Breast cancer

Advanced breast cancer

What is advanced breast cancer?

When breast cancer spreads from the breast or armpit to other areas of the body, it is called advanced breast cancer. It can also be called metastatic or secondary breast cancer. The most common places for breast cancer to spread to are the bones, lungs, liver or sometimes the brain.

Advanced breast cancer can occur months or years after early breast cancer. Occasionally, it’s diagnosed at the same time as the original breast cancer or, on rare occasions, before any tumour in the breast has been diagnosed.

For many people diagnosed with early breast cancer, the future feels uncertain. The fear that the cancer could come back may never go away completely. Being diagnosed with advanced breast cancer can be even more difficult because the hope of staying well is replaced with the realisation that a cure is no longer possible.

Although there is currently no cure for advanced breast cancer, progress is being made and the growth of secondaries can often be controlled with various treatments.

With the latest treatments, some people with advanced breast cancer may live for many years.

It is very difficult to predict how someone’s cancer will progress, and every case is unique. Your medical team may be able to give you some indication regarding this, but if you would rather not have this information, let your team know so they can respect your choice.

What are the signs and symptoms to look out for?

The signs and symptoms of advanced breast cancer vary depending on where the cancer has spread to.

Symptoms include:

  • pain in your bones (for example in the back, hips or ribs) that doesn’t improve with pain relief or lasts for more than one to two weeks and is often worse at night
  • unexplained weight loss and a loss of appetite
  • constant nausea (feeling sick)
  • discomfort or swelling under the ribs or across the upper abdomen
  • feeling constantly tired
  • a dry cough or a feeling of breathlessness
  • severe or ongoing headaches
  • altered vision or speech

However, many symptoms of advanced breast cancer may be the same as those of other conditions. For example, aches and pains in the bones may be due to ageing, arthritis or treatment side effects. Breathlessness and cough can be symptoms of a cold or flu-type illness.

If you have any persistent or unexplained symptoms, the best thing to do is to talk to your doctor or breast care nurse straight away. Don’t worry that any issue is too small to seek advice on, and don’t wait for your next planned appointment. It is important to get any concerning symptoms checked as soon as possible.

How is advanced breast cancer diagnosed?

There are various tests you can have to find out the reason for your symptoms. Your GP can refer you directly for these tests, or to your previous hospital specialist. If you are still having follow up care your hospital team may organise these tests for you.

Most people will need some imaging or x-rays and the type you have depends on where your symptoms are.

Some of the most common tests are:

  • X-ray
  • Ultrasound scan
  • CT scan
  • MRI scan
  • Bone scan

Some people will also require a biopsy. If your x-ray or scan confirms that a tumour is causing your symptoms, sometimes this will be enough to allow a treatment plan to be confirmed. However, for some people a biopsy is needed to confirm the diagnosis again.

It can also be useful to have a new sample or biopsy from the tumour, as occasionally the cancer cell’s biology or receptor status can change (although they are still breast cancer cells), and this can mean that different types of treatment may help.

What is the treatment for advanced breast cancer?

The treatment for secondary breast cancer is different for everyone as it is tailored to your individual needs. It is also dependent on where the cancer is in your body and on the characteristics of the cancer cells. The team looking after you will discuss everything with you and select the best treatment for you to manage the disease but also your quality of life.

Treatments may include some that you have had before such as:

  • Radiation Therapy
  • Stereotactic radiotherapy – sometimes a very precise radiation treatment may be used for people with one or more small secondary breast cancers (this is called oligometastatic disease) that are stable (not progressing) and usually present only in one site in the body. Stereotactic radiotherapy is most commonly used to treat secondary breast cancer in the brain but can sometimes be used in other areas of the body, like the lungs and liver. This treatment enables high doses of radiation to be delivered with extreme accuracy over fewer visits. Your specialist team will be able to tell you if it is available and suitable for you.
  • Chemotherapy
  • Targeted Therapy
  • Hormonal Therapy
  • Surgery – this is different to the original diagnosis but is sometimes used to improve symptoms. For example, surgery can be used to strengthen and repair weakened or fractured bones when the breast cancer has spread to the bones.In selected cases it may be used for oligometastasis in the liver.
  • Bone strengthening drugs – Bisphosphonates are a group of drugs used to treat secondary breast cancer in the bone.They inhibit the breakdown and absorption of bone and reduce pain.

Some people may have a combination of all of these while others may only be suitable for one. Your doctor will explain this in detail before you start any treatment. You may be able to participate in a clinical trial of a new medication. Ask your oncologist if there are any trials which are appropriate for you and check our clinical trials database.

Advanced breast cancer support

It is also important to consider the need for support when diagnosed with advanced breast cancer.

When you find out that your breast cancer has spread you may experience many different emotions. Reactions can include disbelief, denial, shock, anger, fear, numbness and helplessness. Your emotions may swing from one extreme to the other or change from one day to the next.

Your mind may race ahead with worries about what’s going to happen to you. You may feel concern for people close to you or disappointment about plans that might have to change or not go ahead.

You may also find yourself questioning the value of everything that you went through following your first breast cancer diagnosis. Although these feelings are normal, don’t be afraid to ask for support to help you manage them.

Your GP and other medical team will help to guide you in accessing support at any time while living with advanced breast cancer.


You may wish to consider asking for help with:

  • Practical issues, such as work, finances and any responsibilities you have caring for others
  • Family issues, such as your relationships with your children and partner
  • Emotional issues, such as feeling isolated, depressed, worried or angry
  • Spiritual issues, such as loss of faith or feelings of regret


Support that you might choose to have includes:

  • Counselling services, where you can talk about your problems and feelings
  • Seeing a psychologist or psychiatrist
  • Talking to others with secondary breast cancer
  • Getting help from support groups, helplines, online forums and social media

Sweet Louise

Sweet Louise is an organisation that's solely focused on supporting women and men with advanced breast cancer.

Established by the Louise Perkins Foundation and inspired by the life of Louise Perkins, Sweet Louise was launched in October 2005 and is uniquely focused on the needs of New Zealanders living with secondary breast cancer.

Sweet Louise’s mission is to improve the quality of life for all New Zealanders with secondary breast cancer by offering access to a wide range of practical and supportive services.

Metavivors

Metavivors is a closed NZ forum specifically for those with advanced breast cancer. For more information contact bcac@breastcancer.org.nz.

For more information on support services visit: Support.

Video

BCFNZ Webinar 1: Living a normal(ish) life with ABC

Presented by the Breast Cancer Foundation New Zealand.

An advanced breast cancer diagnosis can be a life-changing event. In this webinar Christine Manins, Sinda Hall and Juliet Ireland will chat about coping with your diagnosis, tackling treatment and living well with the disease.

Palliative Care

You may also be referred to a palliative care team for treatment and support. Sometimes palliative care is confused with end of life care, but it’s not the same thing and it can be invaluable in your overall care. It can be included right from the very beginning of your advanced breast cancer treatment.

It will help you to:

  • Manage the symptoms of your cancer
  • Reduce the side effects of your treatments
  • Improve your quality of life

Palliative care that your treatment team may provide or organise for you include:

  • Psychological support for you and your carers, to help with any distress
  • Management of symptoms and side effects, including reducing pain, fatigue and infections
  • Social support to help with personal care and daily living, friendship, work, and finances and any responsibilities you have caring for others
  • Meeting your spiritual needs, for example by giving you opportunities to discuss your thoughts, questions and beliefs, or providing contact with a faith leader
  • Services such as lymphoedema care, physiotherapy, psychosexual counselling
  • Complementary therapy advice or provision
  • Support for your family and friends (both practical and emotional)
  • Discussions about end of life care at an appropriate time for you to ensure that your wishes are carried out including where and how you’d like to be cared for at that time and the support needed for you and your loved ones

Living with advanced breast cancer

Many women find the uncertainty of their situation one of the most difficult aspects of the diagnosis to manage. Some cope best by living in the present and not thinking too much about the future. Others find that planning ahead gives them a greater sense of control. The only right approach is the one that works best for you.

Fatigue

One of the most common symptoms that people experience with advanced breast cancer is extreme tiredness. This can be very severe and feel very different to the ordinary tiredness that everyone experiences at some time. For some it will come and go, and for others it may be relentless and may be distressing and interfere with everyday life. This tiredness can be a result of the shock and reaction to the diagnosis, or due to the physical effects of the cancer itself. It can also be due to medication or side effects of treatment.

If you feel that you are experiencing severe fatigue there are some things that you can do to help:

  • Discuss your symptoms with your medical team (they can check for underlying causes, e.g. anemia, and suggest treatment).
  • Keep a record or a diary – if you are more tired at certain times in the day you can plan to have a rest at these times.
  • Be realistic about what you can do. Try to prioritise what you have (or want) to do and plan your days so you have a balance of activity and rest. If you know that you have something planned that you really want to do then try to rest the day before.
  • Regular physical activity has been shown to improve energy levels and reduce fatigue. Short walks can help increase your appetite, give you more energy and improve wellbeing.
  • Try to eat as well as possible so your body continues to get the nutrients it needs. If your appetite is poor, it may help to eat smaller amounts more often and drink plenty of fluids to keep hydrated. You could also ask to be referred to a dietitian for advice.
  • Although remaining independent and doing things for yourself is extremely important, also try to accept offers of help from others.

Anxiety and Depression

If you’re living with secondary breast cancer, it’s common to have ups and downs and to experience a range of emotions, including anxiety and depression. For some people, their inner reserve and support from friends and family helps them to get through periods of sadness and worry. For others, the psychological impact of their cancer becomes strong enough to affect their ability to do day-to-day things. When this happens, professional services can help.

Your treatment team or GP can refer you to services to provide emotional and psychological support. They should let you know what informal and formal support is available, and how you can access it.

Support that you might choose to have includes:

  • Counselling services, where you can talk about your problems and feelings
  • Cognitive behavioural therapy. This can help you change negative patterns of thinking and behaviour. Unlike some techniques, it focuses on problems you’re having in the ‘here and now’ instead of exploring the causes of your distress or symptoms in the past, and looks for ways to improve your state of mind in the present.
  • Mindfulness. This involves focusing on the present moment to reduce stress and improve quality of life. This means noticing sights, smells, sounds and tastes, as well as thoughts and feelings from one moment to the next.
  • Seeing a psychologist or psychiatrist
  • Talking to others with secondary breast cancer
  • Getting help from support groups, helplines, online forums and social media groups

Sometimes medication may also help and your treatment team may suggest anti-depressants, anti-anxiety drugs or other medications. Don't be ashamed to admit that you’re finding it hard to cope and need help, or that you need to take medication. Some people find it particularly hard to seek professional advice, but it can help to relieve these symptoms and allow you to regain some control of your life.

Complementary therapies such as aromatherapy, massage or reflexology can help you to relax and reduce stress and anxiety.