Treating metastatic breast cancer in the lung

Treatments for lung metastases are often very effective in stopping the growth or decreasing the size of the metastases.

There are 2 main ways of treating lung metastases.

• The more common way is with whole body or 'systemic' treatments and therapies.
• Less common is local treatment on a single part of the body, such as surgery to the liver or radiotherapy.

These aim to reduce your symptoms and stop or delay the progression of lung metastases, to give you the best possible quality of life.

What influences treatment decisions

The treatments recommended for you will depend on:
your symptoms

• the number and location of lung metastases
• whether there is cancer in other parts of the body
• the subtype of the cancer – such as ER+, PR+, HER2+positive, triple negative
• the treatments you’ve had in the past
• your general health
• your personal preferences.

Systemic treatments

Options are hormone-blocking therapies, chemotherapy and targeted therapies, and immunotherapy.

The type of systemic treatment you have will depend on the subtype of breast cancer. This information is in your pathology report.

Find out about treatments for your subtype of breast cancer:

• hormone receptor positive
• HER2-positive
• triple negative

Local treatments

Metastases in the lung can spread into the layers of tissue that line the lung (‘pleura’). There is usually a small amount of fluid between the 2 membrane layers. Lung metastases cause more fluid to develop. This can sometimes cause pain, discomfort and difficulty breathing.

Pleural drainage is a procedure to drain this fluid under local anaesthetic, using a small tube. Once the fluid is removed, breathing is easier. This procedure can be repeated as often as necessary. It is usually done in the radiology department.

Pleurodesis is a procedure to reduce the space between the lung and chest wall. This stops fluid from building up between the membrane layers. The most common and effective method uses a tiny camera and small incisions (‘VATS pleurodesis’). It is a form of keyhole surgery. Recovery time is much quicker than for larger surgeries but you may need a night in hospital.

Surgery

Occasionally, doctors may consider surgery to remove a lung metastasis that is causing pain or breathing problems.

Your specialist will talk you if they think this is an option.

They will consider factors such as:

• the specific part of your lung that is affected
• the risk versus benefit of the procedure
• your general health and personal preference.

Radiotherapy

Radiotherapy is sometimes effective in treating isolated lesions in the lung. Radiotherapy to a specific body part is called ‘stereotactic body radiation therapy’ (SBRT).

Radiotherapy is also an important part of treatment for ‘superior vena cava obstruction’. If cancer causes the lymph nodes of the chest to enlarge, this swelling can block the large vein (‘vena cava’). This stops blood from flowing to the heart.

The lymph nodes in the centre of the chest ('mediastinum'), not the lungs themselves, can be treated with radiotherapy if they are causing an obstruction.