Breast cancer may spread to the bones, brain, lungs and liver.
Hormonal treatment and chemotherapy are the main treatments in such
cases. New chemotherapy drugs, such as Taxol, Taxotere and Xeloda,
have recently been developed and are effective in women with
metastatic breast cancer.
Women with metastatic breast cancer that contains special proteins
called HER2 or c-erbB2 can be treated with the drug Herceptin. This
drug, which usually lacks most of the serious side-effects of
chemotherapy, prevents tumour growth. It can be used as a back up to
standard chemotherapy, or in combination with the newer drugs, like
Taxol.
Fluid accumulation around the lungs and stomach can be drained to
relieve any discomfort. Tumour deposits in the bones can be treated
with radiotherapy and/or drugs. Cancer that has spread into the brain
can be treated with steroids and radiotherapy. Pain can be controlled
with several types of drug, including those that are aspirin based,
and morphine. Some of the stronger painkillers can cause constipation
and nausea, so laxatives and anti-nausea drugs may need to be taken as
well.
Breast cancer patients are usually advised to attend regular follow-up
clinics for at least three years. The purposes of the follow-up clinic
are listed below:
. To provide reassurance for patients who may be concerned about their
cancer returning or spreading.
. To allow early detection and treatment of any cancer recurrence.
Only around 1 in 10 patients will see their cancer recur during the
follow-up period. The chance of recurrence depends upon the nature of
the original cancer and whether it was treated by removal of the
tumour lump only, or by removal of the whole breast. Recurrence is
most likely in the first two years of follow-up and is usually
detected by mammogram.
. To detect any new breast cancer in the other breast. The risk of
developing a second breast cancer is six times higher in breast cancer
patients than in women with no previous history of the disease.
However, new cancers are usually suitable for lumpectomy.
. To detect any cancer spread to other parts of the body (metastases)
and to treat them accordingly.
Patients are usually interviewed by their breast specialist and
asked about any new symptoms. The doctor will examine both breasts
and armpits. Other parts of the body, such as the abdomen (the stomach
area) may also be examined. If a breast lump is discovered then
the appropriate tests, such as needle biopsy and mammography, will
be performed. All patients who have had curative surgery for breast
cancer should have regular mammograms every year as this is the
best way of discovering recurrent or new breast cancer. Other investigations,
such as bone scan, liver scan and blood tests, are not usually required
if the patient is well and if nothing is found on examination. Such
investigations can raise the false possibility of cancer spread
when it has not actually occurred.
The normal interval between follow-up visits is 6 or 12 months,
but initially the visits tend to be more frequent. The patient may
attend two follow-up clinics: one will be a surgical clinic, and
the other will be for the planning of any additional treatments
such as radiotherapy or chemotherapy, and is called a medical oncology
clinic. In some centres the two clinics (surgical and medical) are
combined into one.
Up to 10% of all breast cancers are inherited owing to faulty genes.
Several genes have been linked to breast cancer, including the BRCA-1
and BRCA-2 genes. Many women with a family history of breast cancer
are understandably very anxious and seek medical advice. Some breast
cancer units have Family History Clinics to deal with such cases.
The patient is interviewed by a breast specialist and asked several
questions to assess the breast cancer risk, including a detailed
family history of breast and ovarian cancer. After the patient has
been examined, her risk of developing breast cancer can be assessed
(Table 9).
Low-risk
Medium-risk
High-risk
The chance
of breast cancer is increased
2–3 times
The chance
of breast cancer is increased
3–5 times
The chance
of breast cancer is increased
5–9 times
