Sites & Symptoms of Secondary Spread

BONE

The bone is the most common site to which breast cancer cells spread. Bones most often affected are the spine, ribs, skull, pelvis and the femur or humerus. Metastasis of the bone can cause severe, progressive pain, swelling and, if undetected, bones that are more easily fractured or broken. Treatment is given to relieve symptoms and slow the growth of the cancer and, although it cannot be cured, it can often be treated for many years.

Key symptoms to look out for are:-

Pain

Bone metastases can cause pain in or near the affected area which may feel like a dull ache or be an acute stabbing or burning pain. The pain may be there all the time or get worse when moving or at night.

Bone fractures

If the affected bones have been weakened by the cancer, you may be at risk of breaking a bone. If a bone fractures, you may have surgery to repair the fracture and will most likely be given bone strengthening drugs, bisphosphonates, to stop this happening again.

Spinal Cord Compression

A potentially serious complication if you have cancer in your spine is spinal cord compression which is caused if one of the vertebrae fractures or collapses causing pressure on the spinal cord. This is a medical emergency and needs immediate treatment. Some of the symptoms of spinal cord compression are:

  • Increased pain or tenderness in or around the spine
  • Changes in sensations such as pins and needles or weakness in the legs
  • Incontinence

Anaemia

Sometimes secondary bone cancer can affect how the bone marrow works which can cause a lack of red blood cells or anaemia. You may feel more tired or breathless on exertion. A blood test will detect if your symptoms are caused through anaemia but you would need a bone marrow biopsy to confirm if the bone marrow is affected.

Hypercalcaemia (excessive calcium in the blood)

Secondary breast cancer in the bone can alter the bone structure so that too much calcium is released into the bloodstream. If the calcium level gets too high you may get symptoms such as:

nausea and/or vomiting constipation drowsiness excessive thirst weakness confusion

A blood test will show if your symptoms are being caused through hypercalcaemia and appropriate treatment will be given to help flush the excess calcium from your body.

LIVER

The liver is the only organ in the body to be able to repair itself and people can live with only a portion of the liver. Although there are sometimes no obvious signs that the cancer has spread to the liver it can cause the following symptoms depending on the position of the tumours and how big they are.

Pain

Some people will have pain or discomfort around the liver area or, if the liver has become enlarged, pain may be felt in the upper abdomen or occasionally in the right shoulder. Occasionally an enlarged liver can press on the diaphragm and cause hiccups.

Nausea and vomiting

If the liver is enlarged this may put pressure on your stomach causing nausea and vomiting, or if the liver is not working properly toxins can build up in the body causing sickness.

Loss of appetite

You may find that that you feel less hungry than usual and can’t face large or heavy meals. Nutritional supplements can help or you may find it easier to have smaller meals more often.

Jaundice and Itchy Skin

If the cancer is blocking the bile duct or if the liver is seriously affected by the cancer, you may develop jaundice. The whites of your eyes and skin may develop a yellowish tinge and your urine may become darker and your faeces paler. If the jaundice is caused through the bile duct being blocked, a stent can be inserted into the bile duct to drain the excess bile and relieve the symptoms. Jaundice can cause the skin to itch which can be worse at night or in the heat.

Ascites

Cancer in the liver can cause a build up of excess fluid called ascites which may make your abdomen swollen and uncomfortable. This can be relieved by draining the fluid and a diuretic can be prescribed to slow down the build up of fluid.

LUNG

The most common symptoms for secondary cancer of the lung include a chronic cough, breathlessness or persistent pain or discomfort in the chest area.

Chronic cough

A cough which doesn’t seem to be getting better may be a sign that the cancer has spread to the lungs. It may be caused by the cancer itself or by an infection. Sometimes the cough is a persistent dry, ticklish cough or it can be productive, ie bring up phlegm.

Shortness of breath

If the cancer has spread to the lungs, it may be narrowing or blocking your airways or sometimes the cancer causes inflammation and swelling which makes breathing more difficult. You may also be at more risk of infections which can cause breathlessness. This may be more noticeable on exertion but some people find they are more breathless when lying down.

Pleural effusion

Sometimes the cancer can cause an excess of fluid in the pleural space which is called a pleural effusion. This can make you feel breathless as it is restricting the lungs. The symptoms can be eased by inserting a drain to remove the excess fluid that has built up

BRAIN

The symptoms of brain metastases will depend on which area of the brain the cancer has been affected as certain areas of the brain are responsible for different functions. You may experience some of the symptoms but it is very unlikely that you will get all of them. Symptoms can appear suddenly but usually will develop over time. The most common symptoms are:

  • Persistent headache or pressure to the head - These headaches are often different from headaches you may normally get, being more severe and sometimes accompanied by nausea and vomiting. The headaches can often be worse in the morning on waking and get less intense throughout the day.
  • Vision disturbances - Most often visual disturbances present as double or blurred/wavy vision
  • Weakness or feeling numb down one side of the body
  • Unsteadiness
  • Seizures or fits

Less common symptoms include:

  • Behavioural or personality changes
  • Confusion
  • Memory problems
  • Difficulty with speech

For information on the various treatments available, please see the section on treatment options.

SKIN

Commonly referred to as skin mets, sometimes cancer cells can start growing in the skin. The first appearance of skin mets may be a pink or red raised lump often on or around an operation scar where the primary cancer was removed.

Sometimes skin mets can grow in other area of the body. Sometimes skin mets have the appearance of a painless raised nodule, they could look a bit like a boil or have the appearance of a dry scaly patch.

See your doctor immediately if you have any concerns. Skin mets can be treated but, without treatment, the area may become bigger and may bleed or start to weep.

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