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Cancer results from the abnormal and irregular cell proliferation and growth resulting in a mass of cells known as tumor. The tumor is made up of millions of cancer cells and is known as the primary cancer or primary tumor. In the malignant tumors, there is a tendency for the tumor cells to break away from the original site of formation and migrate to other parts of the body to form tumors in the new site. This new cancer or tumor is known as metastatic or secondary cancer. In case of breast cancer, the breast cancerous cells migrate to different parts of the body forming secondary breast cancer.

The cancer cells migrate through the blood stream or the lymph fluid of the lymphatic system. After breaking away from the primary tumor, the cancer cells migrate into the blood stream and in some cases may be trapped in various tissues or organs within the body. On getting trapped, some of the cancer cells may face ultimate death, while the others may remain inactive within the organ or tissue for years. These inactive cancer cells may become active after some time to start dividing to form secondary breast cancer. The reason behind the death of some cancer cells and the dormancy of other cancer cells remains unknown and requires detailed research to elucidate the exact mechanism for the formation of secondary breast cancer.

The migration of the breast cancer cells is limited to some parts of the body and hence, the probability of formation of secondary breast cancer is restricted to these specific parts within the body. The movement of the cancer cells via the lymphatic system causes their spread to the lymphatic nodes that are nearby the breast such as the neck, collarbone, etc. The migration via the bloodstream results in the formation of secondary breast cancer in primarily three regions within the body: bone, liver, and lungs. There is a minor possibility of the spread of the cancer cells to the brain. Usually, secondary breast cancer is known to affect one particular region within the body, however in some rare cases, it may affect more than one place.

Metastatic or secondary breast cancer is a life-threatening disease and has low survival rate as complete cure is not possible, only management of the disease for a period of time usually less than a decade is possible. It is a chronic condition. According to MD Anderson researchers, 40% of women with recurrent or metastatic breast cancer survive at least for five years. The treatment for the metastatic cancer takes a number of factors into consideration such as the body part affected, history of past treatments undergone, general health history, details of menopause if already had. The secondary breast cancer usually responds to a number of treatments that help in the control of the disease for a long time with as few side effects as possible. Clinical trials and researches are going on to develop new types of treatments for the disease.

Proper counselling of the patient is very essential before staring the treatment to console the patient and give elaborate idea and information about the treatment procedure to overcome the shock of getting to know the condition. The discussion about the different treatment options available and suitable for that particular patient are analysed by including her family members before starting the actual course of treatment.

The different types of therapies available for the treatment of secondary breast cancer are:

I) Hormone therapy: It is the most common method of treatment and helps in the shrinkage of the cancer thereby helping in its control. The presence of oestrogen receptors (ER positive) and Progesterone receptors (PER positive) are analysed in the cancer cells as their presence helps in the effective hormone therapy. Compared to Chemotherapy, Hormone therapy is accompanied with fewer negative side effects.

II) Chemotherapy: It is applicable if the cancer cells are found to be hormone receptors negative. It treats the cancer cells spread throughout the body. It is most suitable for secondary breast cancer in liver and lungs.

III) Biological therapy: Biological therapy uses monoclonal antibody trastuzumab (Herceptin). The main role of Herceptin is the targeting of the protein HER2 that is responsible for the growth and multiplication of the breast cancer cells. However, this treatment if effective only in HER2 positive women, who constitute about one out of four breast cancer patients. Hence, the combination of this with other treatments is usually adopted. A monoclonal antibody denosumab (Prolia, Xgeva) is generally used in the treatment of secondary breast cancer that has spread to the bones.

IV) Radiotherapy: It helps in the treatment of individual parts of the body. It is effective in the treatment of secondary breast cancer that has spread to the bones, brain, mastectomy scar or the skin around the breast area.

The presence or absence of female hormones in the pre- or post-menopausal period decides the course of treatment, due to the influence of the hormone levels, apart from the growth rate of the secondary breast cancer. A class of drugs bisphosphates available in two forms-
a) pills like Fosamax and Actonel
b) Venous injections like Aredia and Zometa
has helped in women with secondary breast cancer in bones.

Research is ongoing in metastatic breast cancer and the scientists are hopeful about the development of new drugs and treatments for the disease in near future.