Treating symptoms of secondary breast cancer

Tiredness or fatigue  is a common symptom of advanced cancer. It can feel a bit overwhelming and as though you don’t have any energy. 

Fatigue is often caused by the cancer treatment you have and it can last for some time after you finish your treatment.

Let your doctor or nurse know if you’re very tired as they might be able to prescribe medicine or other treatments to help. For example, a blood transfusion can give you more energy if you’re tired due to anaemia (low red blood cell levels).

Resting

It’s important to rest a few times throughout the day. Resting regularly can help you feel less tired and more able to cope. You don't have to sleep during these times. Just sitting or lying down will help. 

Exercise 

Exercising can be hard when you feel very tired. But research shows that daily light to moderate exercise can give you more energy. Going for a gentle walk is very good. Gentle exercises in bed or standing up can help if you can’t move around easily. 

Your hospital physiotherapist might be able to help you plan an exercise programme that suits your needs.

You might not feel like eating and may lose weight. It is important to eat as much as you can.

Tips:

• Eating several small meals and snacks throughout the day can be easier to manage.
• Ask your doctor or dietitan to recommend high calorie drinks to boost your calorie intake.
• Eat whatever you feel like eating rather than what you think you should eat.
• Drink plenty of fluids even if you can't eat.
• Don't fill your stomach with a large amount of liquid before eating.
• Try to eat high calorie foods to keep your weight up.

Swelling in the arm or around the site of your breast cancer is called lymphoedema. It develops because:

• your lymph glands have been removed or affected by your radiotherapy
• cancer has blocked your lymph glands

If you have cancer in your liver, fluid may collect in your abdomen, making it swell. This fluid is called ascites.

Pain can affect you physically and how you feel emotionally. It's a very personal experience that is different for everyone. Pain relief treatment can vary from one person to another. What works for you might not help someone else. So it is important to have an individual treatment plan to control your pain.

Treatment can often help reduce pain. For example, an enlarged liver may cause pain in your right side or shoulder. Hormone therapy, chemotherapy or targeted drugs that shrink the cancer in the liver can treat the pain.

Cancer in your bones can cause pain. Radiotherapy, chemotherapy, targeted drugs such as denosumab, and drugs called bisphosphonates can all help to get rid of or reduce bone pain.

Painkillers are also available if other treatments haven't controlled your pain or to control it until other treatments start to work.

Pain can usually be well controlled. With good pain control, most people should be able to be free of pain when they are lying or sitting. The first step is to tell your doctor or nurse that you have pain so that they can find the right painkillers for you.

Your doctor will ask you questions about the pain you have. They may ask you to fill in questionnaires or rate your pain on a pain scale. This helps to describe your pain and what might make it worse or better. 

You might feel breathless if your cancer has spread to your lungs or if you have low red blood cell levels (anaemia). You can learn breathing techniques that can help. You might need a blood transfusion to give you red blood cells if you have anaemia.

Tell your doctor or nurse if you feel breathless. There are ways to improve your breathing. For example, medicines to make your breathing easier.

Constipation is a common problem for people with cancer and a side effect of some cancer treatments. It means difficulty having a poo and you probably won’t have regular bowel movements. You might not have one for a few days or more.

With advanced breast cancer you may become constipated if:

• you take certain painkillers (including morphine)
• there is too much calcium in your blood (hypercalcaemia)
• your treatment has made you lose your appetite and you are not eating as much as usual
• you are not able to move about as much as usual

Don't be embarrassed to ask for help with constipation. The longer you leave it the more problems it can cause. Fibre in your diet and plenty of fluids will help, but you may also need to take a laxative. Your doctor can prescribe one. Many hospital and community nurses know about constipation and can talk to you about how to prevent or relieve it.

Sickness

Treatment for sickness depends on what is causing it. It can be due to side effects of treatment or symptoms of the spread of breast cancer.  

Some painkillers or cancer treatments can cause sickness. You will also feel sick if you are constipated.

It is a good idea to talk this over in detail with a doctor or nurse. Then, you can get the treatment you need.

Some people find that ginger is a good natural remedy for sickness. Try eating stem ginger or crystallised ginger if you like it. Or you can slowly sip ginger beer or ginger ale.

Calcium is an important nutrient that our body needs. Breast cancer in the bones can affect the amount of calcium in the body.

Cancer cells in your bone can mean that the damaged bone releases calcium into your bloodstream. A high level of calcium in the blood is called hypercalcaemia and can cause:

• sickness
• tiredness
• confusion
• irritability

You will need treatment from your specialist If you have hypercalcaemia. You may have to spend a day or two in hospital to get your calcium levels down.

You will have fluids through a drip into your bloodstream. This helps to flush the extra calcium out of your system. Drinking plenty will also help, if you are able to.

You are likely to have a drug called a bisphosphonate. These medicines can help to control hypercalcaemia. You have the bisphosphonate by drip or as tablets.

You might have bone pain if your cancer has spread to your bone. This is called secondary bone cancer. Your bones might be weaker, so they could break more easily. Your doctor and nurse can help you to be pain free most of the time.

Possible treatments include:

• hormone treatment
• radiotherapy
• surgery
• bisphosphonates
• radiofrequency ablation (RFA)
• painkillers
• a targeted treatment called denosumab

You might find that complementary therapies, such as relaxation or gentle massage, may also help.

Cancer that has spread into the spinal bones can cause pressure on the spinal cord. This is called spinal cord compression. The pressure on the spinal cord stops the nerves from working normally. This can cause:

• back pain
• changes in sensation, such as tingling or numbness
• changes in the way your bowel or bladder work
• difficulty walking

Breast cancer that has spread to your liver can often make you feel ill and tired. You may also have:

• discomfort or pain on the right side of your tummy (abdomen) where the liver is
• sickness (nausea)
• loss of appetite
• a swollen abdomen
• weight loss
• hiccups

Secondary breast cancer in the liver can cause pain if the cancer presses on the fibrous tissue covering the liver (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 in the liver can usually be well controlled.

The thought of cancer spreading to and 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.
• problems with control of parts of the body, it depends on where in the brain the cancer cells are for example, an arm or a leg may be weaker than usual or may feel numb
• memory problems.
• changes in how you behave

Very rarely, you may have eyesight problems. Tell your doctor straightaway if you have any changes to your vision. But remember that eye problems can have many causes so it may not be due to cancer. If you are having some types of hormone therapy, chemotherapy or biological therapies, these can occasionally affect your vision.

Treatment for secondary cancer in the brain includes:

• steroids
• radiotherapy
• chemotherapy
• surgery
• hormone therpay