SECONDARY BREAST CANCER

What is secondary breast cancer & its Symptoms

What secondary breast cancer is

A cancer is made up of millions of cancer cells. These form a tumour. The original cancer is known as a primary tumour or the primary cancer. Some cells may break away and spread to another part of the body and form a new tumour. This is called a metastasis or a secondary cancer.

So a secondary breast cancer is when the cancer that started in the breast spreads to another part of the body. The secondary cancer is made of breast cancer cells.

The symptoms of secondary breast cancer depend on which part of the body the breast cancer has spread to. For example, a woman with secondary breast cancer cells in the bone will have different symptoms from a woman with secondary breast cancer in the liver.

How breast cancer cells spread

Cancer cells can spread from a primary breast cancer to another part of the body through the bloodstream or in the lymph fluid which flows through the lymphatic system.

When the cancer cells are in the bloodstream or lymphatic system, they can get trapped in different organs and tissues. Often they die. Sometimes they stay inactive (dormant) for many years. But sometimes they may grow and divide to form a secondary breast cancer many years later. No one knows why some cancer cells stay inactive or what sometimes makes them form a secondary cancer. Researchers are trying to find out.

Where breast cancer cells can spread to

Breast cancer cells are more likely to spread to certain parts of the body than others. Breast cancer cells travelling in the lymphatic system can spread to lymph nodes anywhere in the body. The most common lymph nodes affected are those close to the breast, such as in the neck, or under or above the collarbone.

Cancer cells travelling in the bloodstream are most likely to settle in

• The bones
• The liver
• The lungs
• The cancer cells may also spread to the brain but this is not common.

Secondary breast cancer may only affect one part of the body but it is common for it to affect more than one place at a time.
Symptoms of secondary breast cancer

General symptoms

Most women with secondary breast cancer will only have one or two, or a few, of the symptoms mentioned on this page. The symptoms vary depending on which part of your body the breast cancer has spread to. In some women who have secondary breast cancer, the cancer goes to only one or two places. But there are general symptoms such as

• Being more tired than usual
• Low energy levels
• Feeling under the weather
• Having a poor appetite
  Remember that many of these general symptoms are the same as for
• Colds
• Flu
• The side effects of radiotherapy, chemotherapy, hormone therapy or biological therapy for primary breast cancer

General symptoms on their own may be caused by common illnesses and may not be due to secondary breast cancer. For example, if you have back pain, you may think breast cancer cells have spread to your spinal bones. But the pain is more likely to be caused by something like a muscle strain. If you have symptoms you are worried about that have lasted for more than a week or two, discuss them with your GP, cancer specialist, or breast care nurse.

The lymph nodes

If breast cancer cells have spread to the lymph nodes in the armpit you may feel a firm, often painless, swelling under your arm. This may also cause swelling in the arm called lymphoedema. The swelling occurs because it is more difficult for fluid to drain from the tissues in your arm if the lymph nodes are blocked. Your hand may also swell.

The swelling is uncomfortable and can be painful if it is severe. It can also make it more difficult for you to move your arm. As soon as you notice any swelling in your arm or hand, talk to your specialist or breast care nurse. Treatment may help to shrink the cancer and reduce the lymphoedema.

Breast cancer cells can also spread to lymph nodes in other parts of the body. The most common places are the nodes behind the breastbone or above or below the collar bones. Let your specialist or breast care nurse know if you find swelling or lumps in these areas.

Bone symptoms

Many women with secondary breast cancer in the bone first feel it as an ache in the affected bone. This can get quite painful. You may have trouble getting to sleep at night or difficulty moving around. You may find that you need to take painkillers.

Remember that if you have been treated for breast cancer, discuss any new pain with your doctor or breast care nurse. You may worry that a new ache or pain means that the cancer has spread. But it may be due to an everyday ache or muscle strain. Your doctor will look into any pain that lasts more than a few days or does not seem to be getting better. This can help to put your mind at rest.

Secondary cancer in the bone may damage the part of the bone affected by cancer cells. The more the bone is damaged, the weaker it gets. Pain and weakness can make it hard to move around. A very weak bone may break more easily too. This is known as a pathological fracture. A weakened bone will be treated with surgery or radiotherapy to strengthen it, or sometimes a combination of both treatments. If the bone fractures, this is also treated with surgery or radiotherapy.

Sometimes when bones are damaged by secondary cancer, the bone cells release calcium into the blood. This is called hypercalcaemia and can cause various symptoms such as

• Tiredness
• Nausea
• Constipation
• Irritability
• Thirst
• Confusion

Remember that secondary breast cancer in a bone can be treated. Usually treatment can be started long before your bone becomes weak enough to break or cause a lot of pain.

Liver symptoms

If the breast cancer has spread to your liver you may often feel ill and tired. You may also have

• Discomfort on the right side of your abdomen (where the liver is)
• Nausea
• Loss of appetite
• A swollen abdomen

Secondary breast cancer in the liver can cause pain if the cancer presses on the fibrous tissue covering the liver (the capsule) or causes swelling in the liver that stretches the capsule.

The liver has a lot of functions in the body. One is to make bile to help digest food in the intestine. If the drainage channels leading from the liver are blocked by secondary cancer, bile may build up in the blood. This causes jaundice where the skin and whites of the eyes become yellow and your skin may feel itchy.

The liver can still work well when part of it, or even most of it, is affected by cancer cells. And the symptoms of secondary breast cancer cells in the liver can usually be well controlled.

Lung symptoms

The first symptoms of secondary breast cancer in the lungs are usually a cough and breathlessness.

Cancer cells on the outside of the lungs can irritate the lining around the lungs (the pleura) and cause discomfort when breathing. Fluid may build up and press on the lungs. This is known as a pleural effusion. Some women notice quite a change in their breathing if this happens.

Breathing problems can be frightening. But there are ways to treat breathlessness from secondary breast cancer. These soon make it easier to breathe.

Brain symptoms

The idea of secondary cancer affecting the brain can be very frightening. But the brain can work well even if part of it is put out of action by secondary cancer cells.

Secondary breast cancer in the brain can cause different symptoms depending on which part of the brain is affected.

• You may have headaches and feel sick
• The part of the body controlled by the site of the secondary cells may not work properly – for example, an arm or a leg may be weaker than usual or may feel numb
• You may have memory problems
• You may find yourself behaving in a way that is not usual for you

Very rarely, breast cancer can affect the eyes. If you notice any problems with your eyesight, tell your doctor. But remember that eye problems can have many causes so it may not be due to cancer. And some types of hormone therapy for breast cancer can occasionally affect your vision.