The difference between

Primary and secondary breast cancer

Most cancers start in one place. The place where a cancer starts is called the primary site. For example, if you have cancer that started in the breast, you have primary breast cancer.

Cancers can spread around the body if left untreated, and in some cases, even if the patient is currently receiving a cancer treatment. This can occur in a number of ways, like when the cancer cells get into the lymphatic system and reaches the lymph nodes.

When the cancer has spread to a new location, this location is known as the secondary site. For example, if your breast cancer has spread to the lungs, you have secondary site is the lung and you have secondary breast cancer.1

The most common places primary cancer can spread to are:2

The bones, lungs, liver, skin and brain.

You know you best

Stages of breast cancer

Learning about the different stages of breast cancer may help you feel more prepared as you continue to communicate with your doctor and manage your symptoms.

Download our short guide to learn more.

Understanding stage of breast cancer
Catching a diagnosis early

You could improve your quality of life with early second line treatment

You understand your body better than anybody else, which means healthcare professionals will only know something is wrong if you let them know. This means that if you feel any new symptoms, it is important that you let your doctor or nurse know as soon as you notice them, as this might mean the cancer has returned as secondary

Read on to find out more about symptoms of secondary breast cancer in various parts of the body.

Woman consulting doctor
Doctor with iPad
What to look out for

Symptoms of SBC

These are dependent on where the cancer has spread. 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 be also 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.

Red flag symptoms

Take a moment to learn about the symptoms you might experience if the cancer has spread to another area in your body. If you experience these symptoms, you should contact your cancer specialist as soon as possible.


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 LFTs 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

The meninges

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

What you might expect

Menopause symptoms
due to cancer treatment

It is possible for some women undergoing cancer treatment to start menopause early, or to experience the symptoms of menopause. The symptoms of menopause can be difficult to manage and can affect your quality of life, so you should check with your healthcare professional if there is anything you can do to help you live with the symptoms, or if there are any appropriate treatments that could help to improve your quality of life with menopause and secondary breast cancer.


Hormone (endocrine) therapies, ovarian suppression and chemotherapy are cancer treatments that have been known to cause early menopause or symptoms.

Ovarian suppression can be temporary (e.g. via medication) or permanent (e.g. via Surgery). Depending on your treatment, menopause could be reversible post treatment.

It can be difficult, especially for women who want to start a family, to come to terms with the possibility of being infertile. However, even if you stop having periods and experience menopausal symptoms, you could still be fertile and may still be able to get pregnant. You might also still be fertile when experiencing menopause, as your ovaries may still be working.

It is important to note that there are options, should you want to start a family, that could allow you to have a child despite having started menopause. With options like egg freezing (before cancer treatment), surrogacy and IVF, it is possible that you could have a child.

Listen to your body

Intimacy and breast cancer

It's perfectly normal to feel worried about the effect of secondary breast cancer on your intimate life. You might feel your confidence has taken a hit or your feelings about yourself as a woman might have changed. It can take time to readjust and regain your confidence, so it can be extremely helpful, when you're ready, to speak with your partner openly and honestly about your feelings and what you want from your intimate relationship.

Here are some tips for talking to your partner:


  • Try to be open and honest about your feelings and try to avoid mixed signals.
  • Set time aside outside of those intimate moments to avoid feeling awkward for interrupting.
  • Try not to focus too much on negatives - let your partner things you have enjoyed with them too.
  • Keep the conversation going regularly so you are both very clear on boundaries and expectations.
  • If you find certain subjects too uncomfortable to discuss in person, try texting or an alternative form of communication.

Your breast cancer team can be a great help if you are worried about your sex life with breast cancer or menopause symptoms. There is also specialist help you can receive. You might find you and your partner could benefit from talking to a counsellor about the intimate part of your relationship. Your GP or healthcare professional should be able to help you arrange this if necessary.

Couple on bench


  1. Northern Ireland Cancer Network. What is the difference between primary and secondary cancer? Available online at: [Last accessed: August 2022]
  2. Macmillan Cancer Support. Secondary Breast Cancer. Available online at: [Last accessed: August 2022]
  3. Macmillan Cancer Support. Symptoms of Secondary Breast Cancer. Available online at: [Last accessed: August 2022]
  4. Macmillan Cancer Support. Understanding secondary breast cancer. Available online at: [Last accessed: August 2022]
  5. Breast Cancer. Lung metastasis: Symptoms and Diagnosis. Available online at: [Last accessed: August 2022]
  6. Breast Cancer. Liver metastasis: Symptoms and Diagnosis. Available online at: [Last accessed: August 2022]
  7. Breast Cancer. Brain metastasis: Symptoms and Diagnosis. Available online at: [Last accessed: August 2022]

UK | October 2022 | 124190-1



You know you best

Make your next appointment count

Your healthcare team is your best resource throughout your treatment. Talk openly and often with them about your doubts, questions and concerns. It might make you feel more in control if you take some time to plan for your appointment. Making notes before, during and after can help you retain information and make the most of your visits. We have developed a guide to support you in having these conversations with some tips to help you get the information you need.

Download your Moments That Count appointment guide.

Moments That Count has been developed and funded by Novartis Pharmaceuticals UK Limited. It has been created in collaboration with secondary breast cancer patients whose knowledge and insights have informed the content and direction for the campaign.

This website is part of a programme that is funded by Novartis Pharmaceuticals UK Limited. Novartis Pharmaceuticals UK Limited is a private limited liability company registered in England and Wales under number 119006. Registered office 2nd Floor, The WestWorks Building, White City Place, 195 Wood Lane, London, W12 7FQ. Use of this website is governed by our Terms of Use and the Cookies and Privacy Policy.

Reporting side-effects

If you get side effects with any medication you are taking, talk to your doctor, pharmacist or nurse.This includes any possible side effects not listed in the information leaflet that comes in the pack. You can report side effects via the Yellow Card Scheme at By reporting side effects, you can help provide more information on the safety of your medication.

©2022 Novartis Pharmaceuticals UK Ltd - UK | September 2022 | 124182-1 | This site is intended for an audience in the UK.