Symptoms of secondary breast cancer

Most women with secondary breast cancer will not have all, or even most, of the symptoms discussed below. Some women have no symptoms and the secondary breast cancer is only discovered after a routine check-up.

General symptoms

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 – but it is important to remember that these general symptoms may also be caused by other conditions, such as colds and flu. They can also occur for weeks or months after treatment for primary breast cancer and may not be due to a secondary breast cancer.

Local recurrence

Sometimes a few breast cancer cells, that were too small to see, are left at the area of the operation after surgery. If this happens, the cancer may come back in the remaining breast tissue after a lumpectomy, in the skin near the breast after a mastectomy, or in the operation scar.

When this happens, the first sign is usually a small lump (sometimes called a nodule) on the skin or in the scar, or there may be a lump in the deeper breast tissue. A nodule can usually be treated and controlled, but it is important to report it to your doctor as soon as you notice it, because if it is left untreated the skin in the area may break down and become sore or ulcerated.

Secondary breast cancer in the lymph nodes

If the breast cancer cells have spread to the lymph nodes they will cause a firm, usually painless, swelling. This most often happens in the lymph nodes of the armpit (axilla) or in the neck.

Lymphoedema (swollen arm)

Lymphoedema is the term used for swelling. Swelling of the arm can develop if secondary cancer cells block the lymph glands in the armpit. It can also occur if the lymph nodes in the armpit have been treated by radiotherapy or have been removed by surgery. If the lymph glands of the armpit are damaged or blocked, they may be unable to do their job of draining fluid from the tissues in the arm or fighting infection in the arm. Fluid then builds up, causing swelling.

Lymphoedema can be very uncomfortable and can make it difficult to move the arm, as well as making infection more likely to develop there.

The treatment for lymphoedema is discussed on the Controlling syptoms page.

Secondary breast cancer in the bone

The first sign of a secondary cancer in the bones is usually a nagging ache in the 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 of the bone 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).

When bones are affected by secondary cancer cells, extra 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 cases 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.

Secondary breast cancer in the liver

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

Some women feel sick and lose their appetite. Secondary breast cancer in the liver is only painful if the secondary cancer is 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 the blood and cause jaundice. This will make the skin and the whites of the eyes become yellow and may make the skin feel itchy.

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

Secondary breast cancer in the lungs

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 and these can quickly make your breathing easier.

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

Secondary breast cancer in the brain

The idea of secondary cancer affecting a part of the 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 brain tumour can often be well managed.

If a secondary breast cancer develops in part of the brain, pressure may build up within the brain 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 brain tumour may be a fit (seizure). Sometimes, the part of the body controlled by the area of the brain affected by the secondary cancer may not work properly. This can occasionally cause an arm or a leg to become weaker than usual, or a feeling of numbness, tingling, or pins and needles. Sometimes, brain tumours may cause a change in personality.