Diagnosing secondary breast cancer
Some women are diagnosed after going to see their own doctor (GP) with a new symptom. Your GP may arrange some tests for you or refer you directly to your cancer specialist (oncologist).
Some women don’t have obvious symptoms. They may be diagnosed when results of a routine test at their follow-up clinic indicate that more tests are needed.
Occasionally, women are diagnosed with secondary cancer first without a previous diagnosis of primary breast cancer.
Your cancer doctor (oncologist) will examine you and ask questions about your symptoms and general health. You will usually also see a specialist breast nurse who will give you information and support. Some hospitals have nurses who only see women with secondary breast cancer.
Your doctor and nurse will explain which tests you need. You will usually have some of the following:
Blood tests alone cannot diagnose secondary breast cancer but the results may show you need other tests. Blood tests can be used to:
check how well the liver is working
check the level of calcium in the blood
measure the number of blood cells (full blood count) to show how the bone marrow, where blood cells are made, is working
measure tumour markers - some cancers produce proteins or tumour markers that may be raised. But the results aren’t always reliable so it’s not always helpful to do this.
A tiny amount of a 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.
CT (computurised tomography) scan
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A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of the body. 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
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This test uses magnetism to build up a detailed picture of areas of your body. 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.
Some women have a piece of tissue removed (biopsy) from the secondary cancer to confirm the diagnosis. But it’s also becoming more usual to do a biopsy to find out if the secondary cancer cells have certain receptors (ER or HER2). This is because the secondary cancer may not be exactly the same as the primary breast cancer.
You will usually have a biopsy carried out under a local anaesthetic as an outpatient. An ultrasound (which uses sound waves to build up a picture) or a CT scan may be used to guide the needle into the right place. The area may feel a bit uncomfortable for a couple of days afterwards and you may need to take some painkillers.
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.
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.
This test uses sound waves to build up a picture of the liver, and can measure the size and position of any secondary cancers.
An ultrasound scan 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 you have a CT scan of the liver so an ultrasound may not be needed.
This is occasionally done if CT scan or bone scan results are not definite.
This is a combination of a CT scan, which takes a series of x-rays to build up a three-dimensional picture, and a positron emission tomography (PET) scan. A PET scan 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.
You may have to travel to a specialist centre to have one. You can’t 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 your results
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It may take up to two weeks for the results of your tests to be ready, and a follow-up appointment will be made for you. This waiting period can often be a very anxious time and it may help you to talk things over with a relative, close friend, your specialist nurse at the hospital or a support organisation. You can also contact our cancer support specialists.