1. Tests you may have
If you have any symptoms of , you may be offered a number of tests. These will help check whether the cancer has spread from the breast to another part of the body.
Your specialist will examine you, discuss your symptoms and explain any tests you need.
The tests you have may depend on your symptoms. For example, if you have pain that affects your bones, you may have a bone scan. Some frequently used tests include the following.
CT (computerised tomography) scan
A CT scan uses x-rays to take detailed pictures across the body. Before the scan you may be given a liquid known as a contrast solution. This is usually injected into a vein, and helps produce clearer images.
MRI (magnetic resonance imaging) scan
This scan uses magnetism and radio waves to produce a series of images of the inside of the body. An MRI doesn’t expose the body to x-ray radiation. Like a CT scan you may have a contrast solution injected into a vein.
This combines a PET scan with a CT scan to produce a 3D image, giving details on both the structure, function and activity of the organs or tissue being looked at.
A biopsy can give information about cells in the body. If you have an area of suspected secondary breast cancer a biopsy may be performed to confirm the diagnosis. It can also give useful information about the features of the secondary breast cancer if this is the cause. For example, whether it is a hormone receptor positive breast cancer or HER2 positive.
When breast cancer spreads to other parts of the body, the amount of certain substances in the blood may increase. Blood tests can measure these substances and show any changes.
Some people have a blood test for tumour markers. These are proteins found in the blood that may be produced by the body in response to the presence of cancer.
However, it’s not clear how reliable the measurement of blood tumour markers is. This is because they can be raised for different reasons, such as other benign (not cancer) health conditions or the treatment for these.
For some people, tumour markers may be normal even when breast cancer has come back.
If tumour markers are raised at the time of diagnosis, an may continue to check them regularly.
2. Tests for secondary breast cancer in the bone
X-ray of the bone
An x-ray can show changes in the bone. The x-ray may not be able to pick up small areas of cancer.
A bone scan checks the whole skeleton. It can help identify changes to the bone caused by injury, healing or disease such as cancer.
A small amount of radioactive substance is injected into a vein, usually in the arm, two to three hours before the scan. This helps identify if there’s been a change in the bones (often called a ‘hot spot’).
In most cases your specialist will be able to tell if you have secondary breast cancer in the bone from your symptoms and scans. However, in some cases a biopsy can help confirm the diagnosis and decide what treatment may help.
A biopsy involves taking a small piece of bone to be examined under a microscope. This may be done using local or general anaesthetic.
A biopsy may be recommended if only one area of bone is affected, it has been a long time since you finished treatment for primary breast cancer, or you have had more than one type of invasive cancer.
3. Tests for secondary breast cancer in the lungs
A chest x-ray is often the first investigation that will be done to see if there is secondary breast cancer in the lung.
Sometimes a biopsy of the lung is taken. This involves removing a small piece of tissue from the lung, to be looked at under a microscope. You will usually be sedated for this.
If you have a build-up of fluid in the space around the lungs (pleural effusion), a sample of fluid can also be taken for testing.
Another common procedure for taking a lung biopsy is a bronchoscopy. A tube called a bronchoscope is passed through the mouth, windpipe and down into the lungs.
A biopsy may then be performed.
CT-guided lung biopsy
Sometimes a biopsy can be taken from the lung through the skin, under local anaesthetic, with a needle using a CT scan for guidance.
EBUS (endobronchial ultrasound)
This test involves passing an ultrasound probe attached to a bronchoscope into the lungs. It allows the doctor to see the lungs and lymph nodes and take a biopsy if required.
4. Tests for secondary breast cancer in the liver
An ultrasound scan uses high-frequency sound waves to produce an image of the liver to show any abnormalities.
In most cases your specialist will be able to tell if you have secondary breast cancer in the liver from your symptoms and scans.
However, where possible, it’s useful to have a biopsy to confirm the diagnosis and guide decisions about your treatment.
A biopsy involves removing a small piece of tissue from the liver, under local anaesthetic, to be examined under a microscope. An ultrasound is usually used as a guide.
You’ll need to stay in hospital for a few hours after the liver biopsy because of the risk of bleeding.
5. Tests for secondary breast cancer in the brain
A neurological examination is a series of simple tests that provide information about the nervous system.
Your specialist may look in your eyes with an instrument called an ophthalmoscope to see if there is swelling at the back of the eyes caused by pressure from the brain.
They may check your arms and legs for changes in feeling and strength, and changes in your reflexes.
They may also look at your balance and how you are walking.
In most cases your specialist will be able to tell if you have secondary breast cancer in the brain from your symptoms and scans. Very occasionally a biopsy is needed to confirm the diagnosis.
This involves removing a small piece of tissue from the brain, under general anaesthetic, to be examined under a microscope.
6. Tests for secondary breast cancer in the skin
To confirm a diagnosis of secondary breast cancer in the skin, a punch biopsy may be performed.
You’ll be given a local anaesthetic before a tiny cutter device is used to take a very small piece of tissue from the area. It’s not unusual for the area to bleed a little after the biopsy so you’ll usually have a small dressing or plaster applied afterwards.
7. Waiting for test results
Secondary breast cancer treatment
Waiting for test results can be very stressful. It may take a few weeks to get all the results of your tests.
You should be offered an appointment to discuss your results once all the results are available. This is really important to ensure your team have all the information they need to plan your treatment and care.
It’s a good idea to take someone with you when your results are available, in case you need support.