Secondary breast cancer in the lung

1. What is secondary breast cancer in the lung?
2. What’s my outlook?
3. Newly diagnosed or worried about a symptom?
4. How do the lungs work?
5. How is secondary breast cancer in the lung treated?
6. Palliative and supportive care
7. How to manage the symptoms of secondary breast cancer in the lung
8. Blood clots
9. Support for living with secondary breast cancer

1.  What is secondary breast cancer in the lung?

Secondary breast cancer in the lung happens when breast cancer cells spread to the lung(s). You may hear this called lung metastases or secondaries in the lung.

Breast cancer cells can spread to the lungs through the lymphatic or blood system. The lymph nodes in the centre of the chest may also be affected.

When breast cancer spreads to the lungs 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 lung is not the same as cancer that started in the lung.

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2. What’s my outlook?

When they get their diagnosis, many people want to know how long they’ve got to live.

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 predict accurately 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. How do the lungs work?

The lungs

Lung diagram

To understand the symptoms of secondary breast cancer in the lung and how it is treated, it may help to know how the lungs work.

The lungs take up most of the chest area, extending from the collarbone down to the waist. They are protected by the ribcage. When we breathe in, our chest expands, our lungs inflate and air is drawn in.

The lungs are attached to the inside of the chest wall by two thin layers of tissue called the pleura. There’s a small space (sometimes called the pleural space) between the two layers of tissue that’s filled with a small amount of fluid. This fluid stops the two layers rubbing together when we breathe.

Each lung is made up of sections called lobes. The air we breathe in is carried to our lungs by the trachea (windpipe), which divides into tubes known as the left bronchus and right bronchus (or bronchi when talking about both). The bronchi then divide into smaller tubes called bronchioles. At the end of the bronchioles are millions of tiny air sacs (alveoli). It’s here that oxygen from the air we breathe in is absorbed into the bloodstream and carbon dioxide is passed from the bloodstream into the air we breathe out.

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

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

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

  • how extensive the cancer is within the lung
  • whether the cancer has spread to other organs
  • any symptoms you have
  • what treatment you’ve had in the past
  • the features of the cancer
  • whether you have been through the menopause
  • your general health

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

Find out more about treatments for secondary breast cancer.

You may also be referred to the respiratory team, who specialise in treating people with breathing difficulties. They can help plan your treatment or manage your symptoms. Your care would continue under your usual breast oncologist, but with involvement or advice from the other team.

Hormone (endocrine) therapy

Hormone therapy is used to treat breast cancers that are oestrogen receptor positive (ER+).
The tissue from the biopsy or surgery for primary breast cancer will have been tested to see if it is ER+. However, your specialist may discuss taking a sample of tissue from your lung to retest the hormone receptors.

Chemotherapy

Chemotherapy is treatment aimed at destroying cancer cells using anti-cancer drugs. It aims to slow down and control the growth of the cancer and to relieve symptoms.
You may be offered a course of a single drug or combination of chemotherapy drugs. This will depend on any chemotherapy you had in the past and how long ago you had it.

Targeted (biological) therapies

Targeted therapies are group of drugs that block the growth and spread of cancer. They target and interfere with processes in the cells that help cancer grow.

The most widely used targeted therapy is trastuzumab (Herceptin). Only people whose cancer is HER2 positive will benefit from trastuzumab. Tissue from a biopsy or surgery for primary breast cancer will usually have been tested to see if it's HER2 positive. If you have had a biopsy of your secondary breast cancer in the lung then this will be tested to find out if it is HER2 positive.

Radiotherapy

Radiotherapy uses high energy x-rays to destroy cancer cells. It’s sometimes used to treat symptoms caused by secondary breast cancer in the lung, for example if large lymph nodes in the centre of the chest are affected. It can be given as a single dose or divided into a number of doses over a few days.

Stereotactic radiotherapy (also known as radiosurgery)

Stereotactic radiotherapy (SRS) is a very precise radiation treatment that may be considered for people with a single or a small number of secondary cancers in the lung. This treatment allows high doses of radiation to be delivered with extreme accuracy and minimal damage to the surrounding tissue.

Stereotactic radiotherapy may be delivered using a number of different types of treatment machines, for example CyberKnife. Stereotactic radiotherapy is a specialist treatment that is not available in all hospitals – you may need to travel to a different centre. Your specialist team can tell you if it may be suitable for you.

Surgery

Although surgery will not cure secondary breast cancer in the lung, occasionally an oncologist may ask the opinion of a specialist lung surgeon. This is more likely if the area of secondary breast cancer in the lung is very small, can be easily accessed by the surgeon, and there is no other secondary breast cancer elsewhere in the body.

Video-assisted thoracoscopic surgery (VATS)

Video-assisted thoracoscopic surgery (VATS) is a type of operation that allows doctors to see inside the chest and lungs. Under general anaesthetic, a thin tube with a built-in camera (known as a thoracoscope) is placed through a small cut in the side of the chest to help the surgeon see inside. One or two other small cuts are made in the skin, and surgical instruments can be passed though these. It can be used to take tissue from the lung for a biopsy or to treat a pleural effusion.

Radiofrequency ablation

Radiofrequency ablation (RFA) involves inserting a needle into individual tumours in the lung and destroying them with heat. RFA is a specialist treatment and is not widely available. It can be used alone or in combination with other treatments. Your specialist team can tell you if it may be suitable for you.

Availability of treatments

Some treatments for secondary breast cancer may not be routinely available. You may still be able to access these treatments in other ways.

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 information about accessing a treatment, you can speak to your specialist team. You can also call our Helpline on 0808 800 6000 to talk through your concerns.

Clinical trials

Your specialist may talk with you about a clinical trial, or if you are interested in taking part in clinical research you can ask them if you are eligible for a clinical trial. Find out more about clinical trials.

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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 in the lung

Breathlessness

One of the more common symptoms of secondary breast cancer in the lung is breathlessness. The medical term for this is dyspnoea.

Breathlessness does not cause harm but can be distressing and frightening, which can make your symptoms worse. You may find breathing is uncomfortable, or feel that you can’t get enough air into your lungs. You may experience breathlessness when you are still or lying down, but it is often more noticeable when you are moving. However, it’s still good to be as active as you can.

Breathlessness can happen for different reasons. For example, sometimes the lymph channels in the lung are affected by the cancer, and can become inflamed and blocked. This is called lymphangitis. Steroid drugs such as dexamethasone or prednisolone can sometimes help reduce this.

Secondary breast cancer in the lung can increase the risk of chest infections, which can also cause breathlessness. In this case you may be treated with antibiotics.

There are several practical things you can do to help ease your breathlessness. Cooling your face with cold water, using a hand-held fan or sitting near an open window can be helpful.

You may also find exercise can help relieve breathlessness.

Physiotherapy can be helpful in treating breathlessness. Learning relaxation and breathing techniques to use when you start feeling breathless can also help. Your medical team may be able to refer you to a physiotherapist or to a palliative and supportive care team to teach you breathing exercises. A number of palliative care services provide groups, classes and clinics for this purpose.

If necessary, your doctors can give you medicines such as lorazepam from a group of drugs called benzodiazepines (which have sedative and muscle relaxant properties), Ventolin (a drug that can relax the airways) or low doses of codeine or morphine to help ease the feeling of breathlessness.

Oxygen has not been found to be a helpful treatment for breathlessness. 

Cough

A persistent cough is another common symptom that can be distressing and tiring. It may be caused by the cancer itself, or an infection. Phlegm can build up in the chest and throat and may be difficult to bring up.

Cough medicines can help to control coughing, or medicines known as mucolytic medicines may be prescribed to help loosen the phlegm. Your doctors may recommend a nebuliser, which is a device that turns liquid medicine into a mist that can be inhaled through a mouthpiece. Using 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 a codeine-based drug or low-dose morphine or steroids.

Pain

Although many people with secondary breast cancer in the lung do not experience pain, if the cancer affects the lining around the lungs (the pleura) it may cause irritation leading to pain or discomfort when breathing. This is often worse when breathing in or coughing.

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

Find out more about pain and secondary breast cancer.

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

Pleural effusion

A pleural effusion is a build-up of extra fluid between the pleural layers and will usually be confirmed by a chest x-ray. It may develop if cancer cells have spread into the pleura, causing irritation and producing fluid that can then build up.

It might make you feel breathless but this can sometimes be eased by getting rid of the extra fluid. This can be done in two ways. A small amount can be removed by numbing the area with a local anaesthetic and drawing the fluid off with a needle and syringe.

If there is a larger amount of fluid, a narrow drainage tube can be inserted into the pleural space, also under a local anaesthetic. It will then be stitched into place and connected to a drainage bottle. This allows the fluid to drain out slowly over time (often a few days). This procedure can be repeated if the fluid builds up again. Sometimes a permanent drain may be inserted so fluid can be drained regularly and more easily at home.  

Sometimes after a pleural effusion has been drained another procedure called a pleurodesis is performed. This involves injecting a drug or powder into the drain, then leaving the drain clamped for about one hour before removing it. This aims to seal the two layers of the pleura together to prevent the fluid building up again.

Poor appetite and weight loss  

Sometimes people with secondary breast cancer can’t eat as much as usual. This means they have difficulty maintaining their weight as well as providing the body with energy. Poor appetite can be due to the effects of the cancer, treatment or anxiety. A small number of people may have difficulty swallowing.
You might find it easier to eat little and often instead of having set meals. If you still feel you aren’t eating enough, or are losing weight, talk to your doctor or nurse about dietary supplements or ask to speak to a dietitian for specialist advice.
In some circumstances you may be prescribed medication to help stimulate your appetite.
Fatigue (extreme tiredness)
Cancer-related fatigue is one of the most common symptoms experienced by 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. Causes such as difficulty sleeping or anaemia can be treated and may improve the feelings of fatigue.

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

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8. 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)

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9. Support for living with secondary breast cancer

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.

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

Last reviewed: August 2017
Next planned review begins 2019

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