Primary and secondary breast cancer defined

There are some general symptoms, which may differ from person to person and can include:³

•  Feeling more tired than usual
•  Loss of appetite
•  Feeling generally unwell for no obvious reason

These symptoms can also be associated with a wide range of other conditions, so if you experience any of them you should let your healthcare professional know. You should always let them know if you develop any new symptoms, especially if they last more than 1 or 2 weeks.

The most common symptom of secondary breast cancer in the bones is an ongoing ache in the affected bone/bones. If you are experiencing pain when you move around, or you are having difficulty sleeping because of the pain, this could be due to the cancer having spread to the bones.⁴

Too much calcium

If the cancer has spread to a bone, it can cause damage. If this happens, the bone can release calcium into the bloodstream. A high level of calcium in the blood is known as hypercalcaemia which can cause the following symptoms:⁴

• Feeling tired, nauseous, dehydrated and/or weak
• Passing more urine than usual
• Constipation
• Feeling confused

A healthcare professional can detect elevated levels of calcium in the bloodstream with a blood test before any symptoms develop.

A break in the bone

If the bone is damaged by cancer over time, it could become weaker and eventually lead to a break or a fracture. In most cases treatment will begin before the bone weakens enough to break.4
 

Pressure on the spinal cord

Cancer that has spread to the bones of the spine can cause pressure on the spinal cord. This is known as spinal cord compression. The symptoms can include:⁴

• Unexplained pain in the back, around the chest and neck areas or down the arms and legs
• Numbness or pins and needles in toes, fingers or buttocks                        
• Unsteadiness or difficulty walking
• Problems controlling your bladder or bowel.

Spread of breast cancer to the lung(s) (lung metastasis) can be symptomless. However, symptoms can include discomfort in the lung, shortness of breath, coughing up blood and a persistent cough. Other signs include:^4,5

• Pleural effusion – build-up of excess fluid between the layers of tissue outside the lungs, which cause pain on breathing, cough, or shortness of breath
• Wheezing – whistling or rattling sound in the chest
• Pain in the lung

If the cancer has spread to the liver, it is likely that you will feel some pain or discomfort around the area of the liver. The liver sits under the lower ribs on the right side of the abdomen. Other symptoms can include:^4,6
General feelings of unwellness

• Loss of appetite
• Fatigue
• Bloating
• Jaundice

Secondary breast cancer in the liver can cause a build-up of bile in the blood. This is known as jaundice. Symptoms of jaundice can include yellowing of the skin and the whites of the eyes, and itchy skin.
Sometimes liver metastasis might be found incidentally via abnormal liver function tests, and the patients could be completely asymptomatic.

Secondary breast cancers can sometimes spread to the skin. Known as skin secondaries or metastases, it can develop on or just below the skin. This can happen to women who already have secondary breast cancer.

Possible symptoms of secondary cancer that has spread to the skin include:⁴

• A firm painless lump on the skin
• Many lumps of different size on the skin
• Inflamed skin (areas of redness, swelling, or irritation)
• Bleeding, pain or infections

Skin secondaries can appear near the area of the primary cancer, for example on the skin around a scar or around the chest. They have also been known to develop on the scalp, neck, back and upper limbs.

A variety of treatments can be used to treat skin secondaries.

The symptoms experienced with brain metastasis may be dependent on which part of the brain the cancer has spread to. The symptoms can include:^4,7

• Weakness in the muscles, numbness and feeling unsteady (ataxia)
• Seizures or fits
• Mood and personality changes
• Sensory changes
• Memory problems

Sometimes, breast cancer cells spread to tissue that covers the brain and spinal cord (meninges). Doctors call this meningeal metastases or carcinomatous meningitis. It causes symptoms similar to a secondary cancer in the brain.⁴