Most women with secondary breast cancer will only have a few of the symptoms discussed below. Some women have no symptoms and the secondary breast cancer is discovered only after a routine check-up.

The symptoms will depend on which part of the body is affected. However, there are a few general symptoms which some women have. These include:

• being more tired than usual
• generally feeling unwell
• having less of an appetite.

It is important to discuss any new symptoms with your doctor, particularly if they seem to be continuing.

However, general symptoms may also be caused by other conditions, such as colds and flu. These symptoms are also side effects of cancer treatment and can occur for weeks or months after completing treatment for primary breast cancer. Therefore the side effects are not always due to a secondary breast cancer.

The following information is about specific symptoms of secondary breast cancer. We also have detailed information about secondary cancers in the bones, lymph nodes, liver, lung and brain. We have not included information about rarer symptoms of secondary breast cancer.

Sometimes a small number of breast cancer cells, that were too small to see, are left at the area of the operation after surgery. If this happens, these cancer cells may grow and form a new lump. Lumps may form in the remaining breast tissue after a lumpectomy, in the skin near the breast after a mastectomy, or in the operation scar. However, most cancers that are found after a lumpectomy are new cancers and not a recurrence.

The first sign of a local recurrence is usually the development of a small lump (sometimes called a nodule) in the skin or in the scar, or there may be a lump in the deeper breast tissue. These local recurrences can usually be treated and controlled, but it is important to report it to your doctor as soon as you notice it. If it is left untreated the skin in the area may break down and become sore (ulcerated).

If the breast cancer cells have spread to the lymph nodes they will cause a firm, usually painless, swelling. This happens most often in the lymph nodes of the armpit (axilla) or in the neck, but can affect lymph nodes in other parts of the body, such as behind the breast bone (sternum) or next to the collar bones.

It is common for breast cancer to spread to the lymph nodes in the armpit. This isn’t always a sign that the cancer is secondary or metastatic. Many women with early breast cancer (stages 2–3) have cancer in these lymph nodes when the cancer is first diagnosed, and this is treated either by removing the nodes or by having radiotherapy.

Lymphoedema (swollen arm)

If cancer cells grow and block the lymph glands in the armpit, the arm on that side of the body can swell – this is called lymphoedema.

Lymphoedema can also occur if the lymph nodes in the armpit have been treated by radiotherapy or have been removed by surgery. This can cause scarring that damages the lymph nodes that drain the arm. If the lymph glands of the armpit are damaged or blocked, they may be unable to drain fluid from the tissues in the arm or fight infection. Fluid then builds up, causing swelling.

Lymphoedema can be very uncomfortable. It can make moving your arm difficult, and there is a greater likelihood of developing an infection in the arm.

Treatment for lymphoedema is discussed on the controlling symptoms page.

The first sign of a secondary cancer in the bones is usually a nagging ache in the affected bone. This can become painful, making it difficult to get to sleep at night or to move around without taking painkillers. The pain is generally present both day and night, whereas an arthritic type pain is often worse early in the morning and is not there all the time.

Women who have had treatment for breast cancer should always discuss any new pain which lasts more than two weeks with their doctor. It is very understandable to worry that a new ache or pain means the cancer has spread, but the cause is very often an everyday ache or muscle strain. Your doctor will do tests to find the cause of any continuing pain, which can help to put your mind at rest.

A secondary cancer in the bone may gradually damage the bone. The damage only happens in the part affected by the cancer cells. The more the bone is damaged, the weaker it becomes. Pain and weakness can make getting around difficult, and a bone that is very weak may break (fracture).

Sometimes breaking a bone is the first symptom of secondary breast cancer in the bone. These fractures can happen after a very minor injury, simply because the bone is weakened. When a bone breaks in this way, it is called a pathological fracture.

When bones are affected by secondary cancer cells, increased amounts of calcium (the substance that helps to build bones) may be released into the blood. Too much calcium in the blood is called hypercalcaemia. It can cause symptoms such as tiredness, feeling sick, constipation, thirst and confusion. However, in many people hypercalcaemia is discovered during a blood test before any symptoms develop.

Secondary breast cancer in a bone can be treated. For most women, treatment can be started long before the bone becomes weak enough to break or cause severe pain.

Treatment for hypercalcaemia is discussed on the controlling symptoms page.

The first sign of secondary breast cancer in the lung may be a persistent cough, or breathlessness. Breathing problems can be frightening, but there are very effective ways of relieving breathlessness which can quickly make your breathing easier.

If cancer cells settle on the outside of the lungs, they irritate the membrane which covers the lungs (the pleura). This causes fluid to build up, which presses on the lungs. This is known as a pleural effusion.

We have further information on pleural effusions and coping with breathlessness.

Women whose breast cancer has spread to the liver may feel generally unwell and tired, with a loss of energy. It may feel uncomfortable in the area of the liver (on the right side of the abdomen, just under the lower ribs).

Some women feel sick (nauseous) and lose their appetite. Secondary breast cancer in the liver is only painful if the secondary cancer is on the outside of the liver and pressing on the capsule surrounding the liver, which is unusual.

The liver produces a substance called bile, which helps to digest food in the intestine. If the bile ducts leading out of the liver are blocked by secondary cancer, bile may build up in blood and cause jaundice. This causes the skin and the whites of eyes to become yellow and may make skin feel itchy.

The liver is a large organ and is capable of working efficiently when part of it, or even most of it, is affected by cancer. The symptoms of secondary breast cancer cells affecting the liver can usually be effectively controlled.

The idea of secondary cancer affecting a part of your brain can be very frightening. The brain controls the body, and it can be worrying to think of losing some control. However, the symptoms of a secondary tumour in the brain can often be well managed.

If a secondary breast cancer develops in part of your brain, pressure may build up and cause headaches and nausea (feeling sick). These symptoms may be worse on waking in the morning and get better through the day. The headaches are often at the back of the head. They are often worsened by coughing and sneezing.

Sometimes the first sign of a spread of the cancer to the brain may be a seizure (fit). Secondary cancer may affect an area of the brain which controls a certain part of the body. This can occasionally cause an arm or a leg to become weaker than usual, or there may be a feeling of numbness, tingling, or pins and needles. Sometimes, secondary cancer in the brain may cause a change in personality.

It is important to remember that no woman with secondary breast cancer is going to have all, or even most, of the symptoms discussed here. Secondary breast cancer is many different conditions; the only common factor is that the cancer cells all started from a primary breast cancer. Each condition has its own particular set of symptoms and treatment.