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Your treatment options

The goals of cancer treatment are to prevent it from spreading further, to relieve some of the painful symptoms cancer causes, and to ensure you have the best possible quality of life.

What are the main types of treatment?

The treatment you will receive for your metastatic breast cancer (MBC) largely depends on the type and characteristics of the cancer you have. Standard treatments include anti-hormonal agents, chemotherapy and radiotherapy. Surgery (such as a mastectomy) is rarely used.

There have been some significant advances in medicines for breast cancer in recent years. There are many more options available to your oncologist than before. Each of these forms of treatment is described below. 

  • Chemotherapy
  • Radiotherapy
  • Anti-hormonal therapy
  • Targeted therapies
  • Bone stabilising agents
  • Surgery
  • Chemotherapy

    Chemotherapy drugs send toxic substances to kill cancer cells. They can, unfortunately, harm normal cells too, and this can cause side effects. Some chemo drugs are given as a pill that you can take at home. Others are given by intravenous infusion and you may have to go to hospital to receive them.

    Chemotherapy is not always right for all types of MBC. Whether you receive chemo will depend on your health, what medicines you have taken before and the type of cancer you have. There are many different types of chemotherapies. If you have too many side effects with one kind, your doctor may be able to switch you to another.

  • Radiotherapy

    Radiotherapy is the use of high-energy rays that kill cancer cells. In MBC, radiotherapy may be given to control your cancer. It can also be used to relieve bone pain if the cancer therapy does not relieve it fast enough. It is common to radiate metastases in the bone that are causing pain.

    Radiotherapy for MBC is usually given as a single dose or as a short course over a few days. If you are well enough, you are usually given radiotherapy as an outpatient, and do not have to stay overnight in hospital.

    However, if you are having chemotherapy at the same time, you may need to stay in hospital. Side effects of radiotherapy will vary depending on which part of the body is being treated.

  • Anti-hormonal therapy

    Anti-hormonal therapies are used to treat breast cancers that are sensitive to hormones, particularly oestrogen.

    There are a number of different hormone-based therapy drugs that work in different ways in the body. Anti-hormonal therapies are usually given as pills, but some are given as injections. You may take them with or without chemotherapy.

    Whether you are given anti-hormonal therapy, and what type, will depend on whether you have gone through the menopause, how much time has passed since your diagnosis and what kind of treatment you took for your initial breast cancer (if this is a recurrence). If you have had anti-hormonal therapy in the past you may still take it again.

  • Targeted therapies

    Targeted therapies are drugs that work by blocking the specific ways that breast cancer cells divide and grow. Like chemotherapy and anti-hormonal therapy, their aim is to control the progression of the cancer.

    Since they only work on specific types of breast cancer, targeted therapies are only recommended for women with that particular type of cancer.

    There are several therapies that target HER2 receptors. These drugs work in people with high levels of HER2 in the cancer cells, but they do not work in cancers that do not have this protein.

    To find out if any targeted therapies are right for you, your doctor will have to find out exactly what kind of cancer you have.

  • Bone stabilising agents

    These are drugs that are used to treat metastases in the bone. They work by helping to strengthen your bones and help reduce bone loss.

    They can help relieve bone pain and reduce the long-term risk of bone breaks. They are taken as pills or injections. The injections are given every three to four weeks.

  • Surgery

    Surgery is rarely used in MBC. When it is used, it is because removing tumour tissue will substantially lower the tumour load, improve your body function, or will help to relieve pain.

    If you have breast cancer surgery, you will also receive drug therapy and/or radiation.

Treatments for specific cancer types

Hormone receptor-positive, HER2-negative
can be treated with drugs that suppress the production of the hormones oestrogen and progesterone, or drugs that block the receptors for these hormones (anti-hormonal therapy). Anti-hormonal treatment can sometimes be given in combination with other targeted treatment. At some point during the course of the disease it may also be treated with chemotherapy.

Hormone receptor-negative, HER2-positive
can be treated with HER2-targeted therapies and chemotherapy.

Hormone receptor-positive, HER2-positive
can be treated with both HER2-targeted drugs and anti-hormonal therapies. 

Hormone receptor-negative, HER2-negative, 
also called triple-negative breast cancer, can be treated by chemotherapy.

How often do I take treatment and for how long?

Unlike in early breast cancer, where your treatment is given for a fixed period of time, treatment for MBC is life-long
This is because ongoing treatments are needed to control your cancer and prevent it from getting worse. 

You may need ongoing treatment for symptoms of metastases. As a result, you may be given one drug or a combination of drugs. 
After some time, you may be switched to different drugs. 

You may be given the same treatment several times, alternated with other treatments.
You might stop taking one treatment temporarily and then need to return to it later.

The medicines you take will likely include intravenous treatment that is administered in a doctor’s surgery or in the hospital.
This is given weekly, every 3 weeks, or less often. Radiotherapy is usually given on a daily basis. You may alternate weeks with drug therapy and radiotherapy.
Again, there is no single best way to treat MBC. 
Every person’s situation is different.

Understandably, some women may be tempted to stop their treatment once they feel better or, on the contrary, if it makes them feel sick. However, as much as possible, it is critical to keep taking your treatment for as long as it is prescribed. Talk to your doctor if you are thinking about stopping your treatment.

How does my doctor measure if my treatment is working?

Your oncologist will conduct a number of tests over time to find out if your treatment is working
These may include looking at:

The size of your tumour/metastases

Your doctor may run scans to see if your tumour or metastases are growing, shrinking or staying the same size. These may include computed tomography (CT) or magnetic resonance imaging (MRI) scans.

The level of tumour markers

Tumour markers are proteins or other substances that are often, but not always, found in the blood when tumours (also known as a carcinoma or an adenocarcinoma) are active in the body. 

The presence of elevated tumour markers often indicates active disease. 

The levels of tumour markers over time can be used by your doctor to monitor the efficacy of your treatment.

The level of circulating tumour cells

Circulating tumour cells (CTCs) are cancer cells that have detached from the primary tumour and are circulating in the bloodstream. 

CTCs can act as ‘seeds’ for new tumours (metastases) at other sites in the body. Your doctor may monitor the level of CTCs in your blood to see how well you are responding to treatment.

Development of new metastases

Your doctor will want to make sure that cancer cells have not spread to other parts of the body.

For this, imaging such as CT or MRI scans can be used. 

The more a cancer spreads in the body, the more serious it is and a change of treatment may be needed.