Supportive care for secondary breast cancer

The symptoms of secondary breast cancer are usually helped with cancer treatment. Sometimes this works quickly and you may notice an improvement within a few days. But sometimes it may take a few weeks before you feel better. There are also other ways to manage symptoms.

You may have some general symptoms, such as feeling very tired. Other symptoms depend on where in the body the cancer has spread to. Sometimes symptoms, such as bone symptoms may cause possible complications that need to be treated.

You will not get all the symptoms mentioned here. Some women get very few symptoms. Always let your doctor or specialist nurse know if you have new symptoms or if your symptoms get worse.

Many hospitals have doctors and nurses who are experts in treating pain and other symptoms. They are sometimes called supportive or palliative care specialists.

Tiredness

Feeling very tired (fatigue) is a common symptom. Treatments may help improve tiredness. You are likely to be tired during treatment and for a while afterwards. But this should slowly improve. Make sure you get enough rest. But it can help to try to balance this with some gentle physical activity.

Sometimes tiredness is caused by a low number of red blood cells. This is called anaemia. Your doctor can do a blood test to check this. They may prescribe drugs to treat anaemia. You may need to have a blood transfusion.

We have more information about getting enough rest and managing fatigue.

Feeling sick

Your doctor can prescribe different anti-sickness drugs. You usually take them by mouth. But they can also be given as:

  • a skin patch
  • suppositories
  • injections under the skin.

Let your doctor or specialist nurse know if the drug you are taking is not working, so they can prescribe a different one.

We also have more information about managing nausea that may help.

Constipation

Constipation can be caused by some chemotherapy drugs, anti-sickness drugs and, often, by painkillers. Your doctor can prescribe a medicine called a laxative to stimulate the bowel.

We have more information about managing constipation.

Lymphoedema (swelling of the arm)

You may develop lymphoedema as a result of treatments or because the cancer is blocking lymph nodes in the armpit. There are effective ways of reducing the swelling and managing lymphoedema. If you notice any swelling in your arm or hand, always let your doctor or specialist nurse know as soon as possible.

Pain

There are different painkillers, depending on the type of pain you have. You may need a combination of drugs. You usually have painkillers by mouth. But they can also be given as:

  • a skin patch
  • suppository (put into the back passage)
  • an injection into the skin.

It is important to take your painkillers regularly. Always let your doctor or nurse know if they are not controlling the pain.

Steroids can be used to reduce swelling, for example if the cancer is in the liver. Reducing swelling improves the pain.

We have more information about controlling pain.

Treating bone problems

Sometimes secondary breast cancer in the bone may cause pain or other problems that need treatment. There are different ways in which bone symptoms can be managed.

Treating bone pain

If breast cancer has spread to the bones and is causing pain, you may be given:

  • drugs called non-steroidal anti-inflammatory drugs (NSAIDs)
  • bone-strengthening drugs called bisphosphonates or denosumab
  • a single session or short course of radiotherapy.

Radiotherapy is very effective at treating bone pain but it can take a few weeks to work. Take your painkillers regularly until the radiotherapy works.

Too much calcium in the blood (hypercalcaemia)

Secondary cancer in the bone can cause calcium to go from the damaged bone into the blood. If you have high levels of calcium in the blood, you may:

  • feel very tired and thirsty
  • pass lots of urine (pee)
  • feel sick
  • be irritable and confused.

Tell your doctor or specialist nurse if you have these symptoms.

Your specialist nurse or doctor will give you a drip (infusion) of fluids to flush the extra calcium from your body. They will also give you drugs called bisphosphonates as a drip to lower the calcium levels. Your symptoms should go away within 2 days.

Strengthening a weakened bone

If a secondary breast cancer has weakened a bone, usually in the hip or leg, you may need an operation to strengthen it. You may have radiotherapy before or after surgery. This can help repair the bone or try to get rid of any cancer cells.

You have the operation under a general anaesthetic. The surgeon puts a metal pin into the centre of the bone and may fix a metal plate to it. The pin and plate stay in permanently. It holds the bone in place and prevents it from breaking.

If one of your hip joints has been affected by the cancer, you may have surgery to replace the joint. Surgery is also sometimes used to treat secondary breast cancer that has spread to the spine.

You have to stay in hospital for a week or longer after the operation so you can recover fully. But most women can get up and start walking 2 days after surgery.

Spinal cord compression

Spinal cord compression is not common, but it is very important that it is diagnosed quickly. It can happen when the cancer grows in, or near to, the spine and presses on the spinal cord and nerves. Symptoms can include:

  • unexplained pain in the back, around the chest, neck, or down the arm or legs
  • numbness or pins and needles in toes, fingers or buttocks
  • unsteadiness or difficulty walking
  • problems controlling your bladder or bowel.

It is important to let your cancer doctor or specialist nurse know straightaway if you have any of these symptoms. The earlier treatment starts, the more likely it is to be effective. Steroids, radiotherapy and surgery can be used. We have more information about spinal cord compression.

Breathlessness

If the cancer has spread to the lung you may become breathless. Sitting down when you are doing everyday things such as washing, dressing or making food can help you to manage breathlessness. There are also controlled breathing or relaxation techniques that can help.

Pleural effusion

If cancer cells spread to the lining of the lungs (pleura), it can cause fluid to build up. This is called a pleural effusion. It can make you breathless. Your doctor can treat this by passing a narrow tube into your chest to drain off the fluid. This usually improves your breathing straight away. If it comes back, the fluid can usually be drained again. It may be possible to have a special catheter put in that allows you to drain the fluid into a bottle while you are at home.

To stop fluid build-up, your doctor may recommend a treatment that seals the two layers of the pleura together. This is called a pleurodesis. You will need to have a short stay in hospital.

Build-up of fluid in the tummy

Ascites is a build-up of fluid between the two layers of the peritoneum which is a membrane that lines the tummy (abdomen).

Ascites can be caused by secondary cancer that has spread to the liver or the peritoneum. Ascites causes the tummy to swell, which can make you feel full, breathless or sick.

To treat ascites, doctors usually make a small cut in the tummy and insert a tube to drain the fluid. This will quickly improve your symptoms. You can have it done again if the fluid builds up again

Managing the symptoms of a secondary brain tumour

A secondary brain tumour can cause different symptoms, such as headaches or weakness in an area of the body. These can be frightening, but the symptoms can often be controlled with:

Radiotherapy can often improve symptoms quickly. You can also have drugs to treat headaches or to control fits (seizures) if needed. We have more information about a secondary cancer in the brain.

Complementary therapies

Some women find using certain complementary therapies along with their treatments helps them to feel better. This may include relaxation therapies, visualisation or yoga.

Some therapies may help reduce treatment side effects or symptoms, or make you feel less anxious. Always tell your cancer doctor or nurse if you are having any complementary therapies. Some may interact with chemotherapy or other treatments. This includes complementary therapies that involve taking supplements or other medicines.

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