1. What is secondary breast cancer in the liver?
2. What’s my outlook?
3. Newly diagnosed or worried about a symptom?
4. How is secondary breast cancer in the liver treated?
5. Palliative and supportive care
6. How to manage the symptoms of secondary breast cancer in the liver
7. Blood clots
8. Support for living with secondary breast cancer
Secondary breast cancer in the liver happens when breast cancer cells spread to the liver. It can also be known as liver metastases.
When breast cancer spreads to the liver, it can be treated but cannot be cured.
Treatment aims to control and slow down the spread of the cancer, relieve symptoms and give you the best quality of life for as long as possible.
Secondary breast cancer in the liver is not the same as cancer that started in the liver.
When they get their diagnosis, many people want to know how long they’ve got to live.
As treatments have improved, more and more people are living longer after a diagnosis of secondary breast cancer. However, life expectancy is difficult to predict as each person’s case is different and no two cancers are the same.
Your specialist can talk to you about the likely progression of your secondary breast cancer. You may worry if their answers are vague, but it isn’t possible to accurately predict how each person’s illness will respond to treatment.
In the days or weeks after a diagnosis of secondary breast cancer, you may feel in turmoil and find it hard to think clearly.
You can read our information for people newly diagnosed with secondary breast cancer, including where to find support.
If you haven’t been diagnosed but are worried about a symptom, find out more about the signs and symptoms of secondary breast cancer.
Treatments for secondary breast cancer in the liver can be given alone or in combination.
When making decisions about how best to treat you, your specialist team will consider:
- how extensive the cancer is within the liver
- whether the cancer has spread to other organs
- any symptoms you have
- what treatment you’ve had in the past
- the characteristics of the cancer
- whether you’ve been through the menopause
- your general health.
Your specialist should discuss any recommendations with you and take into account your wishes. They’ll talk with you about your options, explain the aim of treatment and help you weigh up the potential benefits against the possible side effects.
Find out more about treatments for secondary breast cancer.
Hormone (endocrine) therapy
Hormone therapy is used to treat breast cancers that are oestrogen receptor positive (ER+). Tissue from the biopsy or surgery for primary breast cancer will have been tested to see if it's ER+. However, your specialist may discuss taking a sample of tissue from your liver to retest this.
You may be offered a course of a single drug or combination of chemotherapy drugs. This will depend on any chemotherapy you had in the past and how long ago you had it.
Targeted (biological) therapies
Only people whose cancer is HER2 positive will benefit from targeted therapies. Tissue from a biopsy or surgery for primary breast cancer will usually have been tested to see if it's HER2 positive. However, your specialist may discuss taking a sample of tissue from your liver to retest this.
Although surgery won’t cure secondary breast cancer in the liver, occasionally your specialist may ask the opinion of a surgeon.
Surgery is more likely if the area of secondary breast cancer in the liver is very small, can be easily accessed by the surgeon, and there’s no other secondary breast cancer elsewhere in the body. However, in most cases several areas of the liver are affected and surgery isn’t possible. Liver transplants are not an option for people who have secondary breast cancer.
Thermal or cryoablation
Thermal or cryoablation can be used alone or in combination with surgery. These procedures destroy cancer cells by either heating or freezing them. For example, radiofrequency ablation (RFA) involves inserting a needle into individual tumours in the liver and destroying them with heat.
RFA is a specialist treatment and not widely available. Your specialist team can tell you if it may be suitable for you depending on the number, size and location of the tumours in the liver.
Stereotactic radiotherapy (also known as radiosurgery)
Very precise radiotherapy may be considered for people with small secondary cancers in the liver who have a good level of general health and fitness. This treatment allows high doses of radiation to be delivered with extreme accuracy and minimal damage to the surrounding tissue.
Stereotactic radiotherapy may also be called CyberKnife, which is the name of the radiotherapy machine. CyberKnife is a specialist treatment that’s only available in some centres. Your specialist team can tell you if it may be suitable for you.
Intrahepatic chemotherapy and chemoembolisation
Intrahepatic chemotherapy and chemoembolisation involve giving chemotherapy directly into the liver. This is done through a thin tube, called a catheter, into the main blood supply to the liver.
Giving chemotherapy directly into the liver means a higher concentration of the drug can be delivered to the area of cancer.
In chemoembolisation, the chemotherapy is delivered along with an oily liquid or foam which blocks the blood supply to the cancer. The cancer is deprived of oxygen and nutrients, and the chemotherapy stays in the area for longer. The liver continues to be supplied with blood in the normal way.
These treatments are usually only available as part of a clinical trial.
Availability of treatments
Some treatments for secondary breast cancer may not be routinely available on the NHS. You may still be able to access these treatments, for example through the Cancer Drugs Fund (in England) or other funding body.
Macmillan Cancer Support has information about what you can do if your treatment isn’t available.
It can be frustrating and distressing if a drug you and your cancer specialist feel could benefit you isn’t routinely available. For help and advice about accessing a treatment, you can speak to your doctor or specialist nurse. You can also call our Helpline on 0808 800 600 to talk through your concerns.
Palliative and supportive care focuses on symptom control and support. It’s an extremely important part of the care and treatment for many people with secondary breast cancer and can significantly improve quality of life for them and their families.
Palliative care is usually associated with end-of-life treatment. However, people value having it at any stage of their illness, alongside their medical treatment, to help prevent and relieve symptoms such as pain or fatigue. It can also help with the emotional, social and spiritual effects of secondary breast cancer.
You can be referred by your specialist team, GP or breast care nurse depending on your situation.
You may have discomfort around the liver area only, pain under the ribs or across the upper abdomen, or sometimes pain in the right shoulder, which is caused by the enlarged liver pressing on nerves that go to the shoulder.
Most pain can be relieved or controlled. Once pain is under control, many people feel less anxious and can eat and sleep better.
Find out about pain control and secondary breast cancer.
There are many different types of pain relief and often a combination of drugs will be needed. It’s very important that your pain is assessed regularly by your nurse or doctor to make sure it stays under control.
Nausea and vomiting
If you feel sick (nausea) or are vomiting, it’s likely to be due to your cancer, its treatment or emotional side effects such as anxiety. 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.
In most cases, nausea and vomiting can be controlled and treated with anti-sickness drugs. It’s important for your doctor to try to find out the cause so that it can be managed effectively.
You can help your specialist or palliative care team decide what treatment will work best by keeping a record of what makes nausea or vomiting worse or when it happens.
Poor appetite and weight loss
Sometimes people with secondary breast cancer can’t eat as much as usual. This means they have difficulty maintaining their weight as well as providing the body with energy. Poor appetite can be due to the effects of the cancer, treatment or anxiety.
You might find it easier to eat little and often instead of having set meals. If you still feel you aren’t eating enough, or are losing weight, talk to your doctor or nurse about dietary supplements or ask to speak to a dietitian for specialist advice.
In some circumstances you may be prescribed medication to help stimulate your appetite.
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 is a large build-up of fluid in the abdomen. It can take weeks or months to develop and can make your abdomen swollen and uncomfortable. It can sometimes make you feel breathless or nauseous.
A procedure called paracentesis may be used to relieve symptoms. This involves numbing the skin with local anaesthetic and inserting a needle into the lower abdomen. It’s often done at the same time as an ultrasound examination. A small tube is 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, often over a few hours and sometimes a few days.
Although you’ll be aware of the tube, 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 water tablet (diuretic) is occasionally prescribed to slow down the build-up of fluid. Some people may need to keep the drain in permanently.
Fatigue (extreme tiredness)
Cancer-related fatigue is one of the most common symptoms in people with secondary breast cancer. Fatigue may have a significant effect on your ability to cope, your mood and your relationships.
Tell your doctor or palliative care team about the fatigue so you can be fully assessed. Causes such as difficulty sleeping or anaemia (see below) can be treated and may improve the feelings of fatigue.
Find out more about fatigue and secondary breast cancer and how to cope.
Having too few red blood cells is called anaemia. You may become anaemic for a number of different reasons, for example due to problems with blood clotting.
If you feel particularly tired, breathless or dizzy, let your specialist team know. A blood test can be done to find out if you’re anaemic. In some cases tablets may be prescribed or a blood transfusion may be necessary.
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.
Jaundice can occur when the bile duct becomes blocked or when the liver is seriously affected by the cancer. If tests show your bile duct is blocked, you may need to have a tube called a stent inserted to keep the bile duct open.
A procedure called an ERCP (endoscopic retrograde cholangiopancreatography) 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 to access 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 to help reduce jaundice, it can often be put in place at the same time. You will be given medication to make you feel drowsy beforehand and asked not to eat or drink anything for several hours before this test.
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 interrupts your sleep.
Try to avoid alcohol, spicy food and heat (hot baths or direct sunlight), all of which can make the itching worse.
People with breast cancer have a higher risk of blood clots. Their risk is higher because of the cancer itself and some treatments for breast cancer.
You may be at risk of a blood clot forming known as a deep vein thrombosis (DVT). People with a DVT are at risk of developing a pulmonary embolism. This is when part of the blood clot breaks away and travels to the lung.
Blood clots can be harmful but are treatable so it’s important to report symptoms as soon as possible.
If you experience any of the following symptoms contact your local A&E department, GP or specialist team straight away.
- Pain, redness/discolouration, heat and swelling of the calf, leg or thigh.
- Swelling, redness or tenderness where a central line is inserted to give chemotherapy, for example in the arm, chest area or up into the neck.
- Shortness of breath.
- Tightness in the chest.
- Unexplained cough (may cough up blood).
Find out more about blood clots.
Everyone’s experience of being diagnosed with secondary breast cancer is different, and people cope in their own way.
For many people, uncertainty can be the hardest part of living with secondary breast cancer.
You may find it helpful to talk to someone else who’s had a diagnosis of secondary breast cancer.
- Chat to other people living with secondary breast cancer on our online Forum.
- Meet other women with a secondary diagnosis and get information and support at a Living with Secondary Breast Cancer meet-up.
- Live Chat is a weekly private chat room where you can talk about whatever’s on your mind.
You can also call Breast Cancer Care’s Helpline free on 0808 800 6000.