer in the brain that can be safely accessed by the surgeon.

Surgery may also be used to relieve pressure on the brain.

Targeted (biological) therapies

This is a group of drugs that block the growth and spread of cancer. They target and interfere with processes in the cells that cause cancer to grow. Find out more about targeted therapies

The most widely used targeted therapy is trastuzumab (Herceptin). Only people whose cancer has high levels of HER2 (called HER2 positive) will benefit from having trastuzumab. HER2 is a protein that makes cancer cells grow.

The tissue from the biopsy or surgery for your primary (early) breast cancer will have been tested to see if it is HER2 positive. If you have had a biopsy of your secondary breast cancer in the brain then this will be tested to find out if it is HER2 positive.

The benefits of targeted therapies for the treatment of secondary breast cancer in the brain are being studied in clinical trials.

Hormone (endocrine) therapy

Hormone therapy is used to treat breast cancers that are oestrogen receptor positive (ER+). Tissue from the biopsy or surgery for primary breast cancer will have been tested to see if it's ER+. If you have had a biopsy from your secondary breast cancer in the brain this will be tested to see if it is ER+.

Chemotherapy

Chemotherapy is treatment aimed at destroying cancer cells using anti-cancer drugs (also called cytotoxic drugs), and is sometimes used to treat secondary breast cancer in the brain. If chemotherapy is an option, your specialist team will discuss this with you.

Availability of treatments

Some treatments for secondary breast cancer may not be routinely available on the NHS. Currently you may still be able to access these treatments, for example through the Cancer Drugs Fund (in England) or other funding bodies.

Macmillan Cancer Support has information about what you can do if your treatment isn’t available.

It can be frustrating and distressing if a treatment you and your cancer specialist feel could benefit you isn’t routinely available. For help and advice about accessing a treatment, you can speak to your doctor or specialist nurse. You can also call our Helpline on 0808 800 600 to talk through your concerns.  

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6. Palliative and supportive care

Palliative and supportive care focuses on symptom control and support. It’s an extremely important part of the care and treatment for many people with secondary breast cancer and can significantly improve quality of life for them and their families.  

Palliative care is usually associated with end-of-life treatment. However, people value having it at any stage of their illness, alongside their medical treatment, to help prevent and relieve symptoms such as pain or fatigue. It can also help with the emotional, social and spiritual effects of secondary breast cancer.

You can be referred by your specialist team, GP or breast care nurse depending on your situation.

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7. How to manage the symptoms of secondary breast cancer of the brain

Seizures (fits)

A seizure is a short-term period of abnormal activity in the brain. Usually the person will lose consciousness and their muscles will twitch. It can happen without warning and can be very frightening to watch. Seizures may also happen without much movement – instead, the person may stare into space or be unable to talk. Sometimes only the hand or leg will jerk – this is called a partial seizure.

Most seizures pass quickly and are not necessarily a medical emergency. However there are different causes of fits so you should tell your GP or specialist team if you start having them. They can usually be managed by medication.

Nausea and vomiting

If you experience nausea (feeling sick) or vomiting (being sick), it may be due to your secondary breast cancer in the brain or elsewhere in the body, its treatment or emotional side effects such as anxiety.

In most cases, nausea and vomiting can be controlled and treated with anti-sickness drugs, steroids or benzodiazepines (drugs that work on the brain and nerves to produce a calming effect). It’s important for your doctor to try to find out the cause so that it can be managed effectively.

You can help your specialist or palliative care team decide what treatment will work best by keeping a record of what makes nausea or vomiting worse or when it happens.

Pain

You may experience headaches that occur due to the build-up of pressure within the brain caused by the area(s) of secondary breast cancer. These might be different to headaches you’ve had before (they may get worse, continue for days or not go away completely).

Most pain can be relieved or controlled. Once pain is under control, many people feel less anxious and can eat and sleep better.

Find out about pain control and secondary breast cancer.

There are many different types of pain relief and often a combination of drugs will be needed. It’s very important that your pain is assessed regularly by your nurse or doctor to make sure it stays under control.

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8. Fatigue (extreme tiredness)

Cancer-related fatigue is one of the most common symptoms in people with secondary breast cancer. Fatigue may have a significant effect on your ability to cope, your mood and your relationships.

Tell your doctor or palliative care team about the fatigue so you can be fully assessed.

Find out more about fatigue and secondary breast cancer and how to cope.

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9. Blood clots

People with breast cancer have a higher risk of blood clots. Their risk is higher because of the cancer itself and some treatments for breast cancer.

You may be at risk of a blood clot forming known as a deep vein thrombosis (DVT). People with a DVT are at risk of developing a pulmonary embolism. This is when part of the blood clot breaks away and travels to the lung.

Blood clots can be harmful but are treatable so it’s important to report symptoms as soon as possible.

If you experience any of the following symptoms contact your local A&E department, GP or specialist team straight away.

  • Pain, redness/discolouration, heat and swelling of the calf, leg or thigh.
  • Swelling, redness or tenderness where a central line is inserted to give chemotherapy, for example in the arm, chest area or up into the neck.
  • Shortness of breath.
  • Tightness in the chest.
  • Unexplained cough (may cough up blood).

Find out more about blood clots.

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10. Can I drive if I have secondary breast cancer in the brain?

If you drive, you are required by law to tell the Driver and Vehicle Licensing Agency (DVLA, or DVA in Northern Ireland) that you have secondary cancer in the brain. If you have been diagnosed with secondary breast cancer in the brain you will not be allowed to drive again until you have their approval. Once you have given up your licence, DVLA medical advisers will decide if a licence can be issued back to you and when this might be.

You can call the DVLA on 0300 790 6806 or use their email service via the DVLA website.

If you have secondary breast cancer you can apply for a Blue Badge. This will allow you to park closer to your destination, whether you are the driver or the passenger.

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11. Support for living with secondary breast cancer in the brain

Everyone’s experience of being diagnosed with secondary breast cancer is different, and people cope in their own way.

For many people, uncertainty can be the hardest part of living with secondary breast cancer.

You may find it helpful to talk to someone else who’s had a diagnosis of secondary breast cancer.

  • Chat to other people living with secondary breast cancer on our online Forum.
  • Meet other women with a secondary diagnosis and get information and support at a Living with Secondary Breast Cancer meet-up.
  • Live Chat is a weekly private chat room where you can talk about whatever’s on your mind.

You can also call Breast Cancer Care’s Helpline free on 0808 800 6000.Back to top


Last reviewed: August 2017
Next planned review begins 2019

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