Advanced Breast Cancer

Monitoring Your Cancer

Part of living with advanced breast cancer is ongoing testing to keep track of the disease. Although it may feel overwhelming and inconvenient, frequent testing is necessary. The goal is to detect any changes in the disease itself or in its response to treatment early so they can be addressed immediately.

What is Long-Term Monitoring?

Your doctor will regularly perform routine physical exams and blood and imaging tests because no single test provides the complete picture of how your cancer responds to treatment (see Table 1). 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 most commonly used imaging tests for monitoring advanced cancer are bone scans, computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET) and X-rays.

They measure the size of an existing tumor or metastasis, which is cancer that has spread to other parts of your body, such as the bone, brain, liver and lungs. You are encouraged to report any specific symptoms.

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

Tumor markers may be tested periodically to determine if the cancer is responding to therapy or if it has spread. Also known as biomarkers, molecular markers, biological markers or serum markers, these substances are produced by cancer cells or other cells in the body in response to cancer. They can include specific genes, proteins or molecules of the tumor.

Some tumor markers your doctor may test include estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor-2 (HER2), cancer antigen 125 (CA 125), carcinoembryonic antigen (CEA), cancer antigen 15-3 (CA 15-3), cancer antigen 27-29 (CA 27-29) and circulating tumor cells, which are pieces of the tumor that break off and move throughout the bloodstream. Higher numbers indicate the cancer may be growing.

It’s also important to keep the lines of communication open with your doctor between regularly scheduled appointments. All of the detailed information you share can be vital for monitoring and to manage any long-term side effects. Be sure to tell your doctor if any symptoms or side effects begin, and include how you’re feeling physically, mentally and emotionally.

Getting a Handle on Scanxiety

Though you might not be familiar with the name, “scanxiety” is the anxiety associated with follow-up scans. The feeling is understandable because the results will indicate whether your treatment is working the way it is intended. You may begin to feel anxious as the appointment nears and stay that way until you get your results. That is a lot of stress to put on your mind and your body, so it is key to find ways to manage it.

  • Recognize and accept that it is okay to be scared. Be open about your fears with your friends, a support group or a therapist.
  • Keep your mind occupied with things you enjoy, such as reading, playing games or gardening. Staying busy gives you less time to worry.
  • Exercise daily, if possible. It is a stress reliever, and you will feel better physically and emotionally.
  • Calm your nerves with meditation, yoga or deep breathing.
  • Contact your doctor if you become overwhelmed. Medication or therapy may help.


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