Metastatic Breast Cancer Pleural Effusion Prognosis, Secondary Breast Cancer In The Lung

Secondary breast cancer in the liverSecondary breast cancer that has spread to the skin (skin metastases)

1. What is secondary breast cancer in the lung?2.What’s my prognosis (outlook)?3. The lungs4. Newly diagnosed or worried about a symptom?5. What treatments may I be offered?6. Clinical trials7. Palliative and supportive care8. Availability of treatments9. Managing symptoms of secondary breast cancer in the lung10. Exercise and secondary breast cancer in the lung11. Support for living with secondary breast cancer in the lung

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). It can also be known as lung metastases or secondaries in the lung.

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Secondary breast cancer in the lung is not the same as cancer that started in the lung.

Usually secondary breast cancer occurs months or years after primary breast cancer. But sometimes it’s found at the same time as the primary breast cancer, or before the primary breast cancer has been diagnosed. In this situation, the breast cancer has already spread to the other parts of the body such as thelung. This is referred to as ‘de novo’ metastatic (secondary) breast cancer, meaning the breast cancer is metastatic from the start.

2. What’s my prognosis (outlook)?

When breast cancer spreads to the lung, 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.

After a diagnosis of secondary breast cancer, 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 (growth and spread) of your secondary breast cancer. You may worry if their answers are vague, but it’s not possible to accurately predicthow each person’s illness will respond to treatment.

3. The lungs

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The lungs take up most of the chest area, extending from the collarbone down to the abdomen (tummy). They are protected by the ribcage. When we breathe in, our chest expands, our lungs inflate and air is drawn in. The diaphragm is a large dome-shaped muscle that separates the chest cavity from the abdomen (tummy). It constantly expands and relaxes to help the breathing process.

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 or virtual 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.

4. Newly diagnosed or worried about a symptom?

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

You can read ourinformation 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 thesigns and symptoms of secondary breast cancer.

5. What treatments may I be offered?

Treatment for secondary breast cancer in the lung aims to relieve symptoms and slow down the growth of the cancer.

Treatments can be given on their own or in combination.

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

How extensive the cancer is within the lungWhether the cancer has spread to other organsAny symptoms you haveWhat treatment you’ve had in the pastThe features of the cancerWhether you’ve been through the menopauseYour 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 your treatment will be and help you weigh up the potential benefits against the possible side effects you may have.

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

See our tips to help you feel confident you’re getting the best care.

Hormone (endocrine) therapy

Hormone therapy is used to treat breast cancers that are oestrogen receptor positive.

If you had a biopsy or surgery for primary breast cancer, the tissue removed will have been tested to see if it is ER+. However, in some people the oestrogen receptors change during the development of secondary breast cancer. Because of this, your doctor may discuss having a biopsy to retest for hormone receptors.

Chemotherapy

Chemotherapy destroys cancer cells using anti-cancer drugs. A number of chemotherapy drugs are used to treat secondary breast cancer. These drugs may be given on their own or in combination. The drugs you’re offered will depend on many factors, including any chemotherapy you had in the past and how long ago you had it.

Targeted therapies (also called 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 help cancer grow.

The type of targeted therapy you are offered will depend on the features of your breast cancer.Find out more about the different types oftargeted therapy.

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 (also called fractions) over a few days.

Stereotactic radiotherapy (also known as radiosurgery or stereotactic ablative body radiotherapy)

Very precise radiotherapy may be considered for some people with a limited number of small secondary cancers in the lungs who have a good level of general health and fitness. This treatment allows high doses of radiation to be delivered with accuracy and minimal damage to the surrounding tissue.

Stereotactic radiotherapy used to treat secondary breast cancer in the lung may also be called CyberKnife, which is the name of the radiotherapy machine. CyberKnife is aspecialist treatment that’s only available in some centres. Your treatment team can tell you if it may be suitable for you.

Surgery

Although surgery will not cure secondary breast cancer in the lung, occasionally it may be part of a treatment plan. Surgery is more likely to be performed if the area of secondary breast cancer in the lung is very small, can be easily accessed by the surgeon, and there’s 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.

6. Clinical trials

Many breast cancer trials look at new treatments or different ways of giving existing treatments, such as surgical techniques, chemotherapy, targeted therapies or radiotherapy. Your specialist may talk with you about a clinical trial, or if you’re interested in taking part in research you can ask them if there are any clinical trials you’re eligible to enter.

Read our general information aboutclinical trials.

You can also find listings of current trials on theCancer Research websiteand on theNational Institute for Health Research (NIHR) website.

7. 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.

People often associate palliative care with end-of-life treatment. However, many 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.

The palliative and supportive care teams are based in hospitals, hospices and the community. You can be referred by your treatment team, GP or breast care nurse depending on your situation.

8. Availability of treatments

Some treatments for secondary breast cancer may not be routinely available on the NHS. You may still be able to access these treatments in other ways, such as a clinical trial.

Find out more about theavailability of treatments.

9. Managing 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, 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.

Lymphangitis

Sometimes the lymph channels in the lung can become blocked by breast cancer cells, causing inflammation and scarring. This is called lymphangitis.

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Lymph fluid is unable to drain away from the lungs and affects the amount of oxygen reaching the blood. A common symptom of lymphangitis is breathlessness. It may also cause a dry cough and, occasionally, coughing up blood. These symptoms can be present even before it’s possible to see anything on an x-ray or scan.

If you have lymphangitis caused by your secondary breast cancer, your doctor will usually recommend treatment with chemotherapy. Steroid drugs such as dexamethasone or prednisolone may also be used.

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. Sitting forward with your arms and elbows on a raised, supportive surface can help you feel like you can breathe better.

You may also find exercise can help relieve breathlessness.

Physiotherapy

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 services provide groups, classes and clinics for this purpose.

Occupational therapy

An assessment by an occupational therapist can offer practical solutions to managing breathlessness on a day-to-day basis. They may suggest making changes around the house, such as positioning a chair or stool to stop and rest at while walking between rooms.

Relaxation

Many people find complementary therapies and relaxation helpful in managing their breathlessness.

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 caused by secondary breast cancer in the lung.

Psychological support

Anxiety and low mood can also make breathlessness worse. You can ask your oncologist, GP, specialist nurse or palliative care nurse about accessing psychological support to help you manage this.

Cough

An ongoing 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

Pain relief is a very important part of the care of many people with secondary breast cancer. Once pain is under control, many people feel less anxious and can eat and sleep better.

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. It’s very important that your pain is assessed regularly by your nurse or doctor to make sure it stays under control.

Find out more about pain and secondary breast cancer.

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. 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). Leaving the drain in until the fluid has drained completely often helps pleura stick back together. 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. Low energy levels can affect mobility (moving around) and might make it harder to manage any symptoms such as breathlessness.

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, are losing weight or have no interest in food, talk to your doctor or specialist 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.

Everyone knows what it feels like to be tired sometimes, but cancer-related fatigue can feel much more severe. It can come and go or be continuous, and this can be distressing and frustrating.

Fatigue has many causes, from psychological factors such as the stress of coping with the diagnosis, to physical ones such as the side effects of treatment, loss of appetite, medication, disturbed sleep or progression (growth and spread) of the cancer.

Fatigue may have a significant effect on your ability to cope with your cancer and its treatment. It can also affect your everyday activities and quality of life.

Find tips onmanaging fatigue.

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 (PE). 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 thighSwelling, redness or tenderness where a central line is inserted to give chemotherapy, for example in the arm, chest area or up into the neckShortness of breathTightness in the chestUnexplained cough (or coughing up blood)

10. Exercise and secondary breast cancer in the lung

Some people with secondary breast cancer in the lung have no symptoms while others have a combination of pain, sickness, loss of appetite, hiccups, tiredness and fatigue. While physical activity may help reduce some symptoms it’s important to listen to your body and not push yourself too hard. Gentle, regular activity, such as walking, is often most effective.

If you’re currently having treatment you may need to exercise at a slightly lower level. Stop if it hurts or feels like you’re working too hard.

When choosing your exercise, try to focus on aerobic activities such as walking, swimming or cycling. Activities such as dancing and gardening can also be beneficial. You could also include some light toning or conditioning exercises such as stretching or low-impact yoga. The most important thing is to choose something you can safely enjoy.

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

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

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

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

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