Metastatic (secondary) breast cancer in the liver

Metastatic breast cancer in the liver occurs when cancer that started in the breast spreads to 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 (liver cancer).

Breast cancer cells can spread to the liver through the lymphatic system or the blood.

The liver 

The liver is a large organ that sits on the right side of your upper tummy (abdomen), just under your ribs.

It’s made up of different sections (called lobes) and is surrounded by a capsule. It is close to several other organs including your:

• Bowel
• Diaphragm (the muscle that separates the chest and abdomen)
• Right kidney

The liver produces a liquid called bile which helps to digest food. Bile is stored in the gallbladder and is released into the small bowel through the bile duct.

The liver converts food into heat and energy, stores sugar (glucose) and vitamins, and breaks down harmful substances such as alcohol and drugs.

It also produces important proteins including those needed to help the blood clot.

The liver can carry on working even if part of it is affected by metastatic breast cancer.

You may have several symptoms. It’s important to report any new or ongoing symptoms to your treatment team, however minor they seem.

Symptoms can range from mild to severe, depending on how much of the liver is affected by the cancer.

Symptoms include:

• Pain in the tummy (abdomen) which may also be felt in the right shoulder
• Discomfort or pain in the right side of the abdomen under the ribs
• Feeling sick (nausea)
• Loss of appetite and weight loss
• Hiccups
• Build-up of fluid in the abdomen causing swelling (ascites)
• A general feeling of being unwell
• Feeling constantly tired
• Itching and yellowing of the skin (jaundice)

Find out more about the symptoms of metastatic breast cancer.

When breast cancer spreads to the liver, it can be treated but cannot be cured.

If you’ve been told you have metastatic breast cancer in the liver, you may want to know how long you have to live.

Life expectancy is difficult to predict. Each person’s case is different, and no 2 cancers progress or respond to treatment in the same way. 

However, as treatments have improved, more and more people are living much longer after a diagnosis of metastatic breast cancer. 

Your treatment team can talk to you about how your metastatic breast cancer may progress. 

You may worry if their answers are vague, but it’s very difficult to accurately predict how each person’s cancer will respond to treatment.

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.

Your treatment may include:

• Hormone (endocrine) therapy
• Chemotherapy
• Targeted therapies
• Surgery
• Radiofrequency ablation and cryotherapy
• Targeted radiotherapy

You may have these treatments on their own or in combination.

Hormone (endocrine) therapy

Some breast cancers use the hormone oestrogen in the body to help them grow. These are known as oestrogen receptor positive or ER-positive breast cancers.

Hormone therapies block or stop the effect of oestrogen on breast cancer cells. Different hormone therapy drugs do this in different ways.

Targeted therapies

Targeted therapy is the name given to a group of drugs that block the growth and spread of cancer. They target and interfere with processes in the cells that help cancer grow.

The type of targeted therapy you have will depend on the features of your cancer.

Chemotherapy

Chemotherapy destroys cancer cells by affecting their ability to divide and grow.

A number of chemotherapy drugs are used to treat metastatic breast cancer. These drugs may be given alone or in combination with targeted therapies.

The drugs you’re offered will depend on many things, including any chemotherapy you had in the past and how long ago you had it.

Other treatments

Drugs are the main treatment for metastatic breast cancer in the liver.

Sometimes treatments may be used, such as:

• Surgery
• Targeted radiotherapy
• Treatment using heat (thermal ablation) or freezing (cryoablation)
• Chemotherapy given directly to the liver (local chemotherapy)

These can treat the cancer in the liver and help relieve symptoms.

They will not treat cancer in other areas of the body, so may be useful for people whose metastatic breast cancer only affects their liver.

Clinical trials

Clinical trials and research studies are an important part of treatment for metastatic breast cancer.

Many breast cancer trials look at new treatments or different ways of giving existing treatments, such as surgical techniques, chemotherapy, targeted therapies or radiotherapy. These treatments may improve symptoms or help you live longer.

If you’re interested in taking part in a clinical trial, your treatment team can discuss this with you.  

Make 2nds Count is a charity that supports research into metastatic breast cancer. Visit their website make2ndscount.co.uk for more information. 

METUPUK, a patient advocacy group working to improve outcomes for those living with metastatic breast cancer, also has information about trials on its website metupuk.org.uk

Supportive and palliative care

Best supportive care focuses on symptom control and support. It includes palliative care, if necessary.

It’s an extremely important part of the care and treatment for many people with metastatic breast cancer. It can significantly improve quality of life for them and their families.

You may associate palliative care with end-of-life treatment. But many people value having it at any stage of their diagnosis.

You may have it alongside your medical treatment. Or if you’re no longer on treatment for your cancer, to help prevent and relieve symptoms such as pain or fatigue. It can also help with the emotional, social, spiritual and financial effects of metastatic breast cancer.

Best supportive and palliative care teams are based in hospitals, hospices and the community.

Your treatment team, GP or specialist nurse can refer you depending on your situation. Or you may be able to refer yourself. 

Availability of treatments

Some treatments for metastatic breast cancer may not be routinely available on the NHS.

It can be frustrating and distressing if a treatment you and your treatment team feel could benefit you is not routinely available.

You may still be able to access these treatments in other ways, such as a clinical trial, early or compassionate access schemes, or privately. For help and advice about accessing a treatment, you can speak to your treatment team. You can also call our free helpline on 0808 800 6000 to talk this through.

Find out more about new cancer drug treatments.

Macmillan Cancer Support also has information about what you can do if a treatment is not available. Visit their website macmillan.org.uk or call 0808 808 0000 to find out more.

Many people with metastatic breast cancer in the liver feel well. However, symptoms can affect your quality of life if they are not controlled.

Pain

Pain relief is a very important part of the care of many people with metastatic breast cancer.

Pain can affect your mobility and quality of life.

Once pain is under control, many people feel less anxious and can eat and sleep better.

You may have:

• Discomfort around the liver area
• Pain under your ribs or across your upper tummy (abdomen)
• Pain in your right shoulder (this is called referred pain and is caused by the enlarged liver pressing on nerves that go to the shoulder)

It’s very important your specialist nurse, treatment team, GP or palliative care nurse regularly assesses your pain to make sure it stays under control.

Find out more about pain control and metastatic breast cancer.

Nausea and vomiting 

Nausea (feeling sick) or vomiting (being sick) are likely to be due to:

• Your treatment
• The cancer putting pressure on the stomach or causing the liver not to work properly 
• Emotional side effects such as anxiety

Nausea and vomiting can almost always be controlled and treated with anti-sickness drugs.

It’s important for your treatment team to try to find out the cause so that it can be managed effectively.

You can help your treatment or supportive and palliative care team decide what treatment will work best by keeping a diary of what makes nausea or vomiting worse and when it happens.

Poor appetite and weight loss 

You may find you can’t eat as much as usual. This can make it hard to maintain your weight.

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’re not eating enough, or are losing weight, talk to your specialist nurse, treatment team, GP or palliative care nurse about dietary supplements or ask to speak to a dietitian for specialist advice.

In some cases you may be prescribed medication to help increase your appetite.

You can also read our information about diet and metastatic breast cancer.

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.

Your treatment team may be able to prescribe you medication to help.

Ascites 

Ascites is a large build-up of fluid in the tummy (abdomen).

It can take weeks or months to develop and can make your tummy feel swollen and uncomfortable.

Because the fluid can cause pressure on your stomach and diaphragm, it can sometimes make you feel breathless or sick.

If you start to feel like this, let your treatment team know straight away.

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

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.

Some people may need to keep a drain in permanently that can be managed at home.

Extreme tiredness (cancer-related fatigue)

Cancer-related fatigue is one of the most common symptoms of metastatic breast cancer.

Find out more about managing fatigue. 

Anaemia 

Having too few red blood cells is called anaemia.

If you feel breathless, dizzy or particularly tired, let your treatment team know.

You may become anaemic for several reasons, for example due to problems with blood clotting.

You can have a blood test to find out if you’re anaemic.

You may need to take tablets or have a blood transfusion. Your treatment team will discuss this with you.

Jaundice 

Jaundice is a symptom of metastatic breast cancer in the liver.

It can develop if your bile duct is blocked.

If you develop jaundice, the whites of your eyes and your skin look more yellow. In some cases, your pee (urine) may become darker and your poo may become pale.

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.

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 and keeping it in the fridge to make it soothing when you apply it.

You may be given medication to help relieve the itching. Your treatment team can advise you about this.

Your treatment team may be able to prescribe sleeping tablets if the itching interrupts your sleep at night.

Try to avoid alcohol, spicy food and heat (hot baths or direct sunlight), all of which can make the itching worse.

Blood clots

People with breast cancer have a higher risk of blood clots. Having certain treatments also increases the risk of blood clots such as a DVT (deep vein thrombosis).

If you have a DVT, there’s a risk part of the blood clot could break away and travel to the lung. This is known as a pulmonary embolism (PE).

Blood clots can be life-threatening and should be treated quickly.

Support for living with metastatic breast cancer

Everyone’s experience of being diagnosed with metastatic breast cancer is different, and people cope in their own way.

For many people, uncertainty can be the hardest part of living with metastatic breast cancer.

You may find it helpful to talk to someone else who’s had a diagnosis of metastatic breast cancer:

• Chat to other people living with secondary breast cancer on our online forum
• Find out about Living with Secondary Breast Cancer– please see below

We also have information for anyone caring for someone with metastatic breast cancer.

You can also call our free helpline, below.