Symptoms and diagnosis of lung metastasis
When breast cancer moves into the lung, it often doesn’t cause symptoms. Instead, a doctor might discover a tumor on an imaging test done as part of treatment follow-up, such as a chest CT scan. But sometimes lung metastasis does cause symptoms. Some of these symptoms are:
pain or discomfort in the lungs
shortness of breath
coughing up blood and mucus
It can be difficult to tell the difference between symptoms of lung metastasis and symptoms of the common cold or upper respiratory conditions, especially if you have a history of lung problems. Many doctors recommend that you make an appointment to check out any unusual symptoms persisting for more than a week or two. When doctors suspect lung metastasis, they often order a chest CT scan or a PET scan.
If the scan finds a tumor and a doctor confirms that it’s cancerous, it’s important to also confirm whether it’s a primary lung cancer — a cancer that starts growing in the lungs — or breast cancer that has spread to the lungs. It’s also important to let your doctor know if you smoke or used to smoke. Treatment for primary lung cancer is different from treatment for breast cancer that has spread to the lungs.
To confirm a diagnosis of lung metastasis, your doctor may bring in a thoracic surgeon, a pulmonologist, or an interventional radiologist who specializes in diagnosing and treating lung conditions and order additional tests. These tests may include:
an examination of a mucus sample under a microscope
a bronchoscopy; an examination of the tissue and possibly taking a sample of any suspicious areas by inserting a flexible, lighted tube down your airways and into the lungs
a lung needle biopsy, removing a small sample of tissue by inserting a needle through the skin and into the affected lung using imaging scans of the suspicious area as a guide
surgery, to remove the area of concern for examination
Treatments for lung metastasis
Metastatic breast cancer in any part of the body is usually treated with systemic medicines, which treat cancer throughout the entire body. For lung metastasis, local treatments that specifically target the lungs, such as surgery or radiation, are sometimes recommended. But most lung metastases don’t require local treatments because they don’t cause major symptoms.
Chemotherapy destroys or damages cancer cells as much as possible and, therefore, doctors recommend it as a treatment for metastatic breast cancer. Because chemotherapy medicines are systemic treatments — meaning they affect the entire body — doctors generally recommend chemotherapy if:
the cancer is growing despite other forms of treatment
there is a significant amount of cancer in organs such as the liver or lungs
the cancer is growing quickly
Doctors often combine chemotherapy with targeted therapies, which are medicines that target specific characteristics of cancer cells.
Each person’s chemotherapy treatment plan is different. But there are some general guidelines that doctors follow when using chemotherapy to treat metastatic breast cancer:
If you’ve had chemotherapy before, your doctor may recommend using only one chemotherapy medicine at a time to treat metastatic disease. This way you can get benefits with fewer possible side effects.
In general, doctors use most chemotherapy medicines to treat metastatic disease until side effects become a problem or the medicines stop being effective.
Some chemotherapy medicines seem to work better against cancer tumors when they are combined. Research has shown that combining treatments has contributed to a better overall prognosis for some metastatic cancers.
If breast cancer comes back after chemotherapy or doesn’t respond to chemotherapy medicines, you can try a different combination of medicines. There are many chemotherapy medicines, and if one medicine or combination of medicines doesn’t work, there is almost always something else you can try.
Learn more about Chemotherapy.
Hormonal therapy medicines — also called endocrine therapy or anti-estrogen therapy — are used to help shrink or slow the growth of hormone receptor-positive metastatic breast cancer. Hormonal therapy medicines include:
Arimidex (chemical name: anastrozole)
Aromasin (chemical name: exemestane)
Femara (chemical name: letrozole)
Faslodex (chemical name: fulvestrant)
Hormonal therapy does not work on hormone receptor-negative breast cancer.
Hormonal therapy medicines treat hormone receptor-positive breast cancers in two ways:
by lowering the amount of the hormone estrogen in the body
by blocking the action of estrogen in the body
You usually take hormonal therapy to treat metastatic hormone receptor-positive breast cancer for as long as it works. If the cancer stops responding to one hormonal therapy medicine, your doctor will usually recommend a different hormonal therapy medicine.
Learn more about Hormonal Therapy.
Targeted therapies are treatments that target specific characteristics of cancer cells, such as a protein that allows the cancer cells to grow in a rapid or abnormal way. Targeted therapies are generally less likely than chemotherapy to harm normal, healthy cells. Some targeted therapies are antibodies that work like the antibodies made naturally by our immune systems. Because of this, they are sometimes called immune-targeted therapies.
Learn more about targeted therapies used to treat metastatic breast cancer.
Cancer immunotherapy medicines work by helping your immune system work harder or more efficiently to fight cancer cells.
Your immune system is made up of a number of organs, tissues, and cells that work together to protect you from foreign invaders that can cause disease. When a disease- or infection-causing agent, such as a bacterium, virus, or fungus, gets into your body, your immune system reacts and works to kill the invaders. This self-defense system works to keep you from getting sick.
Immunotherapy uses substances — either made naturally by your body or man-made in a lab — to boost the immune system to:
stop or slow cancer cell growth
stop cancer cells from spreading to other parts of the body
be better at killing cancer cells
Learn more about immunotherapies used to treat metastatic breast cancer.
Doctors may recommend a surgical procedure called minimally invasive thoracoscopy when lung metastases are causing difficult symptoms or problems with lung function. During a minimally invasive thoracoscopy, a thoracic surgeon — a surgeon who specializes in procedures involving the chest — removes the lung lesions or the portion of the lung where the cancer is present through very small incisions.
If you are having complications from lung metastasis, speak with your medical team about the potential benefits of lung surgery, including its risks, and whether you feel well enough to have this procedure.
In carefully selected cases, some doctors may recommend surgery for lung metastases even if there are no symptoms. Typically, this option is limited to people who are generally in good health, have only one area of metastasis, have gone for a few years without any evidence of disease, and have hormone receptor-positive breast cancer (suggesting that the cancer is easier to treat). It’s best if the surgeon is confident that the entire tumor can be removed. These aren’t hard and fast rules, though, and doctors have different opinions about the benefits of surgery for lung metastases. Talk to your medical team to see if a minimally invasive thoracoscopy makes sense for you.
As with bone metastasis, SBRT (stereotactic body radiation therapy) precisely targets high-dose beams of radiation at cancerous areas in the lung, minimizing exposure to healthy tissue nearby. SBRT for lung metastasis is performed as a series of treatments over time.
During RFA (radiofrequency ablation), a surgeon inserts a small probe into a lesion in the lung and destroys it with high-frequency electrical current. However, stereotactic body radiation therapy is much more commonly done than RFA.
If metastatic breast cancer progresses, it can lead to malignant pleural effusion, in which fluid builds up in the sac that surrounds the lungs. It also can lead to malignant ascites, or fluid buildup in the abdominal cavity. These conditions may indicate that the cancer is advancing. Generally, they don’t require local treatment unless they are causing symptoms such as pain, discomfort, or trouble breathing. In these cases, doctors can drain the fluid in two different ways:
Thoracentesis or paracentesis: A doctor inserts a needle into the pleural sac (thoracentesis) or the abdominal area (paracentesis) to remove the excess fluid and improve symptoms.
Implantation of a drainage catheter: If the fluid keeps building up over time, a doctor can implant a drainage catheter under the skin. At-home drainage kits come with a tube and bottle system that you and your caregiver can use to remove the fluid to control your symptoms.
You and your medical team can decide what makes the most sense for your situation.
— Last updated on February 9, 2022, 11:12 PM