Secondary breast cancer in the liver

Sometimes breast cancer cells spread to the liver through the blood or lymph system. This is known as secondary breast cancer in the liver.

The cells that have spread to the liver are breast cancer cells. It’s not the same as having cancer that starts in the liver.

You may also hear this type of spread described as metastases, advanced breast cancer, secondary tumours, secondaries or stage 4 breast cancer.

The information on this page describes:

  • the symptoms of secondary breast cancer in the liver
  • the tests that may be used to confirm a diagnosis.

When breast cancer spreads to the liver, it can be treated but cannot be cured. The purpose of treatment is to try to relieve symptoms and/or slow the growth of the cancer.

Find out more about the treatments for secondary breast cancer in the liver.

What does the liver do?

To understand some of the symptoms, it may help to know where the liver is and what it does.

The liver sits on the right side of your upper abdomen just under the ribs. It’s made up of different sections called lobes and surrounded by a capsule. It’s close to a number of other organs including the bowel, diaphragm (the muscle that separates the chest and abdomen) and right kidney.

The liver produces bile which helps digest food. It converts food into heat and energy, stores glucose and vitamins and breaks down harmful substances such as alcohol and drugs. It also produces important proteins including those that are needed to help the blood to clot. The liver is a large organ and can carry on working even if part of it is affected by secondary breast cancer.

Symptoms and how they can be managed

Symptoms of secondary breast cancer in the liver can range from mild to severe, depending on how much of the liver is affected by the cancer. Always report any new or persistent symptoms to your specialist.

Pain

Some people may have discomfort around the liver area only, while others may feel pain under their ribs or across their upper abdomen. This is because secondary breast cancer in the liver can cause the liver to become enlarged.

Sometimes you may feel pain in the right shoulder. This is called referred pain and is caused by the enlarged liver pressing on nerves that also go to the shoulder.

Most pain can be relieved or controlled. Always tell your doctors if you have pain. They’ll ask you to describe where the pain is, how it feels, how strong it is and what makes it better or worse. This will help them decide what to do to control your pain.

There are many different types of pain relief and often a combination of treatments may be needed. If your pain relief does not seem to be helping, tell your specialist as they can prescribe a different one. If your pain is not properly under control you can be referred to a specialist palliative care or symptom control team.

Find out more about pain control for secondary breast cancer.

Nausea

You may feel sick because the liver is enlarged and puts pressure on the stomach, or because toxins build up in the body from the liver not working properly. This can be treated with anti-sickness drugs.

It’s important for your doctor to try to find out what’s causing the nausea so they can prescribe the correct type of anti-sickness drug to control it.

Loss of appetite and weight loss

You may feel less hungry than usual and lose weight. This can be caused by the effect of the cancer or by the treatment. You might find it easier to eat little and often instead of having set meals.

Nutritional supplements may be useful if you’re finding it difficult to eat. Your GP (local doctor) or specialist can prescribe these or other medicines that may help. They may also refer you to a dietitian for advice.

Hiccups

Hiccups may be a result of the enlarged liver pressing on the diaphragm and causing it to spasm. It may help to sit upright and drink small amounts frequently. There are also medicines that may help.

Ascites

Ascites is an excessive build-up of fluid in the abdomen. It can make your abdomen swollen and uncomfortable, and can sometimes make you feel breathless. Ascites can take weeks or months to develop.

A procedure called paracentesis may be used to relieve the symptoms. This is done by numbing the skin with a local anaesthetic and inserting a needle into the lower abdomen. Often this is done at the same time as an ultrasound examination.

A tube is then passed into the abdominal cavity, stitched into place or held in place by a dressing, and connected to a drainage bag outside your body. This allows the fluid to drain slowly over time, often over a few hours and sometimes over a few days. Occasionally the drain may need to stay in permanently.

Although you’ll be aware of the tube once it’s in place, it shouldn’t be uncomfortable. The tube will be removed once the fluid has stopped draining. This procedure can be repeated if the fluid builds up again. A diuretic (water tablet) is occasionally prescribed to slow down the build-up of fluid.

Tiredness and fatigue

Cancer-related fatigue is one of the most common symptoms experienced by people with secondary breast cancer. Everyone knows what it feels like to be tired sometimes, but cancer-related fatigue can feel much more severe.

It can come and go or be constant, and this can be distressing and frustrating. It has many causes, from psychological factors such as the stress of coping with the diagnosis, to physical ones such as the side effects of treatment or progression of the cancer.

Find out more about fatigue, including tips for coping.

Anaemia

You may become anaemic (a drop in the number of red blood cells) for a number of reasons, for example due to problems with blood clotting. A blood test can be done to find out if you’re anaemic and in some cases tablets may be prescribed or a blood transfusion can help.

Jaundice

Jaundice can occur when the bile duct (a tube coming out of the liver) becomes blocked or when the liver is seriously affected by the cancer.

If you develop jaundice the whites of your eyes and your skin take on a yellow tinge. In some cases your urine may become darker and your stools (faeces) may become pale.

You may need to have a stent (tube) inserted into the bile duct to drain the bile.

Itchy skin

Jaundice can cause itching, which may be worse at night or when you’re hot. It’s important to keep your skin well moisturised. Try using a non-perfumed skin cream. Keeping this in the fridge can make it soothing when you apply it.

Sometimes medication may be prescribed to help relieve the itching and your specialist should be able to advise you about this. Sleeping tablets may help if the itching is stopping you sleep at night. Try to avoid alcohol, spicy food and heat (hot baths or direct sunlight), all of which can make the itching worse.

What investigations will I need?

Your specialist will examine you and may be able to feel if your liver is enlarged. They’ll also discuss any symptoms you have. You may need one or more of the following tests to confirm a diagnosis of secondary breast cancer in the liver.

Blood tests

When liver cells are damaged, certain substances are released that can be detected in the blood. Blood tests can measure these substances and can show if there’s a change in the function of the liver. These tests may also help show how effective any treatment has been.

Some people have a blood test for tumour markers. These are proteins found in the blood which may provide more information about how you’re responding to treatment. There’s some debate about how accurate they are so they’re not always used.

Ultrasound scan

An ultrasound scan uses high-frequency sound waves to produce an image of the liver to show any abnormalities. To help show up any abnormalities more clearly, a coloured dye may be injected into one of your veins. The scan is painless and usually takes less than 30 minutes.

CT (computerised tomography) scan

You may also need a CT scan (also known as a CAT scan). This uses x-rays to take a series of detailed pictures across the body. To help show up any abnormalities more clearly, a coloured dye may be injected into one of your veins. The scan is painless but you will have to lie still for about half an hour.

MRI (magnetic resonance imaging) scan

This scan uses magnetism and radio waves to produce a series of cross sectional images of the inside of the body. It can give more detailed information about soft tissue than a CT scan. An MRI scan is not painful but you will have to lie still for up to an hour.

ERCP (endoscopic retrograde cholangiopancreatography)

If you’re jaundiced this procedure is sometimes used to find out if the bile duct is blocked. A narrow flexible tube with a light at the end is passed through the mouth and the stomach into the bile duct.

A dye is put through the tube and a series of x-rays is taken to look at the movement of the dye through the duct. If you need a stent – a tube that is inserted to keep the duct open – to help reduce jaundice, it can often be put in place at the same time.

You’ll be given medication to make you feel drowsy beforehand. You won’t be able to eat or drink anything for several hours before this test.

Liver biopsy

In most cases your specialist will be able to tell if you have secondary breast cancer in the liver from your symptoms and scans. However, sometimes it’s necessary to have a biopsy taken to confirm the diagnosis.

This involves removing a small piece of tissue from the liver, under local anaesthetic, to be examined under a microscope. You’ll need to stay in hospital for a few hours after the liver biopsy because of the risk of bleeding.

Treatment

Find out about the treatments for secondary breast cancer in the liver

Content last reviewed August 2014; next planned review 2016

Last edited:

13 August 2014