1. What is secondary breast cancer in the lung?
What is secondary breast cancer?
When cancer that started in the breast spreads to 1 or both lungs, it’s called secondary or metastatic breast cancer in the lung.
Some people refer to it as lung metastases or lung mets.
The cells that have spread to the lung are breast cancer cells. It’s not the same as having cancer that starts in the lung (lung cancer).
Breast cancer cells can spread to the lung through the or the blood.
2. Symptoms when breast cancer has spread to the lung
The main symptoms of breast cancer that has spread to the lung are:
- Breathlessness
- Wheezing
- A cough that does not go away
- Coughing up blood
- Pain or tightness in the chest that does not go away
- Loss of appetite and weight loss
- Feeling constantly tired
Other possible effects include:
- Changes to your voice, such as hoarseness
- A build-up of fluid between the lung and chest wall, known as a pleural effusion, which can cause breathlessness or a cough
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 in the lung, you may want to know how long you’ve got to live.
Life expectancy is difficult to predict. Each person’s case is different, and no 2 cancers progress or respond to treatment in the same way.
However, as treatments have improved, more and more people are living much longer after their diagnosis.
Your treatment team can talk to you about how your secondary breast cancer may progress.
You may worry if their answers are vague, but it’s very difficult to accurately predict how each person’s cancer will respond to treatment.
You can read our information for people newly diagnosed with secondary breast cancer.
4. Treatment for secondary breast cancer in the lung
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.
The following treatments can be given on their own or in combination.
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.
Other treatments
Drugs are the main treatment for secondary breast cancer in the lung.
Sometimes treatments such as surgery or may be used to treat the cancer in the lung and help relieve symptoms.
Targeted radiotherapy
Radiotherapy uses high-energy x-rays to destroy cancer cells.
You may be offered very precise radiotherapy (stereotactic radiotherapy or radiosurgery) if you have a limited number of small secondary cancers in the lungs and 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, stereotactic ablative radiotherapy (SABR) or high dose conformal radiotherapy.
The type of radiotherapy you have will depend on your situation. 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.
You’re more likely to have surgery if:
- The area of secondary breast cancer in the lung is very small
- It can be easily accessed by the surgeon
- 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 (where you are put to sleep), a thin tube with a built-in camera (thoracoscope) is placed through a small cut in the side of the chest. 1 or 2 other small cuts are made in the skin, and surgical instruments can be passed through these.
It can be used to take tissue from the lung for a biopsy or to treat a pleural effusion.
5. Managing symptoms
Breathlessness
Breathlessness is 1 of the more common symptoms of secondary breast cancer in the lung. You may hear this called dyspnoea.
Breathlessness affects people differently. It does not cause harm but can be distressing, which can make your symptoms worse.
You may find breathing is uncomfortable, or feel that you can’t get enough air into your lungs.
Breathlessness 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.
In some people the areas of secondary breast cancer can cause a narrowing, put pressure on or block part of the airway. If this happens, your treatment team may recommend a stent. This is a small tube that’s inserted to keep the airway open and help relieve any breathlessness. The stent can usually stay in the airway permanently.
If your breathlessness suddenly gets worse, contact your treatment team immediately.
The following things may help ease breathlessness:
- Access to a cool draft of air from a fan or open window
- Cooling your face with cold water
- Sitting forward with your arms and elbows on a raised, supportive surface
Lymphangitis
Sometimes breast cancer cells can block the lymph channels in the lung, causing inflammation and scarring. This is called lymphangitis.
Lymph fluid cannot drain away from the lungs and this affects the amount of oxygen reaching the blood.
Breathlessness is a common symptom of lymphangitis. 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 treatment team will usually recommend chemotherapy to treat it. You may also have steroid drugs such as dexamethasone or prednisolone.
Medication
If necessary, your treatment team or GP can give you medicines to help ease breathlessness.
Oxygen has not been found to be a helpful treatment for breathlessness caused by secondary breast cancer in the lung.
Other ways to manage breathlessness
The following options can also help ease breathlessness. Speak to your treatment team for more information and referrals:
- Physiotherapy and breathing exercises
- Occupational therapy
- Relaxation
- Exercise
- Psychological support
Macmillan Cancer Support produces a relax and breathe audiobook which helps you learn ways to manage breathlessness.
Cough
An ongoing cough is a 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.
Mucolytic medicines may be prescribed to help loosen the phlegm, making it easier to bring up.
Your treatment team or GP may recommend a nebuliser. This device turns liquid medicine into a mist that you inhale 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 treatment team or GP may prescribe a codeine-based drug or low-dose morphine or steroids.
Pain
Many people with secondary breast cancer in the lung do not have pain.
However, if the cancer affects the lining around the lungs (the pleura), it may cause irritation. This can lead to pain or discomfort when breathing. The pain is often worse when breathing in or coughing.
Most pain can be relieved or controlled.
It’s very important that your specialist nurse, treatment team or GP regularly assesses your pain to make sure it stays under control.
Pleural effusion
A pleural effusion is a build-up of extra fluid between the lung and chest wall.
The lungs are attached to the inside of the chest wall by 2 thin layers of tissue called the pleura. A pleural effusion 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.
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 removing the fluid with a needle and syringe.
If there’s 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 secured in place with stitches and connected to a drainage bottle. The fluid will drain out slowly, often over a few days.
Leaving the drain in until the fluid has drained completely often helps the pleura stick back together. This procedure can be repeated if the fluid builds up again.
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, you may have another procedure called a pleurodesis. This involves injecting a drug or powder into the drain, then leaving the drain clamped for about 1 hour before removing it. This aims to seal the 2 layers of the pleura together to prevent the fluid building up again.
Poor appetite and weight loss
You might find you can’t eat as much as usual. This might make it harder to maintain your weight and get enough energy.
Low energy levels can affect mobility 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’re not eating enough, are losing weight or have no interest in food, talk to your specialist nurse, treatment team or GP about dietary supplements. You can also ask to speak to a dietitian for specialist advice.
In some cases, you may be prescribed medication to help increase your appetite.
You can also read our information about diet and secondary breast cancer.
Extreme tiredness (cancer-related fatigue)
Cancer-related fatigue is 1 of the most common symptoms in people with secondary breast cancer.
Find out more about managing fatigue in our guide (below).
6. Other important information and support
Blood clots
People with breast cancer have a higher risk of blood clots such as a deep vein thrombosis (DVT).
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
If you have any of the following symptoms, contact your treatment team or go to your local A&E department immediately:
- 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 or a sudden increase in breathlessness
- Pain or tightness in the chest
- Unexplained cough or coughing up blood
Find out more about blood clots.
Support for living with secondary breast cancer
Everyone’s experience of 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:
- 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
- Find out about our Living with Secondary Breast Cancer support services below
We also have information for anyone caring for someone with secondary breast cancer.
You can also call our free helpline, below.
