Support For Living With Secondary Breast Cancer
Everyones experience of being diagnosed with 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 whos had a diagnosis of secondary breast cancer.
- Chat to other people living with secondary breast cancer on our online Forum.
- Meet other women with a secondary diagnosis and get information and support at a Living with Secondary Breast Cancer meet-up.
- Live Chat is a weekly private chat room where you can talk about whatever is on your mind.
You can also call Breast Cancer Nows Helpline free on 0808 800 6000.
Symptoms If Cancer Has Spread To The Lymph Nodes
Lymph nodes are part of a system of tubes and glands in the body that filters body fluids and fights infection.
The most common symptom if cancer has spread to the lymph nodes is that they feel hard or swollen. You might have any of the following symptoms if your cancer has spread to the lymph nodes:
- a lump or swelling under your armpit
- swelling in your arm or hand
- a lump or swelling in your breast bone or collar bone area
One of the first places breast cancer can spread to is the lymph nodes under the arm on the same side as the breast cancer. This is not a secondary cancer.
Why Does Metastatic Breast Cancer Happen
Most often, metastatic cancer occurs because treatment didnt destroy all the cancer cells. Sometimes, a few cells remain dormant, or are hidden and undetectable. Then, for reasons providers dont fully understand, the cells begin to grow and spread again.
De novo metastatic breast cancer means that at the time of initial diagnosis, the breast cancer has already spread to other parts of the body. In the absence of treatment, the cancer spreads.
There is nothing you can do to keep breast cancer from metastasizing. And metastatic breast cancer doesnt happen because of something you did.
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How Is Secondary Breast Cancer In The Bone Treated
Treatment for secondary breast cancer in the bone aims to relieve symptoms such as pain, maintain and improve mobility and strengthen the bones, as well as slow down the growth of the cancer.
Treatments can be given alone or in combination.
When making decisions about how the best treatment for you, your specialist team will consider factors such as:
- how extensive the cancer is in the bones
- whether the cancer has spread to other organs
- any symptoms you have
- what treatment youve had in the past
- the features of the cancer
- whether you have been through the menopause
- your general health
Your specialist should discuss any recommendations for treatment with you and take your wishes into account. They will talk with you about your options, explain what the aims of treatment will be and help you weigh up the potential benefits against the possible side effects.
Can Metastatic Breast Cancer Be Cured
There is no cure for metastatic breast cancer. Once the cancer cells have spread to another distant area of the body, its impossible to get rid of them all. However, the right treatment plan can help extend your life and improve its quality.
Metastatic breast cancer treatment aims to shrink tumors, slow their growth and improve your symptoms.
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Treating The Primary Cancer
Chemotherapy, hormone therapy, and immunotherapy target the main cancer. Taken by mouth or injection, they attack any cancer cells in the body. These treatments, called systemic because they affect the whole body, can cause side effects such as nausea, vomiting, fatigue, hair loss, and a higher chance of infection.
What Does Metastatic Bone Pain Feel Like
Bone pain is the most common symptom of metastatic bone cancer. It may be the first sign of metastases. Bone metastases are most likely to occur in the spine, ribs, hips, upper leg, upper arm, and skull.
Sometimes the pain can be sharp. Other times its a dull ache. There may also be some swelling at the site of the pain. Many people find the pain can be worse at night.
In earlier stages, the pain is more likely to come and go. As cancer grows, pain may become more constant. Depending on the site of the bone cancer, movement can increase the pain. Sometimes the pain persists no matter what youre doing or what position youre in.
Bone cancer pain can be caused by:
- inflammation from the cancer cells
- changes in bone structure
- a bone fracture
When cancer cells start growing in bones, they can cause a lot of damage. The affected bones may become very fragile. Even normal daily movements can cause bones to fracture or break.
The most common sites of bone fractures are the arms, legs, or back. Sudden intense pain can be a sign of a broken bone. If this happens, its important to seek medical attention.
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You May Not Know Im Sick By Looking At Me
I may look perfectly healthy, but Im sick, says Silberman. Treatment is hard. I sleep a lot. I still travel, but its difficult. I just visited a friend in Utah for four days, and it wore me out for two weeks.
Just because someone doesnt look like she has advanced-stage cancer, she can be very sick. It can be an invisible illness, says Silberman. You tell somebody you have cancer, but if you have hair, sometimes they dont believe you.
What Else Causes Bone Pain
When were talking about what bone cancer pain feels like, its also good to note that other things can bring about bone pain in your body. 6,7
Osteoporosis: A common bone disease that leads to weak and brittle bones
Bone bruise: When the bone hits a hard surface
Arthritis: Inflammation of the joints that can lead to pain, stiffness, and swelling
Myalgia: Muscle pain that can be both short or long-term and lead to joint pain
Osteomalacia: This refers to bone softening that often happens because of a vitamin-D deficiency and can cause a dull, aching pain
Injury: Injury that occurs due to trauma or force
Pagets disease: A chronic bone disease that affects older adults and leads to excess bone formation
Fracture: Fracture can occur after accidents, injuries, overuse in athletics, or because of weakened bones it can also cause swelling and bruises
Secondary bone cancer: Cancer that started somewhere else and then spread to the bones
Leukemia: Cancer that starts in the bone marrow and leads to overcrowding of cancer cells, which can be a source of joint and bone pain
Osteomyelitis: An infection of the bones that causes bone pain, tenderness, swelling, warmth, and redness
Overuse: From exercise, lifting, or excessive use
Osteonecrosis: This happens when a bones blood supply is compromised, leading to bone collapse due to the death of bone and bone marrow cells
Growing pains: Such as those that happen in children and teenagers
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How Are Bone Metastases Treated
Although it is not possible to cure bone metastases, they are not usually life-threatening. Many women enjoy active lives for many years after bone metastases are diagnosed.
Treatments for bone metastases aim to improve your quality of life by reducing symptoms, such as pain or bone fractures. Treatment will depend on:
- which bones are affected
- whether your bones have been weakened and are in danger of breaking
- characteristics of your original breast cancer, such as type of tumour and the type of receptor the tumour had or HER2 receptor)
- other treatments you have had for primary or secondary breast cancer
- systemic cancer treatments which work on the whole body.
Treatments are often very effective in stopping the growth or decreasing the size of cancerous deposits in the bones. Current treatments are not usually able to completely remove all cancer cells from the bones.
There are three types of treatment for bone metastases:
- treatments to control pain
- local treatments for the bones which are directed at a single bone or area
- systemic cancer treatments (such as
- hormone-blocking therapy, HER2-blocking drugs and chemotherapy) which work on the whole body.
What Should I Ask My Healthcare Provider About Metastatic Breast Cancer
If youve been diagnosed with metastatic breast cancer, ask your provider:
- What are my treatment options?
- What is my prognosis?
- What side effects can I expect?
- Will complementary therapy help me feel better?
- What if I want to stop treatment?
- How can I feel my best during treatment?
A note from Cleveland Clinic
Metastatic breast cancer is advanced breast cancer. Providers classify it as stage 4 breast cancer. It happens when cancer cells, often left behind after previous breast cancer treatment, start to spread to other parts of the body. While there is no cure for metastatic breast cancer, treatment can prolong your life and help you feel better. There are many medications available, so if one treatment isnt working, your care team can try a different approach. If you notice any symptoms or dont feel your best, especially if youve undergone breast cancer treatment in the past, talk to your healthcare provider.
Last reviewed by a Cleveland Clinic medical professional on 04/14/2021.
References
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Medications For More Severe Bone Pain
Tramadol or opioids can be added if the ibuprofen, naproxen or acetaminophen alone dont relieve the pain.
All of these drugs can cause constipation, so you may need to make some changes in your diet or take medications to promote regular bowel movements. For example, your health care provider may recommend eating high-fiber foods and drinking plenty of liquids to manage constipation.
Other side effects of these drugs include sleepiness and nausea. These usually go away after about a week. If they dont, tell your health care provider. These side effects can be treated.
If youre prescribed opioid medications, your health care provider will carefully monitor the amount prescribed so you dont take too much. People may worry about taking opioid medications, fearing side effects or addiction. However, when used as prescribed, these drugs can offer a great deal of pain relief.
Learn more about opioids and other pain medications, their side effects and fear of addition.
Symptoms If Cancer Has Spread To The Bones
You may have any of these symptoms if your cancer has spread to the bones:
- an ache or pain in the affected bone
- breaks in the bones because they are weaker
- breathlessness, looking pale, bruising and bleeding due to low levels of blood cells – blood cells are made in the bone marrow and can be crowded out by the cancer cells
Sometimes when bones are damaged by advanced cancer, the bones release calcium into the blood. This is called hypercalcaemia and can cause various symptoms such as:
- tiredness
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Where Do You Feel Bone Cancer
Bone cancer most often occurs in the legs or upper arms, although any bone can be affected. 3 Pain in the bones can also occur due to metastatic cancer that has begun in another area and spread to the bone . While all cancers can spread and cause metastatic bone cancer, the most common forms include breast cancer and prostate cancer.
Where you feel bone cancer depends on the area that is affected. Here are some types of metastatic bone cancer and where they occur in the body. Well also cover benign tumors, as those can cause discomfort and painful symptoms as well. 5
Many Women Live For Decades With Metastatic Breast Cancer
A stage 4 diagnosis is not an instant death sentence, says Renee Sendelbach, 40, from Austin, Texas, who was diagnosed seven years ago, when she learned that her breast cancer had moved into her lungs, bones, and lymph nodes.
Ive had metastatic breast cancer for five years and Im still kicking, says Susan Rosen, 53, from Franklin, Massachusetts.
According to a 2017 article in the journal Cancer Epidemiology, Biomarkers & Prevention, 34 percent of women diagnosed with metastatic breast cancer have been living with the disease for five years or longer.
The goal of treatment is to keep patients on their feet as long as possible so that they can continue to do what they want to do, says Gretchen Kimmick, MD, associate professor of medicine at the Duke Cancer Institute in Durham, North Carolina.
In recent years, treatment for breast cancer has vastly improved, largely because doctors are able to more accurately target therapy to the type of breast cancer a woman has. The discovery of the HER2 protein and medicines that block it has revolutionized treatment for women with cancers that overexpress this protein, Dr. Kimmick says. This cancer was pretty deadly two decades ago, and now we are starting to debate if weve cured it in some women.
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From Cured To Stage 4
Others, like Teri Pollastro, a 54-year-old stage 4 patient from Seattle, respond surprisingly well.
Diagnosed with early stage ductal carcinoma in situ in 1999, Pollastro underwent a mastectomy but did not receive chemotherapy, radiation or tamoxifen, since her cancer was ER negative.
âThey used the C-word with me, they told me I was cured,â she said. âEvery time I went back to my oncologist, he would roll his eyes at me when I had questions.â
In 2003, Pollastro switched to Seattle Cancer Care Alliance where she saw Dr. Julie Gralow, a breast cancer oncologist and clinical researcher at Fred Hutchinson Cancer Research Center. Gralow discovered Pollastroâs cancer had metastasized to her liver.
âMy husband and I were in shock,â said Pollastro of her mets diagnosis. âYou donât go from being cured to stage 4.â
Pollastro went on Herceptin, a type of immunotherapy for women with HER2-positive metastatic breast cancer, and did six months of chemotherapy.
âI felt better right away with the treatment,â she said. âBut the problem is, it stopped . Thatâs what you can expect with mets. And thereâs always some residual cancer. And that starts percolating.â
And along with mets, she also had to deal with many misconceptions regarding her disease.
The Mercer Island, Washington, mother of two, who often counsels newly diagnosed patients, sometimes even found it difficult to relate to early stage breast cancer survivors.
Types Of Treatment For Bone Metastasis
How doctors treat bone metastasis depends on the extent and location of the bony lesions, Fasano says. Treatments include:
- Treating the underlying cancer. This is the most important step, Fasano tells WebMD. Treatment depends on the type of tumor and where it started in your body. Treatment often includes a combination of drugs that were used to treat the primary cancer when you were first diagnosed.
- Bisphosphonates. Bisphosphonate drugs such as Aredia and Zometa help prevent the breakdown of bone, which can ease pain and reduce your risk of fractures. Doctors will infuse bisphosphonates through an IV “every four weeks to halt or slow the progression of metastasis formation and to help prevent breaks,” says Fasano.
Bisphosphonate therapy is especially important if the metastasis is in a weight-bearing bone or is causing a great deal of pain. If metastasis in the spine is causing severe pain and risking a collapse of vertebrae, Fasano sends the patient for an orthopedic evaluation. For elevated calcium levels, patients will often need intravenous fluids, bisphosphonates, and other medications to help lower levels.
Treatment for bone metastasis can prolong life and relieve symptoms. Much depends upon the type of cancer you have, how old you are, and how much time has elapsed since you first were diagnosed. “But many people can do really well for a long period of time,” Fasano says.
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Can You Survive Stage 4 Bone Cancer
According to the American Cancer Society, the five-year relative survival rate for the most advanced stage of osteosarcoma is 27 percent. Osteosarcoma is the most common type of bone cancer. If you have stage 4 bone cancer, your doctor can give you a professional evaluation of your outlook based on your situation.
What Causes Cancer Pain
There are a number of different causes of cancer pain. For example, the pain can stem from a tumor itself or the damage that it has caused the surrounding tissue or organs. For example, deep pain can occur in the bones from a tumor placing pressure on the bone, and burning pain can occur when a tumor presses against a nerve.
There is also discomfort and pain associated with many cancer treatments, such as chemotherapy. In some cases, the pain you experience is associated with nerve damage. The nerves can be damaged during treatment or from the cancer itself. Additionally, nerves could be signaling the brain that damage is either occurring or could occur. Nerve damage typically cant be reversed and causes chronic pain.
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There Are Good Days And Bad Days
There are days when I say to myself, Ive had enough. I cant take it anymore, says Rosen. But I want to keep on living. I love my life. Overall, I have a great life except for the cancer.
Rosen has a few mantras she uses when things get tough. A lot of the tough times are treatment related, she says. I refer to those as bumps in the road, and , This too shall pass.
Emotional And Spiritual Care
End-of-life care also includes emotional, mental, and spiritual therapy. A personâs healthcare team may include social workers, counselors, mental health professionals, and religious or spiritual advisors.
According to the Anxiety and Depression Association of America, up to 40 percent of people with cancer experience serious mental distress. This may include anxiety, depression, panic attacks, and post-traumatic stress disorder .
Medications, therapy, religious or spiritual rituals, and support groups can help a person cope with mental health issues and stress during this difficult time.
Caregivers may also need help with stress, anxiety, and depression. The palliative care team can usually also provide support and advice to caregivers for their emotional needs.
The Breast Cancer Healthline app provides people with access to an online breast cancer community, where users can connect with others and gain advice and support through group discussions.
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