1. What is breast cancer that has spread to the brain?
What is secondary breast cancer?
Secondary breast cancer in the brain is breast cancer that has spread to the brain. It can also be called metastatic breast cancer in the brain, brain metastases or brain mets.
It’s not the same as having cancer that starts in the brain. The cancer cells that have spread to the brain are breast cancer cells.
For most people with secondary breast cancer in the brain, their breast cancer has already spread to another part of the body such as the bones, liver or lungs.
For some people, the brain may be the only area of secondary breast cancer.
2. Symptoms when breast cancer has spread to the brain
Symptoms of secondary breast cancer in the brain include:
- Headache
- Feeling sick (nausea) and being sick (vomiting)
- Weakness or feeling numb down 1 side of the body
- Unsteadiness or loss of balance and coordination
- Fits (seizures)
- Difficulty with speech
- Problems with vision
- Changes in behaviour, mood or personality
- Confusion
- Memory problems
It’s important to report any new or ongoing symptoms to your GP, breast care nurse or treatment team.
3. What’s my outlook (prognosis)?
If you’ve been told you have secondary breast cancer, you may want to know how long you’ve got to live, which is also known as your outlook or prognosis.
As treatments have improved, more and more people are living longer after their diagnosis, including lots of people with secondary breast cancer in the brain.
Prognosis may depend on:
- How much cancer there is in the body
- Which area or areas of the body are affected
- The features of the breast cancer
Your treatment team can talk to you about how secondary breast cancer may progress. You may worry if their answers are vague, but it’s difficult to accurately predict how each person’s cancer will respond to treatment.
This can be hard to take in but we’re here to help. You can call our helpline or get in touch with one of our nurses by email if you have questions or concerns that you want to discuss. See the bottom of this page for ways to get in touch.
4. Treating secondary breast cancer in the brain
When breast cancer spreads to the brain, it can be treated but cannot be cured.
Treatment aims to relieve symptoms, slow down the growth of the cancer, and give you the best quality of life for as long as possible.
Treatments may be given on their own, at the same time as other treatments or one after the other.
Steroids
Steroids are made naturally in the body but can also be produced artificially for use as medicines.
Steroid drugs, such as dexamethasone, can reduce swelling and pressure caused by the growth of secondary breast cancer in the brain or its treatment (such as radiotherapy).
They can also relieve symptoms like headaches and feeling sick.
You may be prescribed steroids before you have any tests because they can begin to relieve your symptoms quickly.
Steroids are taken as tablets, usually twice a day, in high doses at first.
Once any symptoms are controlled, your treatment team will start to reduce the dose gradually. Your dose may be increased or decreased at different times, depending on your symptoms and any treatment you have had.
It’s very important not to stop taking steroids suddenly. If you take steroids for more than a few days, your body will start to produce less of the natural steroids that it needs to function. When you stop taking steroid medication, your body has to readjust. The dose must be gradually reduced, rather than stopping them suddenly. So make sure you do not run out of medication.
In the UK, if you take steroids for more than 3 weeks you will be given a blue steroid card. Always keep hold of the card and show it to any doctor or nurse treating you. You should also tell your dentist that you are taking steroids if you need to have any dental work done.
Side effects of steroids
Some of the more common side effects of steroids in high doses are:
- Sleeplessness, when taken later in the day
- Indigestion, when taken on an empty stomach
- Infections, including thrush (candidiasis) in the mouth
- Increased appetite
- Mood swings
- Weight gain
- Muscle weakness
- Feeling restless or agitated
- Skin changes
- Diabetes
- Blood clots
- Swollen or puffy face
Taking steroids earlier in the day can help prevent sleeplessness at night.
Taking steroids with food at breakfast and lunchtime will help avoid side effects like indigestion. You will usually be given another tablet to protect your stomach lining.
If you’re concerned about any of these side effects, it may help to discuss them with your treatment team or palliative and supportive care team. For example, you can ask your team to refer you to a dietitian if you’re worried about weight gain.
Radiotherapy
Radiotherapy is the most common treatment for secondary breast cancer in the brain.
It uses high energy x-rays to destroy cancer cells.
You might have it as:
- Targeted radiotherapy
- Whole brain radiotherapy
Targeted radiotherapy
Stereotactic radiosurgery or radiotherapy is a very precise radiation treatment that can precisely target the cancer.
It may be considered if you have a single or limited number of small secondary cancers in the brain. It may also be given together with surgery or whole brain radiotherapy.
High doses of radiation are delivered with extreme accuracy to targeted areas, avoiding healthy brain tissue. Because of this, stereotactic radiosurgery causes fewer side effects than whole brain radiotherapy.
It’s often given as a single treatment and can be repeated if secondary breast cancer in the brain comes back.
Stereotactic radiotherapy may also be called Gamma Knife or CyberKnife, stereotactic ablative radiotherapy (SABR) or high dose conformal radiotherapy.
It’s a specialist treatment that’s not available in all hospitals, so you may need to travel to a different cancer centre to have it. Your treatment team will tell you if it might be suitable for you.
Whole brain radiotherapy
Radiotherapy may be given to the whole brain if:
- There are several areas of secondary breast cancer in different parts of the brain
- You have leptomeningeal metastases (see "Cancer in the tissue around the brain and spinal cord" below)
Whole brain radiotherapy may also be given after surgery or stereotactic radiosurgery.
It’s usually given in daily doses over 1 to 10 days, but this can vary.
Side effects of radiotherapy
Fatigue is a common side effect of radiotherapy, especially after radiotherapy to the brain. Fatigue is extreme tiredness that doesn’t go away with sleep.
Hair loss is another common side effect. Hair usually starts to grow back 2 to 3 months after treatment has finished, although it may not grow back completely or evenly.
Whole brain radiotherapy can cause changes to the brain tissue. You may have problems thinking clearly, difficulty managing tasks you previously found easy, and poor memory or confusion. For most people, these symptoms settle over time.
An occupational therapist can help you to manage everyday tasks. Ask your treatment team or GP if you’d like to be referred.
Surgery
Although it will not cure secondary breast cancer in the brain, your treatment team may recommend surgery to remove the area or areas of cancer.
Surgery is more likely if there’s just 1 or only a few areas of cancer in the brain that the surgeon can safely operate on. It may also be considered if the cancer is causing pressure on the brain.
Surgery can be repeated if secondary breast cancer in the brain comes back.
It’s a very specialised treatment and is often followed by a course of radiotherapy.
Lots of different things will affect whether you have surgery. These include whether surgery will improve your quality of life, your general health and fitness, and whether secondary breast cancer is affecting other areas of your body.
Hormone (endocrine) therapy
If you’ve had hormone therapy before, your treatment team may prescribe the same drug again or change it to a different one.
It can take 2 to 3 months before any benefits from hormone therapy are seen.
Targeted therapy
This group of drugs blocks 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’re offered will depend on the features of your cancer.
Chemotherapy
Chemotherapy destroys cancer cells by affecting their ability to divide and grow.
A number of chemotherapy drugs are used to treat secondary breast cancer. These drugs may be given alone or in combination.
The drugs you’re offered will depend on many things, including any chemotherapy you’ve had in the past and how long ago you had it.
Clinical trials
Many breast cancer trials look at new treatments or different ways of giving existing treatments.
Your specialist may talk with you about clinical trials, or you can ask them if there are any clinical trials you can enter.
Cancer in the tissue around the brain and spinal cord
Sometimes breast cancer spreads to tissues and fluid that surround the brain and spinal cord. This is known as leptomeningeal metastases.
Symptoms can be similar to those of secondary breast cancer in the brain but may be less obvious and more difficult to diagnose.
It’s usually diagnosed using an MRI scan. You may also have a needle inserted into the spine (lumbar puncture) to take a sample of fluid to be looked at under a microscope.
Treatment can include steroids, radiotherapy and chemotherapy. Chemotherapy or targeted therapy drugs may be given directly into the fluid surrounding the brain and spinal cord to treat the cancer.
You may want to ask your treatment team if there are any clinical trials looking at treatment for leptomeningeal metastases. They can tell you about any trials that you may be able to take part in.
There’s more information about leptomeningeal metastases and their treatment on the Cancer Research UK website.
5. Managing symptoms of secondary breast cancer in the brain
Fits (seizures)
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 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 be affected, which is called a partial seizure.
Most seizures pass quickly and are not necessarily a medical emergency. However, seizures can have different causes so tell your GP or treatment team if you start having them.
If you have seizures, your doctor may prescribe epilepsy drugs to keep them under control. You usually take them as tablets.
Nausea and vomiting
Feeling sick (nausea) and being sick (vomiting) can be caused by secondary breast cancer in the brain, or elsewhere in the body, its treatment or the emotional impact.
It’s important for your doctor to try to find out the cause so they can help you manage it.
You can help your treatment team or palliative care team decide what treatment will work best by keeping a record of when it happens and what makes it worse.
In most cases, nausea and vomiting can be controlled and treated with anti-sickness drugs, steroids or benzodiazepines. Benzodiazepines are drugs that work on the brain and nerves to produce a calming effect.
Pain
A build-up of pressure in the brain, caused by areas of secondary breast cancer, can lead to headaches.
These might be different to headaches you’ve had before. They may get worse, continue for days or not go away completely.
Steroids and pain relief can control most pain.
Pain relief is a very important part of care for anyone with secondary breast cancer. Once pain is under control, you may feel less anxious and eat and sleep better.
If your pain is not under control, you can be referred to the or symptom control team for specialist advice.
Extreme tiredness (cancer-related fatigue)
Cancer-related fatigue is 1 of the most common symptoms in people with secondary breast cancer.
Fatigue is extreme tiredness that does not go away with rest or sleep. It has many causes, from the emotional impact of a diagnosis to side effects of treatment or growth and spread of the cancer.
Fatigue may affect how you cope with your cancer and its treatment. It can also make everyday activities harder and affect your quality of life.
Find out more about managing fatigue.
6. Other important information
Blood clots
People with breast cancer have a higher risk of blood clots such as a DVT (deep vein thrombosis).
If you have a DVT, there’s a risk part of the blood clot could break away and travel to the lung. This is known as a pulmonary embolism (PE).
Blood clots can be life-threatening and should be treated quickly.
Blood clot symptoms
Contact your treatment team or go to your local A&E department straight away if you have any of the following symptoms:
- Pain, redness/discolouration of the skin, heat and swelling of the arm or leg
- 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
- Pain or tightness in the chest
- Unexplained cough or coughing up blood
Find out more about blood clots.
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. This is because it could affect your ability to drive safely.
Find out more about reporting a medical condition on the DVLA website, or the DVA website in Northern Ireland.
It’s likely you will have to give up your licence. While this may be temporary, many people will not be allowed to drive again.
You may be able to reapply for your licence after a period of time if the areas of secondary cancer in the brain are under control. You can check with the DVLA or DVA, and your treatment team or GP if you may reapply for your licence.
You can ask your specialist nurse or local cancer information centre about services or practical help that may be available, like transport or financial support to help you get to hospital appointments.
7. 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 different ways.
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
- Join Live Chat, a weekly private chat room where you can talk about what’s on your mind
- Meet other women with a secondary diagnosis and get information and support at a Living with Secondary Breast Cancer meet up
We also have information for anyone caring for someone with secondary breast cancer.
You can also call our free helpline. See below for how to get in touch.
