What the tests can find
Many different tests can be used to find out if breast cancer has spread. The tests vary depending on your symptoms and where the doctor suspects the cancer might have spread to. You may have a whole body CT scan. As the bones, liver and lungs are the most common places for secondary breast cancer, you are most likely to have tests for cancer spread to these parts of the body. You may have had some of the tests when diagnosing your primary breast cancer. You may have had a bone scan or a liver ultrasound at that point.
The tests help to spot secondary breast cancer but cancers don’t often show up on scans until they are bigger than the size of a pea. Unfortunately there is no test that can pick up tiny secondary areas of cancer (micrometastases). Researchers are developing more accurate tests for spotting micrometastases.
In most cases it is the person themselves who suspects something is not right. But it is important to remember that the symptoms of secondary breast cancer are similar to many other common every day illnesses. So the symptoms may not be due to a cancer. If you are worried see your doctor and they can organise tests to find out.
Tests for secondary spread to the bones
X-rays can give a picture of the general condition of the bones. But X-rays may not show up small secondary tumours. A bone scan is better. It shows up tiny areas of affected bone.
During a bone scan, you have a small amount of a mildly radioactive material injected into a vein (usually in the arm). The radioactive material travels around the body in the bloodstream. The bones take it up. More radioactivity is absorbed by abnormal bone than by normal bone. A special scanner is then used to show abnormal areas of bone. They are sometimes called hot spots.
If you are having a bone scan, it’s important to know that hot spots do not necessarily mean cancer. They are just areas of damaged bone. Some other conditions, such as arthritis, also show up as hot spots. You could also have a CT scan or an MRI scan to check for cancer spread to the bones. These scans can sometimes show if the cancer has spread to the bones when the results of bone scans are not certain. Your doctor will look at the combined results of all your tests to see whether you have a secondary breast cancer.
When cancer spreads to the bones, it can make the bone cells release calcium into the bloodstream. Too much calcium in the blood can make you feel drowsy and sick. A blood test can measure the amount of calcium in your blood. If the calcium level is high (hypercalcaemia) you can have treatment to lower the level.
Tests for secondary cancer spread to the liver
If you or your doctor think that your cancer may have spread to the liver, you may have a series of blood tests called liver function tests. You give one blood sample and the laboratory does a series of tests on that. The tests can show if your liver isn’t working as well as it should. But it can’t show whether any problem is due to secondary cancer or something else.
Your doctor may ask you to have a liver ultrasound scan because that can sometimes show secondary cancer in the liver even when the blood tests are normal. Or you may have a CT scan.
Tests for secondary cancer spread to the lungs
A chest X-ray or chest CT scan can show whether there is secondary breast cancer in the lungs. It also shows any build up of fluid around the lungs (a pleural effusion).
Tests for secondary cancer spread to the brain
A brain CT scan (also sometimes called a CAT scan) gives a clear picture of any secondary breast cancer cells in the brain. The scanner takes many cross section X-rays of your head. A computer creates images of the brain. To increase the detail, a technician may inject a dye into a vein, usually in your arm. You may feel hot all over for a few moments after the injection.
Your doctor may suggest an MRI scan to examine the brain. Having this is similar to having a CT scan, but the scanner uses magnetism to build up a picture instead of X-rays.
A PET-CT scan combines a CT scan and a PET scan into one scan. A CT scan takes pictures from all around your body and uses a computer to put them together. A PET scan uses a very small amount of an injected radioactive drug to show where in the body the cells are more active than normal. There is detailed information about PET scans in the cancer tests section.
The PET-CT scanner combines both of these types of information. This allows your doctor to see any changes in the activity of cells and know exactly where the changes are happening. You may have a PET-CT scan if other tests suggest that your breast cancer might have spread to another part of the body, but your doctors need to be sure.
Why tests aren’t used in routine follow up
Most doctors don’t do scans or other tests routinely after breast cancer treatment. They only do them if there is a reason to suspect that something is wrong. Having these tests regularly can’t stop cancer from spreading. And finding out about cancer spread earlier often won’t change how your doctor decides to treat you. One of the most important reasons for not doing tests too often is that many of them expose you to radiation. And your doctor won’t want to keep exposing you to extra doses of radiation when there is no need.
Whether you have tests or not you may continue to worry that the cancer may come back, but it is very important to put this in context. Survival rates for breast cancer are improving. More than 85 out of every 100 women (85%) in England and Wales with breast cancer live for more than 5 years. Although no one will be able to give you a 100% guarantee that your cancer will not spread, for most women there is a very good chance that it has been cured.
There is no test that can pick up microscopic cancer spread. So a negative test doesn’t necessarily mean that there is no cancer spread. People who worry a great deal about cancer spread won’t necessarily have their minds put at rest by a scan, because there is always the chance that microscopic spread has been missed.
Many women find it very difficult to accept that scans and tests are not part of their routine check ups. You may wonder if they are not done because they cost too much. Although many scans are expensive, this is not the reason.
You can talk these issues through with your doctor. If you are very keen to have routine tests, there may be a compromise you can come to about how often you have them. An occasional blood test or ultrasound scan might help to keep an eye on your health and also make you feel less anxious.
Waiting for results
You may worry while you wait for your tests, and then for the results to come through. You may think the cancer has come back or spread. But without the results of the tests you can’t be sure.
You may feel torn between believing there is some other cause for your symptoms, which there may be, and thinking the worst. This uncertainty is often very hard. Many people with cancer say that not knowing is the worst thing about it. If your results confirm that you have secondary breast cancer, at least then you can prepare for your treatment.
What to ask your doctor about advanced breast cancer tests
Some questions you might ask your doctor
- How can I know if aches and pains are symptoms of breast cancer coming back?
- How often should I have tests?
- Can I ask if I want a scan?
- Do I need any tests?
- What sort of tests will I have?
- How accurate are the tests?
- How long will I need to wait for my test?
- How long will the results take?
- Is there anyone who can support me while I wait for the results?
- What will my treatment be if the cancer has come back?
- What will my treatment be if the cancer has spread?