Advanced Breast Cancer

Monitoring Your Cancer

With advanced breast cancer, keeping track of how the disease responds to treatment is an important part of the overall care plan. Routine testing will be done to see if your treatment is slowing or stopping the growth of your cancer. If it’s not, you and your medical team will discuss alternative treatment options.

Pay attention to any new or changing symptoms you have and tell your doctor or medical team about them during your routine visits. At these visits, your doctor will perform a physical examination to see if there are any clinical signs of response. For example, a lymph node that has gotten smaller may mean the cancer is responding to treatment.

In addition, several different tests can be done to determine how well treatment is working. No single test provides the complete picture of how your cancer is responding to treatment. Your medical team will work with you to determine the kind of testing that is best for you and how often it should be done. The tests to monitor your cancer include imaging studies and tumor marker testing. To have a baseline for comparison with later studies, your doctor will perform one or more of these studies before treatment begins.

Imaging studies

Imaging studies are typically done about eight to 12 weeks after treatment starts. These studies enable your doctor to measure the size of a tumor or metastatic site. A tumor or metastatic lesion that is smaller than it was before treatment is one sign that your cancer is responding to treatment. Imaging studies include bone scan, X-rays, computed tomography (CT), magnetic resonance imaging (MRI) and positron-emission tomography (PET) (see Table 1).

Table 1. Imaging Studies to Monitor Cancer

How It Feels
Test Why It's Done How It's Done How It Feels
Bone scan Determine the presence or extent of metastasis to the bones A small amount of a radioactive substance is injected into a vein in your arm. You then lie on a table, and a special camera shows where radioactive material has collected, which indicates cancer. Painless
X-ray Check or monitor metastatic lesions in various organs You lie on a table while the X-ray machine is positioned over a specific part of your body. Painless
CT Monitor metastatic lesions in other organs such as lungs, bones or liver You lie on a table that moves slowly through the CT scanner. Sometimes, a dye (called a contrast) is injected into a vein in your arm before the scan to enhance the quality of the images. Painless
MRI Valuable for viewing the brain, spine and spinal cord You lie on a table within a long, narrow tube while radio waves and strong magnets linked to a computer produce images. Painless, but may cause anxiety if you have claustrophobia (fear of closed-in space). Your doctor can prescribe medication to help you relax.
PET May be beneficial if the results of other imaging studies are inconclusive A small amount of radioactive material (tracer) is injected into a vein. You lie on a table and a special camera shows where the tracer collects, which indicates the cancer has spread. May feel a sting as the tracer is injected, but otherwise painless.

Tumor Markers

Testing on a sample of your blood (taken from a vein in your arm) for tumor markers can help your doctor determine how your tumor is responding to treatment. Tumor markers are specific proteins, called cancer antigens, that cancer cells give off into the bloodstream.

The amount of cancer antigens in a blood sample may provide information about how many cancer cells are in your body. Three cancer antigens are associated with advanced breast cancer: cancer antigen (CA) 15-3, CA 27.29 and carcinoembryonic antigen (CEA). Decreasing or increasing levels of these cancer antigens over time may reflect tumor shrinkage or growth, respectively. Tumor marker testing is usually done before treatment starts and periodically thereafter.

Another tumor marker is circulating tumor cells (CTCs). CTCs are cells that break away from a tumor and enter the bloodstream. A special test can measure the number of CTCs in a blood sample. Studies have shown that CTC testing can help determine the prognosis (predicted outcome) as well as monitor the response to treatment. CTC testing is usually done about three to four months after treatment starts.

Tumor marker testing alone cannot provide complete information about how a tumor is responding to treatment; however, the combination of tumor marker testing and imaging studies provides a clearer picture of how well treatment is working.


Managing the risks of a second cancer

It is important to be aware that a second cancer, one that is new or unrelated to your advanced breast cancer diagnosis, could develop. People with breast cancer are at risk of developing many types of other cancers, including ovarian, uterine, cervical, colon and skin cancers. In addition to asking your doctor about what to watch for, there are a number of things you can do to minimize your risk:

  • Make and keep appointments for preventive screenings.
  • Do monthly skin self-exams, and let your doctor know about new moles or other problems.
  • Follow a healthy diet.
  • Achieve and maintain a healthy weight.
  • Exercise regularly.
  • Avoid tobacco.
  • Limit alcohol intake.
  • Communicate openly and honestly with your doctor.

Additional Resources


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