Secondary breast cancer treatment

Secondary breast cancer may respond to several types of treatment:

• hormone therapy

• radiation treatment

• chemotherapy

• targeted therapies.

The treatment suggested for you will depend on the type of breast cancer you have, the parts of your body the cancer is affecting, and your wishes.

Ngā kōrero matua

Tērā pea ka urupare te matepukupuku ā-ū ki te maha ō ngā momo maimoatanga

• Haumanu taiaki

• Maimoa iraruke

• Hahau 

• Paturopi monoclonal

Ka hāngai te maimoatanga ka whakataunakitia mōu, ki tō momo matepukupuku ā-ū kua pā ki a koe, me ngā wāhi ō tō tinana kei te pā, ki tāu e hiahia ana rānei.

Hormone therapies

Many breast cancer cells contain proteins known as oestrogen receptors and progesterone receptors. A cancer that contains a certain number of these cells is described as hormone-receptor positive.

Hormone-receptor-positive breast cancers may be treated by hormones, whereas hormone-receptor-negative breast cancers do not respond to hormone therapy and are treated with chemotherapy.

Hormone therapy can reduce symptoms and shrink the cancer. It can work well for slow-growing cancers affecting the bone, the skin or the fatty tissue under the skin.

Most hormone therapies work by decreasing the amount of oestrogen in the body, or by stopping the cancer cells using oestrogen to grow. Side effects are rarely serious but can affect quality of life. There are many hormone therapies available, giving doctors the option of trying several types. The hormone treatment prescribed depends on whether you are pre- or post-menopausal.The common hormone treatments include the following.

Tamoxifen hormone treatment

Tamoxifen is one of the most commonly used hormone treatments. This treatment can be used by women of all ages. Tamoxifen is taken as a tablet daily and treatment continues for as long as it continues to provide effective management of your cancer.

Side effects of Tamoxifen

Tamoxifen has been used by thousands of women worldwide for many years and has proved to be a safe medicine with few side effects.Common side effects include:

  • hot flushes/mood swings
  • vaginal dryness and an increased discharge from the vagina
  • in pre-menopausal women, changes in periods.

(Please note Tamoxifen is not a contraceptive.)

Aromatase inhibitors

Aromatase inhibitors work by preventing oestrogen being produced. They are only used by post-menopausal women. Common side effects include:

  • hot flushes
  • vaginal dryness
  • joint pain/stiffness.

Ovarian function suppression (preventing the ovaries from working)

Pre-menopausal women may have ovarian function suppression alongside an aromatase inhibitor. This will bring on an early menopause.Ovarian function suppression can be achieved by:• switching off the ovaries with medication• surgery.25

Goserelin

Goserelin is a medication that switches off the ovaries, stopping them making oestrogen. The medicine does not act directly on the ovaries; it works on the part of the brain that is responsible for stimulating the ovaries to produce oestrogen. The treatment is given as a regular injection under the skin of the abdomen for as long as it provides effective management of your cancer.

Side effects of Goserelin

Goserelin causes early menopause. If goserelin is stopped, your periods may return.

Surgery to remove the ovaries

An operation to remove the ovaries is called an oophorectomy. Periods will stop after surgery and you will have menopausal symptoms straight away.

Radiation treatment

Radiation treatment uses high-energy rays to destroy cancer cells. Radiation treatment can shrink cancers in some parts of the body and help relieve pain.

Radiation treatment is usually recommended to:

  • relieve bone pain
  • prevent and treat spinal cord compression
  • prevent or treat fractures after bone surgery
  • prevent or treat fractures without surgery
  • treat regional recurrence on the skin and in the lymph nodes
  • treat cancer in the brain.
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Side effects of radiation treatment

These depend on the dose, the number of treatments and the part of the body that is treated.Side effects are not common, but may include:

• tiredness

• nausea (feeling sick) if the treatment is given to the abdomen or pelvis. This can be relieved by anti-sickness medications (antiemetics)

• hair loss in the area treated

• a short period of increased pain when you first begin treatment. Continue to take your pain medication as usua

• depending on the dose of radiation, skin in the treatment area becoming dry, flaky, red, itchy or sore—similar to sunburn. If your skin gets very sore it may peel and blister.

Chemotherapy treatment

Chemotherapy is the use of anti-cancer medication to destroy cancer cells. The medication circulates in the bloodstream, reaching cancer cells throughout the body. Chemotherapy treatment may shrink the cancer or prevent it growing bigger.

Chemotherapy is usually recommended when your:

• cancer is not hormone sensitive

• hormone treatments are no longer controlling cancer growth or symptoms and/or

• breast cancer is progressing.

How chemotherapy medications are given

Chemotherapy medications are given by mouth or by injection into a vein.

Side effects of chemotherapy

Chemotherapy medications can damage normal cells as well as cancer cells, leading to side effects that may include:

• nausea—this can usually be managed with anti-emetics. Vomiting is rare

• hair loss—some chemotherapy medications cause temporary hair loss

• tiredness

• change in appetite

• diarrhoea or constipation

• nail changes. 

Most chemotherapy medications can affect the bone marrow, which produces blood cells. If bone marrow function is reduced by chemotherapy, side effects may include:

• a lowered resistance to infection

• bruising or bleeding even from minor cuts (an occasional side effect).

You will have regular blood tests throughout chemotherapy treatment to check your blood cell levels. If you have a low blood cell count, your treatment may be delayed because you are at higher risk of infection. If you develop an infection you will be given antibiotics.

If you develop a fever (if your temperature is 38 degrees Celsius or over) or you feel unwell even with a normal temperature, do not wait to see what happens—take action quickly. Contact your cancer treatment team and follow the advice given.

Ki te puta te kirikā ki a koe (he pāmahana 38 mahana C, neke atu rānei tōu), ki te māuiui rānei koe ahakoa te pai o tō pāmahana, kaua e whakakeke - me tere tonu to whakatikatika. Whakapā atu ki to tapuhi matepukupuku, to rata rānei, ka whai i ngā tohutohu ka hoatuna.

Targeted treatments

Targeted treatments attach to the proteins on, or in, cancer cells to interfere with signals that tell the cancer cells to grow. Targeted treatments include monoclonal antibodies. These are medications that target specific proteins on the surface of the cells and trigger the body’s immune system to attack the cancer cells. Examples of targeted therapies used in breast cancer are the monoclonal antibodies trastuzumab (Herceptin) and pertuzumab (Perjeta). They are only beneficial to people who have ‘HER2-positive’ breast cancer.

Roughly 20 percent of breast cancers are known as HER2-positive cancers. This means they have too many ‘copies’ of a protein called HER2, which makes cancer cells grow and divide. Trastuzumab and pertuzumab work by locking on to the HER2 proteins on the surfaces of the cells, to stop them dividing and growing. Each medication locks on to a different part of the protein. They are often given in combination with chemotherapy.

Side effects of targeted therapies can include an allergic reaction, swelling and wheezing or shortness of breath at the time of the infusion. You will be monitored closely by staff for these and for tiredness, joint and muscle aches. You may be more likely to get an infection. Contact your cancer treatment team straight away if you have any signs of infection or any other symptoms you are concerned about.

Herceptin and Perjeta can affect the way your heart works. You will be monitored for this during your treatment.

Bone-strengthening medication

If you have secondary breast cancer affecting your bones, you may be offered bone-strengthening medication such as bisphosphonates. Bisphosphonates are a group of medications that can slow bone breakdown while allowing new bone to be produced as normal. They can reduce bone pain, control the level of calcium in the blood (hypercalcaemia) and reduce the long-term risk of complications such as fractures. They are usually given over a few hours through an intravenous drip (into the vein). Side effects can include ’flu-like symptoms.

 

Some questions you may want to ask about your treatment

You might like to find out:

• what the risks, benefits and possible side effects are of each treatment

• if you will have to stay in hospital, or if you will be treated as an outpatient

• how long the treatment might take• if there will be any costs for you

• what further treatment you might need and when it would begin

• where you can go for a second opinion if you want one

• what will happen if you choose not to be treated

• if treatment might affect your ability to look after your children or grandchildren

• if you can get help with transport to your treatment

• information on any health professional who can come to your appointments and spend time with you afterwards to explain what was said (be an advocate)

• other treatments that might be available that aren’t currently funded.

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