1. What is secondary breast cancer in the liver?
2. What’s my prognosis (outlook)?
3. The liver
4. Newly diagnosed or worried about a symptom?
5. What treatments may I be offered?
6. Clinical trials
7. Palliative and supportive care
8. Availability of treatments
9. Managing symptoms of secondary breast cancer in the liver
10. Exercise and secondary breast cancer in the liver
11. Support for living with secondary breast cancer in the liver
Secondary breast cancer in the liver happens when breast cancer cells spread to the liver. It can also be known as liver metastases.
Secondary breast cancer in the liver is not the same as cancer that started 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.
After a diagnosis of secondary breast cancer, 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’s not possible to accurately predict how each person’s illness will respond to treatment.
The liver is a large organ that can carry on working even if part of it is affected by secondary breast cancer.
The liver sits on the right side of your upper abdomen just under the ribs. It is made up of different sections called lobes and is surrounded by a capsule. It’s close to a number of other organs including the bowel, the diaphragm (the muscle that separates the chest and abdomen) and the right kidney.
The liver produces bile which helps to digest food. Bile is stored in the gallbladder and released into the small bowel through the bile duct. The liver 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.
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.
Treatment for secondary breast cancer in the liver aims to relieve symptoms and slow down the growth of the cancer.
Treatments can be given alone or in combination.
When making decisions about how best to treat you, your treatment team will consider factors such as:
- 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 features of the cancer
- whether you’ve been through the menopause
- your general health
Your specialist should discuss any recommendations for treatment with you and take into account your wishes. They’ll talk with you about your options, explain what the aim of your treatment will be and help you weigh up the potential benefits against the possible side effects you may have.
Hormone (endocrine) therapy
If you had a biopsy or surgery for primary breast cancer, the tissue removed will have been tested to see if it is ER+. However, in some people the oestrogen receptors change during the development of secondary breast cancer. Because of this, your doctor may discuss performing a biopsy to retest for hormone receptors.
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 it was.
Targeted therapies (also called biological therapies)
This is 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 are offered will depend on the features of your breast cancer.
Find out more about the different types of targeted therapy.
Drugs are the main treatment for secondary breast cancer in the liver. However, sometimes other treatments are used. These can treat the cancer in the liver and help relieve symptoms, but will not treat cancer in other areas of the body, so may be useful for people whose secondary breast cancer only affects their liver.
Although surgery will not cure secondary breast cancer in the liver, occasionally it may be part of a plan of treatment. Surgery is more likely to be performed 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 is not possible. Liver transplants are not an option for people who have secondary breast cancer.
Thermal ablation or cryoablation
Thermal ablation or cryoablation can be used alone or in combination with surgery. These procedures involve destroying 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 treatment team can tell you if it may be suitable for you.
Stereotactic radiotherapy (also known as radiosurgery)
Very precise radiotherapy 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, which is the name of the radiotherapy machine. CyberKnife is a specialist treatment that’s only available in some centres. Your treatment 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 may not be routinely available on the NHS but may be offered as part of a clinical trial.
Many breast cancer trials look at new treatments or different ways of giving existing treatments, such as surgical techniques, chemotherapy, targeted therapies or radiotherapy. Your specialist may talk with you about a clinical trial, or if you’re interested in taking part in research you can ask them if there are any clinical trials you’re eligible to enter.
Read our general information about clinical trials.
You can also find listings of current trials on the Cancer Research website and on the National Institute for Health Research (NIHR) website.
Palliative and supportive care focuses on symptom control and support. It’s an extremely important part of the care and treatment for many people living with secondary breast cancer and can significantly improve quality of life for them and their families.
People often associate palliative care with end-of-life treatment. However, many 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.
The palliative and support care teams are based in hospitals, hospices and the community. You can be referred by your treatment team, GP or breast care nurse depending on your situation.
Some treatments for secondary breast cancer may not be routinely available on the NHS. You may still be able to access these treatments in other ways. Macmillan Cancer Support has information about what you can do if a treatment is not available. Visit their website macmillan.org.uk or call 0808 808 00 00 to find out more.
It can be frustrating and distressing if a treatment you and your cancer specialist feel could benefit you is not routinely available. 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 through your concerns.
Find out more about the availability of treatments.
Pain relief is a very important part of the care of anyone with secondary breast cancer. Once their pain is under control, many people feel less anxious and can eat and sleep better.
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. Steroids may sometimes be used to help relieve this.
Find out about pain control and secondary breast cancer.
Nausea and vomiting
If you experience nausea (feeling sick) or vomiting (being sick), it’s likely to be due to your treatment, the cancer itself putting pressure on the stomach or causing the liver not to work properly, or 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 doctor to try to find out the cause so that it can be managed effectively. You can help your treatment or palliative care team decide which treatment will work best by keeping a diary of what makes nausea or vomiting worse or when it happens.
Poor appetite and weight loss
Sometimes people with secondary breast cancer cannot eat as much as usual. This means they may 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 dietician 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 can 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 might make you feel breathless or nauseous. If you start to get symptoms like this, let your treatment team know straight away.
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. It’s often done at the same time as an ultrasound examination. A small 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, often over a few hours or sometimes a few days.
Although you’ll be aware of the tube once it’s in place, it should not 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. Some people may need to keep a drain in permanently that can be managed at home.
Fatigue (extreme tiredness)
Cancer-related fatigue is one of the most common symptoms experienced by people with secondary 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 continuous, and this can be distressing and frustrating.
Fatigue 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, loss of appetite, medication, disturbed sleep or progression of the cancer.
Find tips on managing fatigue.
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 treatment 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.
Jaundice can occur when the bile duct 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. 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 place a stent (small tube) into the bile duct to hold it open. A narrow flexible tube with a light at the end is passed through the mouth and the stomach to access the bile duct. You’ll be given medication to make you feel drowsy beforehand and asked not to eat or drink anything for several hours before this procedure. Alternatively, a stent can be placed using a procedure called a PTC (percutaneous cholangiopancreatography) where a specialist will numb an area of skin over the liver and use a CT scan or ultrasound to guide the tube through the skin into the bile duct.
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.
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 at night. 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 treatment 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.
Some people with secondary breast cancer in the liver have no symptoms while others have a combination of pain, sickness, loss of appetite, hiccups, tiredness and fatigue. While physical activity may help reduce some symptoms it’s important to listen to your body and not push yourself too hard. Gentle, regular activity, such as walking, is often most effective.
If you’re currently having treatment you may need to exercise at a slightly lower level. Stop straight away if it hurts or feels like you’re working too hard.
When choosing your exercise, try to focus on aerobic activities such as walking, swimming or cycling. Activities such as dancing and gardening can also be beneficial. You could also include some light toning or conditioning exercises such as stretching or low-impact yoga. The most important thing is to choose something you can safely enjoy.
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 Now’s Helpline free on 0808 800 6000.