1. Breast cancer that has spread to the brain
What is secondary breast cancer?
This is known as secondary breast cancer in the brain. It can also be called 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, 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 .
2. What’s my prognosis (outlook)?
When breast cancer spreads to the brain, many people want to know how long they've got to live.
Secondary breast cancer in the brain can be treated but cannot be cured.
As treatments have improved, more and more people are living longer after a diagnosis.
Life expectancy is difficult to predict as each person’s case is different and no two cancers are the same.
Your specialist can talk to you about how your cancer is likely to progress. You may worry if they cannot give you a clear answer, but it’s difficult to accurately predict how each person’s illness will respond to treatment.
3. Newly diagnosed or worried about a symptom?
In the days or weeks after a diagnosis of secondary breast cancer, you may feel in turmoil and find it hard to think clearly.
You can read our information for people newly diagnosed with secondary breast cancer, including where to find support.
If you haven’t been diagnosed but are worried about a symptom, find out more about the signs and symptoms of secondary breast cancer.
4. Treating secondary breast cancer in the brain
Treatment for secondary breast cancer in the brain aims to relieve symptoms and slow down the growth of the cancer.
Treatments may be given alone, in combination or in sequence.
Your care will continue under your breast oncologist. They will often ask the advice of doctors who specialise in treating tumours in the brain. These include neurosurgeons, neuro-oncologists, clinical nurse specialists and radiographers.
When deciding how best to treat you, your treatment team will consider:
- How many tumours you have
- The total amount of space taken up by the secondary breast cancer in the brain
- Which parts of the brain are affected
- Whether the cancer has spread elsewhere in the body
- Whether any other areas of secondary breast cancer are under control
- Any symptoms you have
- What treatment you’ve had in the past
- The features of the cancer
- Whether you’ve been through the menopause
- Your general health
Your treatment team should discuss any recommendations for treatment with you and take into account your wishes.
They will talk with you about your options, explain what the aim of treatment will be and help you weigh up the potential benefits against the possible side effects you may have.
Steroids
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 such as headaches and nausea.
You may start taking steroids before you have any investigations 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 doctor 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, so make sure you don’t run out.
Side effects of steroids
Some of the more common side effects of steroids in high doses are:
- Indigestion, when taken on an empty stomach
- Thrush (candidiasis) in the mouth
- Increased appetite
- Sleeplessness, when taken later in the day
- Mood swings
- Weight gain
- Muscle weakness
- Feeling restless or agitated
- Skin changes
- Diabetes
- Blood clots
Taking steroids with food at breakfast and lunchtime will help avoid side effects such as indigestion. You will usually be given another tablet to protect your stomach lining.
Taking steroids earlier in the day can help prevent sleeplessness at night.
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.
Radiotherapy
Radiotherapy is the most common treatment for secondary breast cancer in the brain.
It uses high energy x-rays to destroy cancer cells.
It may be given as:
- Stereotactic radiosurgery or radiotherapy
- Whole brain radiotherapy
Stereotactic radiosurgery or radiotherapy
Stereotactic radiosurgery or radiotherapy is a very precise radiation treatment.
It may be considered for people with a single or limited number of small secondary cancers in the brain. It may also be given in combination 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.
Treatment is often given in a single visit. It can be repeated if secondary breast cancer in the brain comes back.
Stereotactic radiosurgery or radiotherapy may be delivered using a number of different treatment machines, including Gamma Knife or CyberKnife.
It’s a specialist treatment that’s not available in all hospitals, so you may need to travel to a different centre. 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 a number of areas of secondary breast cancer in different parts of the brain, or if you have leptomeningeal metastases.
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 and can be particularly noticeable when radiotherapy is given to the brain.
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, surgery to remove the area or areas of cancer may be recommended.
Surgery is more likely if there is a single or very few areas of cancer in the brain that the surgeon can safely access. 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.
Surgery is a very specialised treatment and is often followed by a course of radiotherapy.
Whether surgery is an option will depend on the possible improvement to your quality of life, your general health and fitness, and whether secondary breast cancer is affecting other areas of your body.
Hormone (endocrine) therapy
Hormone therapy is used to treat breast cancers that are stimulated to grow by the hormone oestrogen. This type of breast cancer is called oestrogen receptor positive (ER-positive).
If you had a biopsy or surgery for primary breast cancer, the tissue removed will have been tested to see if it was ER-positive.
In some people oestrogen receptors change when secondary breast cancer develops.
Your doctor may discuss doing a biopsy of an area of secondary breast cancer to retest for hormone receptors.
Targeted (biological) therapies
Targeted therapies block the growth and spread of cancer. They target and interfere with processes in the cells that help cancer grow.
The type of targeted therapy drug you are offered will depend on the features of your cancer.
Chemotherapy
Chemotherapy is sometimes used to treat secondary breast cancer in the brain.
Chemotherapy destroys cancer cells using anti-cancer drugs. These drugs may be given alone or in combination.
The drugs you’re offered will depend on many things, including any chemotherapy you had in the past and how long ago it was.
Blood–brain barrier
The blood–brain barrier is a natural filter that protects the brain from harmful chemicals. It only allows certain substances through from the blood to the brain tissues. Because of the blood–brain barrier some drugs may not be as effective in treating secondary breast cancer in the brain as they are in other parts of the body. Your treatment team can discuss this with you.
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 are 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, but you may also have a lumbar puncture (a needle inserted into the spine) 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.
Clinical trials
Many breast cancer trials look at new treatments or different ways of giving existing treatments.
Your specialist may talk with you about a clinical trial, or you can ask them if there are any clinical trials you can enter.
For listings of current trials visit the Cancer Research UK or National Institute for Health and Care Research (NIHR) websites.
Availability of treatments
Some treatments for secondary breast cancer may not be routinely available on the NHS. You may still be able to access these treatments in other ways.
Macmillan Cancer Support has information about what you can do if a treatment is not available.
You can also speak to your treatment team or call our free helpline on 0808 800 6000 to talk through your concerns.
Palliative and supportive care
Palliative and supportive care focuses on symptom control and support.
It’s extremely important for many people with secondary breast cancer and can significantly improve quality of life for them and their families.
People often associate palliative care with end-of-life treatment. However, many people value having it at any stage of their illness, alongside their medical treatment, to help prevent and relieve symptoms such as pain or fatigue.
It can also help with the emotional, social and spiritual effects of secondary breast cancer.
The palliative and supportive care teams are based in hospitals, hospices and the community. Your treatment team, GP or breast care nurse can refer you depending on your situation.
5. Managing symptoms of secondary breast cancer in the brain
Seizures (fits)
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 very 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 – this 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 epileptic drugs to keep them under control. They are usually given as tablets.
Nausea and vomiting
Nausea (feeling sick) or vomiting (being sick) can be caused by secondary breast cancer in the brain or elsewhere in the body, its treatment or emotional side effects such as anxiety.
It’s important for your doctor to try to find out the cause so that it can be managed effectively.
You can help your specialist or palliative care team decide what treatment will work best by keeping a record of what makes it worse or when it happens.
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. You can also be referred to a healthcare professional who specialises in pain management.
Pain relief is a very important part of the care of anyone with secondary breast cancer. Once pain is under control, many people feel less anxious and can eat and sleep better.
Fatigue (extreme tiredness)
Cancer-related fatigue is one of the most common symptoms in people with secondary breast cancer.
Fatigue may have a major effect on your ability to cope with your cancer and its treatment. It can also affect your everyday activities and quality of life.
Fatigue has many causes, from the stress of coping with the diagnosis to side effects of treatment or the cancer progressing.
Find out more about coping with fatigue.
Blood clots
People with breast cancer have a higher risk of blood clots. Their risk is higher because of the cancer itself and some treatments for breast cancer.
You may be at risk of a blood clot forming known as a deep vein thrombosis (DVT). People with a DVT are at risk of developing a pulmonary embolism. This is when part of the blood clot breaks away and travels to the lung.
Blood clots can be harmful but are treatable so it’s important to report symptoms as soon as possible.
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, 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.
6. Can I drive?
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.
Call the DVLA on 0300 790 6806 or use their email service through the website.
In Northern Ireland, you can contact the DVA on 0300 200 7861 or email dva@infrastructure-ni.gov.uk
It’s likely you will have to give up your licence. While this may be temporary, some people will not be allowed to drive again.
Surrendering your driving licence can be hard to deal with. It can feel like you’re losing your independence.
You can ask your specialist nurse or local cancer information centre about services or practical help that may be available.
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 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
- Meet other women with a secondary diagnosis and get information and support at a Living with Secondary Breast Cancer meet-up - see further below
- Live Chat is a weekly private chat room where you can talk about whatever’s on your mind.
You can also call our free helpline, below.
