Secondary breast cancer in the lung

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1 Secondary breast cancer in the lung This booklet is for people who have been diagnosed with secondary breast cancer in the lung. It describes what secondary breast cancer in the lung is, what the symptoms are and the treatments used. Lorem ipsum dolore estes Secondary breast cancer

2 2 Call our Helpline on We hope this booklet answers some of your questions about secondary breast cancer in the lung and helps you to discuss your options with your specialist team. We suggest you read it alongside our Secondary breast cancer resource pack. What is secondary breast cancer in the lung? Sometimes breast cancer cells spread to one or both lungs through the blood or lymph system. It s not uncommon for the lymph nodes in the centre of the chest (mediastinum) to also be affected. The cells that have spread to the lungs are breast cancer cells. It s not the same as having cancer that starts in the lungs (a lung cancer). When breast cancer spreads to the lungs it can be treated but cannot be cured. The purpose of treatment is to try to relieve symptoms and/or slow the growth of the cancer. You may hear this type of spread described as metastases, advanced breast cancer, recurrence of the cancer, secondary tumours, Stage 4 or secondaries. How do the lungs work? To understand some of the symptoms described in this booklet it may help to look at how the lungs work. Collarbone Pleural space Pleura Diaphragm

3 Visit 3 The lungs take up most of the chest area, extending from above 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. The inner layer is attached to the outside of the lungs and the outer layer lines the inside of the chest wall. There s a small space between the two layers of tissue that is filled with a small amount of fluid (sometimes called the pleural space). This fluid allows the pleura to move over each other smoothly and stops the two layers of tissue 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 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. What investigations will I have? You may need one or more of the following tests in order for your doctors to confirm a diagnosis of secondary breast cancer in the lung. Chest x-ray A chest x-ray is often the first investigation that will be done. CT (computerised tomography) scan You may also have a CT scan. This is a type of scan that uses x-rays to take a series of detailed pictures across the body, also known as a CAT scan. PET (positron emission tomography) scan This type of scan shows how effectively parts of the body are working. It s not often used for diagnosis but may help your specialist team see how far the cancer has spread and how well it s responding to treatment. PET-CT scan This combines a CT scan with a PET scan in one test to create a more detailed picture.

4 4 Call our Helpline on MRI scan (magnetic resonance imaging) This scan uses magnetism and radio waves to produce a series of cross-sectional images of the inside of the body. Biopsy Sometimes a biopsy of the lung is taken. This is done under local anaesthetic and a tube (called a bronchoscope) is put through the mouth and down into the lungs. A small piece of lung tissue can then be removed and examined under a microscope. Sometimes a biopsy can be taken through the skin using a CT scan for guidance. In some cases, fluid can collect in the space around the lungs (the pleural space). If this happens, a small amount may be removed with a biopsy for testing. Blood tests You may have blood tests although the type of test can depend on your symptoms and any treatment you are currently having. Your specialist team will discuss what tests they are doing and why you are having them. Some people have a blood test for tumour markers. These are proteins found in the blood which may provide additional information about how you are responding to treatment but there is some debate about how accurate they are so they are not always used. What treatments might I be offered? You will be offered treatments aimed at slowing the growth of the cancer as well as treatments to relieve symptoms such as pain or breathlessness. Your treatment may include hormone therapy, chemotherapy, radiotherapy and targeted therapies, either alone or in combination. Some people may consider asking for a second opinion. You can ask your specialist team to refer you to another specialist in the same hospital or elsewhere. The second opinion may not be different from the one you have already had. The time taken to get a second opinion may delay your treatment slightly, and the specialist treating you will be able to discuss any impact this might have. You may be offered one or more of the following treatments.

5 Visit 5 Hormone (endocrine) therapy Hormone treatments are used to treat cancers that are stimulated to grow by the female hormone oestrogen (known as oestrogen receptor positive or ER+). The tissue from the biopsy or original surgery for primary breast cancer will usually have been tested to see if it is ER+. The hormones oestrogen and progesterone help to stimulate some types of breast cancer to grow. This happens if the tumour cells have hormone receptors on their surface that respond to the hormone. These cancers are sometimes called hormone receptor positive. Your specialist will occasionally discuss taking a sample of lung tissue to re-test the hormone receptor status depending on your individual situation. If you have previously had hormone therapy, your doctor may prescribe the same hormone therapy again or change it to a different drug. For more information about these treatments, see our individual hormone therapy drug booklets. Chemotherapy You may be offered chemotherapy which can be a combination of chemotherapy drugs or a course of a single drug. This will depend on any chemotherapy you have had in the past and how long ago you had it. For more general information about this treatment see our Chemotherapy for breast cancer booklet or our information on chemotherapy drugs. Radiotherapy Radiotherapy is 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 causing symptoms. It can be given as a single dose or divided into a number of doses over a few days. Targeted cancer therapies This group of drugs works by blocking specific ways that breast cancer cells divide and grow. The most well-known targeted therapy is trastuzumab (Herceptin) but the benefits of others are being looked at in clinical trials so it is likely more targeted therapies will become available in the future. Only people whose cancer has high levels of HER2 (HER2 positive), a protein that makes cancer cells grow, can benefit from having

6 6 Call our Helpline on trastuzumab. To find out whether breast cancers are HER2 positive, a laboratory test will usually have been done on tissue from the biopsy or original surgery for primary breast cancer. However, your specialist will occasionally discuss taking a sample of lung tissue to re-test the HER2 receptors depending on your individual situation. If your cancer is HER2 negative, then trastuzumab (Herceptin) will not be of benefit to you. For more information see our Trastuzumab (Herceptin) booklet. Surgery Surgery is rarely used for secondary breast cancer in the lung, especially if more than one area of the lung is affected. If you have secondary breast cancer in the lung you may have microscopic secondary breast cancer cells in other parts of your body too, so surgery will not be appropriate. However, if the secondary tumour in the lung is very small and you have no symptoms or disease elsewhere, your doctor may consider surgery. Video-assisted thoracoscopic surgery (VATS) is a type of operation that allows doctors to see inside the chest and lungs. During this operation 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 (see page 8). What symptoms might I have and how can they be managed? If you have secondary breast cancer in the lung you may have a number of different symptoms. Breathlessness One of the more common symptoms of secondary breast cancer in the lung is breathlessness. The medical term for this is dyspnoea. You may find breathing is uncomfortable, or feel that you can t get enough air into your lungs. This is often more noticeable when you are moving but some people may experience breathlessness when they are still or lying down. Breathlessness can happen for different reasons. For example, sometimes the lymph channels in the lung are affected by the cancer,

7 Visit 7 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. Not being able to breathe properly can make you feel anxious and frightened. This can lead to feeling panicky, which can make your symptoms worse. There are several practical things you can do to help ease your breathlessness. Using a hand-held fan or sitting near an open window to get cool air on your face can be helpful. 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 care doctor or nurse to teach you breathing exercises which may help. 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), or Ventolin, a drug that can relax the airways, or low doses of codeine or morphine to help ease the feeling of breathlessness. You may also find exercise can help relieve breathlessness (see page 10). 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 may help to either control coughing or loosen the phlegm. 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. Pain Most pain can be relieved or controlled. Always tell your doctors if you have pain. They will ask you to describe where the pain is, how it feels, how strong it is and what makes it better or worse. This will help them decide what to do to control your pain. There are many different types of pain relief and often a combination of drugs may

8 8 Call our Helpline on be needed. If pain relief does not seem to be helping, tell your doctors, as they will be able to prescribe a different treatment. You may also be referred to a specialist palliative care or symptom control team, who are experts in managing symptoms. Pleural effusion A pleural effusion is a build-up of extra fluid between the pleural layers and will usually be confirmed with a chest x-ray. It may make you feel breathless but this can sometimes be eased by taking away the extra fluid. This can be done in two ways. A small amount can be removed by numbing the skin over 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 (see How do the lungs work on page 2), also with 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 after a pleural effusion has been drained another procedure called a pleurodesis is performed. This involves injecting a drug or powder preparation into the drain, then leaving the drain clamped for about one hour before removing it. This seals the two layers of the pleura together to prevent the fluid building up again. Loss of appetite and weight loss When you have secondary breast cancer in the lung you may feel less hungry than usual and lose weight. This can be caused by the effect of the cancer or by the treatment. It may help to eat little and often rather than eating normal-sized meals. Nutritional supplements may be useful if you feel you are not managing to eat enough. Your GP (local doctor) or specialist can prescribe these or refer you to a dietitian for advice. Fatigue Cancer-related fatigue is one of the most common symptoms experienced by people with secondary 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 unrelenting, and this can be distressing and frustrating. It 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 or progression of the cancer.

9 Visit 9 Fatigue may have a significant impact on your ability to cope with your cancer and its treatment. It can also affect your everyday activities and have an adverse effect on your quality of life. However, there are things you may wish to try to help you manage fatigue and reduce its effects. Tell your doctor, as its cause may be treatable. Plan your days so you have a balance of activity and rest. Try to have short, achievable periods of physical activity each day, even if it s a short walk. Accept that you may have good days and bad days. Try to prepare for a special occasion by resting beforehand. Try to eat well. 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. Accept offers of practical help from other people to save your energy for things you enjoy. Physical activity Although there has been little research into the benefits of exercise for people with secondary breast cancer, several studies have looked at its effectiveness for people with primary breast cancer. The results have been positive and there seems no reason to believe that people with secondary breast cancer would not experience similar benefits. In fact, people who exercise, even gently, during treatment (for example chemotherapy or radiotherapy) may tolerate treatments better and experience less pain, nausea, sleeplessness and fatigue. Regular exercise may also help to: increase fitness, strength, stamina and flexibility control weight (when combined with a healthy diet) boost the immune system reduce blood pressure. However, it is advisable for people with secondary breast cancer to take a little extra care when starting to exercise. Before starting any exercise it s important to discuss it with your specialist team. If you exercised regularly before being diagnosed, you may find you can continue in exactly the same way. However, you may need to adapt this depending on how you are feeling.

10 10 Call our Helpline on What is regular exercise? Any amount of activity is better than none, so try to minimise the time you spend sitting down or being inactive. Guidance suggests regular exercise means 30 minutes of moderate intensity exercise at least five days a week. That can be a lot so you can begin gently and build up gradually. You do not need to do half an hour in one session. Moderate intensity means you may breathe harder, become warmer and be aware of your heart beating slightly faster than normal. However, you should be able to talk and it should not feel as if you are pushing yourself too hard. If you are currently receiving treatment you may need to exercise at a lower level. It s important to listen to your body and stop straightaway if it hurts or feels like you are working too hard. When choosing your exercise, try to focus on aerobic-type activities such as walking, swimming or cycling. However, less structured 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 enjoy. The symptoms experienced by many people with secondary breast cancer in the lung are similar to those experienced by people with long-term respiratory diseases such as chronic obstructive pulmonary disease (COPD) and asthma. Research has found that when people with respiratory disease exercise regularly they are less breathless, have more stamina, are better able to perform everyday tasks and have a better quality of life. There are a number of things you can do to avoid or reduce breathlessness. Firstly, try to avoid exercising in very cold or dry conditions as this makes it more difficult for your lungs to expand, whether you are exercising or not. Swimming is ideal because swimming pool buildings are usually quite warm and the air is damp. Secondly, always start your exercise session with a gentle warm up to get your body, especially your lungs, ready to exercise and to slowly increase how hard you are breathing so your lungs have time to adjust. Finally, you could try pursed lip breathing. This involves pursing your lips and breathing in and out through the narrowed opening. This reduces the air pressure, making it easier for your lungs to expand and contract.

11 Visit 11 Living with secondary breast cancer in the lung Knowing that your cancer has spread to one or both lungs may leave you feeling a range of emotions similar to when you were first diagnosed, only stronger. There may be times when you feel overcome by fear, anxiety, sadness, depression or anger. The uncertainty of living with secondary cancer can sometimes leave you feeling emotionally very up and down. You may be able to cope with these feelings on your own or with the support of those closest to you. Some people want support from professionals: you can talk to your breast care nurse, palliative care nurse (who may be a Macmillan nurse), clinical trials nurse, hospice or home care specialist nurse. They will have a greater understanding of the specific needs of people with secondary cancers and will be familiar with different ways of coping and adapting to the diagnosis. They also have specialist knowledge in helping with pain and symptom control, or can put you in contact with someone who does. If you are not in regular contact with a palliative care nurse or Macmillan nurse you can ask for a referral to be made through your GP or hospital. You could also contact the breast care nurse who supported you during your treatment for primary breast cancer. You can also contact the Breast Cancer Care Helpline on to talk through your concerns and find out what support may be available in your area. If you would like more help to look at ways of coming to terms with your secondary diagnosis, you can ask if it is possible to speak to a counsellor or psychotherapist.

12 12 Call our Helpline on Notes

13 Visit 13 Helping you face breast cancer A diagnosis of secondary breast cancer can be overwhelming. And the support you need might feel like it s hard to come by. We re here to help. Meet other women with secondary breast cancer and get specialist information on topics relevant to you with our living with secondary breast cancer services. We can help you feel less alone and more in control to make confident decisions about your treatment, lifestyle and care. Ask us Our free Helpline is here to answer any questions about breast cancer and talk through concerns. Or you can Ask the Nurse by via our website. Free Helpline (Text Relay 18001) Monday Friday 9am 5pm, Saturday 10am 2pm Meet people like you Come along to our free Living with Secondary Breast Cancer meet-ups for a chance to chat and share experiences with people who understand what it means to live with secondary breast cancer. They re also a unique opportunity to increase your knowledge as we run longer sessions with guest expert speakers every other month. Topics include pain management, fatigue, claiming benefits and side effects of treatment. Call or visit secondary to find out more. Talk to someone who understands Exchange tips on coping with the side effects of treatment, ask questions, share experiences and talk through concerns at our website s discussion Forum. There s a dedicated area for people with secondary breast cancer, it s easy to use and professionally hosted. Live Chat sessions exclusively for people living with secondary breast cancer take place weekly in a private area of our website. Each session is facilitated by an experienced moderator and a specialist nurse who can point you to sources of help and information. But for most people, being able to talk to others who know what you re going through is what counts.

14 We re here for you: help us to be there for other people too If you found this booklet helpful, please use this form to send us a donation. Our information resources and other services are only free because of support from people such as you. We want to be there for every person facing the emotional and physical trauma of a breast cancer diagnosis. Donate today and together we can ensure that everyone affected by breast cancer has someone to turn to. Donate by post Please accept my donation of 10/ 20/my own choice of I enclose a cheque/po/caf voucher made payable to Breast Cancer Care Donate online You can give using a debit or credit card at My details Name Address Postcode address We might occasionally want to send you more information about our services and activities Please tick if you re happy to receive from us Please tick if you don t want to receive post from us We won t pass on your details to any other organisation or third parties. Please return this form to Breast Cancer Care, Freepost RRKZ-ARZY-YCKG, 5 13 Great Suffolk Street, London SE1 0NS

15 Visit 15 About this booklet Secondary breast cancer in the lungs was written by Breast Cancer Care s clinical specialists, and reviewed by healthcare professionals and people affected by breast cancer. For a full list of the sources we used to research it: Phone You can order or download more copies from For a large print, Braille, DAISY format or audio CD version: Phone Breast Cancer Care, July 2014, BCC40 Edition 4, next planned review 2016

16 Breast Cancer Care is the only UK-wide charity providing specialist support and tailored information for anyone affected by breast cancer. Our clinical expertise and emotional support network help thousands of people find a way to live with, through and beyond breast cancer. Visit or call our free Helpline on (Text Relay 18001). Central Office Breast Cancer Care 5 13 Great Suffolk Street London SE1 0NS Phone: Centres London and South East of England Phone: Wales, South West and Central England Phone: East Midlands and the North of England Phone: Scotland and Northern Ireland Phone: Registered charity in England and Wales Registered charity in Scotland SC Registered company in England Secondary breast cancer

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