Diagnosing secondary breast cancer

Some women are diagnosed with secondary breast cancer because they’ve been attending clinic for follow-up| appointments, and tests have been arranged to check out new symptoms. Sometimes a woman won’t have obvious symptoms but a routine blood test result may indicate that more tests are needed.

Occasionally, a woman’s first symptoms may be due to a secondary cancer, even if she hasn’t been diagnosed with primary breast cancer before.

Blood tests Back to top

Blood tests on their own can’t diagnose secondary breast cancer. However, their results can show if you need to have other tests. Blood tests can be used to:

• Check how well your liver is working - depending on the results you may need further tests, such as an ultrasound and/or CT scan.
• Check the amount of calcium in the blood - too much calcium (hypercalcaemia) may mean there is cancer in the bones.
• Measure the number of blood cells in your blood (full blood count) - this shows how well your bone marrow, which is in the centre of most bones and makes blood cells, is working.
• Look for tumour markers - some cancers produce proteins known as tumour markers that can be measured in the blood. The tumour markers that may be raised in women with secondary breast cancer are CA 15.3, CA 19.9 and CA 125. But often they’re normal even when cancer has come back, so this may not always be a helpful test.

Biopsy Back to top

Some women may have a piece of tissue removed from the secondary cancer (biopsy) to confirm the diagnosis, or to find out more about the secondary cancer. The tissue can be tested to find out if the cancer cells have certain receptors| (ER or HER2), which allow hormones or proteins to attach to the cancer cell.

You’ll usually have a biopsy carried out under a local anaesthetic as an outpatient. An ultrasound or CT scan may be used to guide the needle into the right place. The area of the biopsy may feel a bit uncomfortable for a couple of days afterwards, so you may need to take some painkillers.

X-rays Back to top

Bones 

An x-ray can give a general picture of the condition of bones, but may not be able to detect small areas of secondary tumours. A bone scan is a more sensitive test and is usually needed to confirm the diagnosis.

Lungs

A chest x-ray may help to see if there is secondary breast cancer in the lungs and any build-up of fluid between the membranes on the outside of the lungs (the pleura). A CT or MRI scan is also usually done.

Bone scan Back to top

A tiny amount of mildly radioactive substance is injected into a vein, usually in the arm, and travels around the body in the bloodstream. Abnormal areas of bone absorb more radioactivity than normal bone and show up on a scanner.

The scan pictures are usually taken 2-3 hours after the injection. Bone scans can’t always tell whether an abnormal area is due to cancer or other conditions, such as arthritis. Sometimes more detailed scans, such as CT or MRI scans, may be needed.

Liver ultrasound scan Back to top

This test uses sound waves to build up a picture of the liver, and can measure the size and position of any secondary cancers. Ultrasound is painless and only takes a few minutes. Once you’re lying comfortably a gel is spread onto your tummy (abdomen). A small device like a microphone, which produces sound waves, is passed over the area. The sound waves are converted into a picture by a computer. Usually a CT scan of the liver is taken.

CT (computerised tomography) scan Back to top

A CT scan takes a series of x-rays, which builds up a three-dimensional picture of the inside of the body. It can be used to take pictures of the liver, lungs, bones or the brain.  

The scan takes 10-30 minutes and is painless. It uses a small amount of radiation, which is very unlikely to harm you and will not harm anyone you come into contact with. You will be asked not to eat or drink for at least four hours before the scan.

You may be given a drink or injection of a dye, which allows particular areas to be seen more clearly. This may make you feel hot all over for a few minutes. It’s important to let your doctor know if you are allergic to iodine or have asthma, because you could have a more serious reaction to the injection.

You’ll probably be able to go home as soon as the scan is over.

MRI (magnetic resonance imaging) scan Back to top

This test is similar to a CT scan but uses magnetism instead of x-rays to build up a detailed picture of areas of your body. It can be used to look at the liver, lungs, bones or the brain.

The scanner is a powerful magnet so you may be asked to complete and sign a checklist to make sure it’s safe for you. The checklist asks about any metal implants you may have, for example a pacemaker, surgical clips, bone pins, etc.

You should also tell your doctor if you’ve ever worked with metal or in the metal industry as very tiny fragments of metal can sometimes lodge in the body. If you do have any metal in your body it’s likely that you won’t be able to have an MRI scan. In this situation another type of scan can be used.

Before the scan, you’ll be asked to remove any metal belongings including jewellery. Some people are given an injection of dye into a vein in the arm, which doesn’t usually cause discomfort. This is called a contrast medium and can help the images from the scan to show up more clearly.

During the test you’ll lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It’s painless but can be slightly uncomfortable, and some people feel a bit claustrophobic. It’s also noisy, but you’ll be given earplugs or headphones. You can hear, and speak to, the person operating the scanner.

PET/CT scan Back to top

This is a combination of a CT scan, and a PET (positron emission tomography) scan, which uses low-dose radiation to measure the activity of cells in different parts of the body. PET/CT scans give more detailed information about the part of the body being scanned than a PET scan on its own. They are a new type of scan and you may have to travel to a specialist centre to have one.

You cannot eat for six hours before the scan, although you may be able to drink. A mildly radioactive substance is injected into a vein, usually in your arm. The radiation dose used is very small. The scan is done after at least an hour’s wait. It usually takes 30-90 minutes.

You should be able to go home after the scan.

Waiting for test results Back to top

Having your tests and waiting for results can be a difficult time and it may be a couple of weeks before your results are ready. Talking about how you feel with your family, friends, or your nurse or doctor can often help. You can also contact our cancer support specialists|.