1. What is secondary breast cancer in the liver?
What is secondary breast cancer?
When cancer that started in the breast has spread to the liver, it’s called secondary or metastatic breast cancer in the liver.
Some people refer to it as liver metastases or liver mets.
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.
Breast cancer cells can spread to the liver through the or the blood.
2. Symptoms when breast cancer has spread to the liver
The main symptoms of breast cancer that has spread to the liver are:
- 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
- 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)
You may need one or more tests for your doctor to confirm a diagnosis of secondary breast cancer in the liver.
3. What’s my prognosis (outlook)?
After a diagnosis of secondary breast cancer, some people want to know how long they’ve got to live.
Life expectancy is difficult to predict as each person’s case is different and no two cancers progress or respond to treatment in the same way.
However, as treatments have improved, more and more people are living much longer after their diagnosis.
Your specialist can talk to you about how secondary breast cancer may progress.
You may worry if their answers are vague, but it isn’t possible to accurately predict how each person’s cancer will respond to treatment.
You can read our information for people newly diagnosed with secondary breast cancer.
4. Treatment for secondary breast cancer in the liver
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.
The following treatments can be given alone or in combination.
Hormone (endocrine) therapy
If you have had hormone therapy before, your treatment team may prescribe the same drug again or change it to a different one.
It can take 2 to 3 months before any benefits from hormone therapy are seen.
Targeted (biological) therapy
This group of drugs blocks 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’re offered will depend on the features of your cancer.
Chemotherapy destroys cancer cells using anti-cancer drugs.
A number of chemotherapy drugs are used to treat secondary breast cancer. These drugs may be given alone or in combination.
The drugs you’re offered will depend on many factors, including any chemotherapy you had in the past and how long ago you had it.
Drugs are the main treatment for secondary breast cancer in the liver.
Sometimes treatments such as surgery, or local chemotherapy may be used to treat the cancer in the liver and help relieve symptoms.
Although surgery will not cure secondary breast cancer in the liver, occasionally it may be part of a treatment plan.
Surgery is more likely if:
- The area of secondary breast cancer in the liver is very small
- It can be easily accessed by the surgeon
- There’s no other secondary breast cancer elsewhere in the body
However, in most cases several areas of the liver are affected and surgery is not possible.
Liver transplants are not usually an option for people who have secondary breast cancer.
Treatment using heat or freezing
Thermal ablation or cryoablation can be used alone or in combination with surgery.
These procedures destroy cancer cells by 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 treatment team can tell you if it may be suitable for you.
Very precise radiotherapy (stereotactic radiotherapy or radiosurgery) may be considered for some 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 accuracy and minimal damage to the surrounding tissue.
Stereotactic radiotherapy used to treat secondary breast cancer in the liver may also be called CyberKnife, stereotactic ablative radiotherapy (SABR) or high dose conformal radiotherapy.
The type of radiotherapy you have will depend on your situation. Your treatment team can tell you if it may be suitable for you.
Chemotherapy given directly to the liver
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 that 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 may not be routinely available on the NHS but may be offered as part of a clinical trial.
5. Managing symptoms
Pain relief and secondary (metastatic) breast cancer
Most pain can be relieved or controlled.
You may have:
- Discomfort around the liver area only
- Pain under the ribs or across the upper abdomen
- Pain in the right shoulder, caused by the enlarged liver pressing on nerves that also go to the shoulder
It’s very important your pain is assessed regularly by your nurse or doctor to make sure it stays under control.
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.
You can help your treatment or 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
Sometimes people with secondary breast cancer cannot 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’re not 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 cases you may be prescribed medication to help increase 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 (tummy).
It can take weeks or months to develop and can make your abdomen 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 get symptoms like this, let your treatment team know straightaway.
A procedure called paracentesis may be used to drain the fluid to 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.
Cancer-related fatigue is one of the most common symptoms experienced by people with secondary breast cancer.
Having too few red blood cells is called anaemia.
If you feel particularly tired, breathless or dizzy, let your treatment team know.
You may become anaemic for several reasons, for example due to problems with blood clotting.
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 poo 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.
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 keep it in the fridge to make it soothing when you apply it.
Sometimes medication may be prescribed to help relieve the itching. Your specialist should be able to advise you about this.
Sleeping tablets may help 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.
6. Other important information and support
People with breast cancer have a higher risk of blood clots such as a deep vein thrombosis (DVT). Their risk is higher because of the cancer itself and some treatments for breast cancer.
People with a DVT are at risk of developing a pulmonary embolism (PE). This is when part of the blood clot breaks away and travels to the lung.
Blood clots can be life-threatening but are treatable so it’s important to report symptoms as soon as possible.
Blood clot symptoms
If you have any of the following symptoms, contact your treatment team or go to your local A&E department immediately:
- Pain, redness/discolouration, heat and swelling of the arm or leg
- 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
- Pain or tightness in the chest
- Unexplained cough or coughing up blood
Find out more about blood clots.
Support for living with secondary breast cancer
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
- Find out about our Living with Secondary Breast Cancer support services below
We also have information for anyone caring for someone with secondary breast cancer.
You can also call our free helpline, below.