Monitoring metastatic breast cancer

Your medical team will monitor you carefully during treatment for metastatic breast cancer. 

If your treatment includes chemotherapy, you will have regular appointments with your medical oncology team. If you are having intravenous treatment, this is usually every 3 to 6 weeks.

At each visit, your doctor will assess:

• how you are coping with the treatment
• any side effects you are having.

Tests during treatment for metastatic breast cancer

To check how well treatment is working, your oncologist may ask for tests and scans.

Blood tests

Usually you will have a blood test before each appointment. This may include tumour marker blood tests (if levels were above normal at the start of therapy). 

Tumour markers are proteins found in the blood, such as CA15-3 and CEA, that: 

• the body can produce in response to cancer 
• the cancer tissue itself can produce. 

If the tumour marker levels are higher than normal, this can indicate that metastases are present. 

Doctors can use tumour markers to see how the cancer is responding to treatment. 

It’s important to remember that tumour markers are not always a reliable way to measure the cancer and its activity. For example, your levels may go up even though other evidence shows that the cancer is responding to treatment. 

Some breast cancers do not produce tumour markers at all. For this reason, some medical oncologists don’t check tumour markers. 

Medical oncologists use them with other tests to form a picture of how the cancer is responding to treatment. 

Scans

Every 2 to 4 months, you will have scans to assess how well the treatment is working. These may be a CT scan, PET scan, whole body bone scan (WBBS) or ultrasound.

If it is clear you are doing well on the treatment, your doctor may suggest you have appointments, blood tests and scans less often.

At each visit you will leave with:

• the date of your next appointment and
• an idea of when your next scans are due.

If your cancer has been stable for more than a year, you may only need to see your medical oncologist every 4 to 6 months.

Regular heart tests

If you are having treatment for HER2 metastatic breast cancer, doctors will check your heart function regularly. This is because, for a small number of people, anti-HER2 treatments can make the heart muscle weak.

You may have:

• Echocardiogram ('echo’): this is an ultrasound of the heart, usually done in the cardiology department or
• Gated blood pool scan: this is a nuclear medicine scan, done in the radiology department. It looks at how well the heart is pumping. It measures the amount of blood in the heart during different parts of the heartbeat.

Your first heart test will be done before you start anti-HER2 treatment. Then, you will usually have a test every 3 months.

Other tests during treatment

If you are not feeling well, it’s always important to think about an earlier appointment with your medical oncologist. This is important especially if you develop symptoms that make you think the cancer is becoming more active. Your GP or nurse can help you decide if you need an early appointment with your medical oncologist.

Assessing how well treatment is working

Sometimes it can be difficult to determine if your cancer has become worse or progressed. Scans cannot show everything.

On a regular basis, your doctor will assess:

• how you are feeling generally
• whether you have any specific symptoms
• results of your blood tests, including tumour markers if they are useful in your case
• findings of a physical examination
• results of scans.

If this assessment shows that your treatment is not working, or the side effects are hard to manage, your doctor will discuss the options with you. They may recommend:

• changing the chemotherapy dose
• changing the chemotherapy drug
• changing medication to control side effects
• taking a break from treatment to help with side effects.

Taking a break from treatment

You can talk to your doctor about having a break from treatment for a while if you have a holiday or special event planned.