Breast cancer can affect you in different ways. The symptoms you have depend on where the cancer is. Treatment for breast cancer can also cause side effects.
Breast cancer can sometimes spread to other parts of the body such as the bones and lungs. This is secondary or advanced breast cancer. It is also called metastatic or stage 4 breast cancer. Secondary breast cancer is likely to cause symptoms such as tiredness and loss of appetite.
It can be difficult to cope with the symptoms and the side effects of breast cancer and its treatment. Your doctors and nurses can support you and give you treatment to help relieve the symptoms.
Tell your doctor or nurse about any symptoms that you have so they can help you.
Symptom control team
There are symptom control teams in most cancer units. They can help you to stay as well as possible for as long as possible. They are also in hospices and many general hospitals.
Most symptom control teams have home care services to visit you at home.
Controlling symptoms
Treatments such as chemotherapy, hormone therapy and immunotherapy can help to shrink the cancer, reduce symptoms and help you feel better. You can also have other medicines to help relieve symptoms, such as painkillers.
Symptoms can usually be well controlled. Your doctor or specialist nurse can:
give you medicines or suggest other ways of controlling your symptoms
get the equipment that you need
tell you about things that you or your friends and family can do
Tiredness or is a common symptom of advanced cancer. It can feel a bit overwhelming and as though you don’t have any energy.
Fatigue can also be caused by the cancer treatment you have and it can last for some time after you finish your treatment.
Let your doctor or nurse know if you’re very tired as they might be able to prescribe medicine or other treatments to help. For example, a blood transfusion can give you more energy if you’re tired due to anaemia (low red blood cell levels).
Resting
It’s important to rest a few times throughout the day. Resting regularly can help you feel less tired and more able to cope. You don't have to sleep during these times. Just sitting or lying down will help.
Exercise
Exercising can be hard when you feel very tired. But research shows that daily light to moderate exercise can give you more energy. Going for a gentle walk is very good. Gentle exercises in bed or standing up can help if you can’t move around easily.
Your hospital physiotherapist might be able to help you plan an exercise programme that suits your needs.
Even when you feel tired you may find it hard to sleep. There are different reasons for this, including anxiety, having a lot on your mind and side effects of cancer treatment. You may want to ask your doctor for sleeping pills. These can help to break a pattern of poor sleep and get you back into a better routine.
You can also try some other remedies for sleeplessness such as:
warm milk drinks before bed
natural sleep remedies (for example, homeopathic remedies)
a warm bath in the evening
a relaxing body massage to relieve muscle tension
a little more exercise during the day, if you can manage it
use sleep apps such as Sleepio that can help you manage sleep problems and insomnia
There are other ways that may help you improve your sleep, including acupuncture or relaxation techniques. Do speak to your breast care nurse or doctor if you are having problems sleeping. They can put you in touch with other specialists who can help you.
You might not feel like eating and may lose weight. There can be different reasons for this. But it is important to drink plenty and try to eat when you can.
Talk to your healthcare team if you have lost your appetite. They might be able to help. For example, they can give you medicine to help stop you feeling sick.
Tips:
Eating several small meals and snacks throughout the day can be easier to manage.
Ask your doctor or dietitian to recommend high calorie drinks to boost your calorie intake.
Eat whatever you feel like eating rather than what you think you should eat.
Drink plenty even if you can't eat.
Don't fill your stomach with a large amount of liquid before eating.
Try to eat high calorie foods to keep your weight up.
Pain can affect you physically and how you feel emotionally. It's a very personal experience that is different for everyone. Pain relief treatment can vary from one person to another. What works for you might not help someone else. So having an individual treatment plan to control your pain is important.
Treatment can often help reduce pain. For example, radiotherapy, chemotherapy or targeted drugs can shrink the cancer and reduce the pain.
Painkillers are also available if other treatments haven't controlled your pain or control it until other treatments start to work.
Pain can usually be well controlled. With good pain control, most people should be free of pain when they are lying or sitting. The first step is to tell your doctor or nurse that you have pain so that they can find the right painkillers for you.
Your doctor will ask you questions about the pain you have. They may ask you to fill in questionnaires or rate your pain on a pain scale. This helps to describe your pain and what might make it worse or better.
You might feel breathless if your cancer has spread to the lungs or if you have low red blood cell levels (anaemia). You can learn breathing techniques that can help. You might need a blood transfusion to give you red blood cells if you have anaemia.
Tell your doctor or nurse if you feel breathless. There are ways to improve your breathing. For example, medicines to make your breathing easier.
Constipation is a common problem for people with cancer and a side effect of some cancer treatments. It means difficulty having a poo and you probably won’t have regular bowel movements. You might not have one for a few days or more.
With breast cancer, you may become constipated if:
you take certain painkillers (including morphine)
there is too much calcium in your blood (hypercalcaemia)
treatment has made you lose your appetite and you are not eating as much as usual
you are not able to move about as much as usual
Don't be embarrassed to ask for help with constipation. The longer you leave it the more problems it can cause. Fibre in your diet and plenty of fluids will help, but you may also need to take a laxative. Your doctor can prescribe one. Many hospital and community nurses know about constipation and can talk to you about how to prevent or relieve it.
Contact your doctor or breast care nurse as soon as possible if you have constipation with severe tummy (abdominal) pain and vomiting. Your bowel may be blocked.
Treatment for sickness depends on what is causing it. It can be due to the side effects of treatment or symptoms of breast cancer spread.
Some painkillers or cancer treatments can cause sickness. You might also feel sick if you are constipated.
Tell your doctor or nurse if you have sickness. They can give you the anti sickness treatment you need.
Some people find that ginger is a good natural remedy for sickness. Try eating stem ginger or crystallised ginger if you like it. Or you can slowly sip ginger beer or ginger ale.
Calcium is an important nutrient that our body needs. Breast cancer can spread to the bones and this can affect the amount of calcium in the body.
Cancer cells in your bone can mean that the damaged bone releases calcium into your bloodstream. A high level of calcium in the blood is called hypercalcaemia and can cause:
feeling or being sick
tiredness
confusion
constipation
You need treatment if you have hypercalcaemia. You may have to spend a day or two in the hospital to get your calcium levels down.
You usually have fluids through a drip into your bloodstream. This helps to flush the extra calcium out of your system. Drinking plenty of fluids will also help if you are able to.
You are also likely to have a drug called bisphosphonate. These medicines can help to control hypercalcaemia. You have bisphosphonate by drip or as tablets.
You might have bone pain if your breast cancer has spread to the bones. If this happens, your bones might become weaker so they can break more easily. Your doctor and nurse can help you to be pain free most of the time.
Possible treatments include:
hormone treatment
radiotherapy
surgery
bisphosphonates
radiofrequency ablation (RFA)
painkillers
a targeted treatment called denosumab
You might find that complementary therapies, such as relaxation or gentle massage, may also help.
Cancer that has spread into the spinal bones can cause pressure on the spinal cord. This is called spinal cord compression. The pressure on the spinal cord stops the nerves from working normally. This can cause:
back pain
changes in sensation, such as tingling or numbness
changes in the way your bowel or bladder work
difficulty walking
Spinal cord compression is an emergency. It is important to get treatment as soon as possible.
Breast cancer that has spread to the liver can often make you feel ill and tired. You may also have:
discomfort or pain on the right side of your tummy (abdomen) where the liver is
sickness (nausea)
loss of appetite
a swollen abdomen
weight loss
hiccups
Secondary breast cancer in the liver can cause pain if the cancer presses on the fibrous tissue covering the liver (the capsule).
The liver has a lot of functions in the body. One is to make bile to help digest food in the intestine. If the drainage channels leading from the liver are blocked by secondary cancer, bile may build up in the blood. This causes jaundice, where the skin and whites of the eyes become yellow and your skin may feel itchy.
The liver can still work well when part of it, or even most of it, is affected by cancer cells. And the symptoms of secondary breast cancer in the liver can usually be well controlled.
The thought of cancer spreading to and affecting the brain can be very frightening. But the brain can work well even if part of it is affected by cancer cells.
Secondary breast cancer in the brain can cause different symptoms depending on which part of the brain is affected. You may have:
headaches
feeling or being sick
problems controlling parts of the body. For example, an arm or a leg may be weaker than usual or may feel numb
memory problems
changes in your personality and how you behave
Very rarely, you may have eyesight problems. Tell your doctor straightaway if you have any changes to your vision. But remember that eye problems can have many causes so it may not be due to cancer. If you are having some types of hormone therapy, chemotherapy or biological therapies, these can occasionally affect your vision.
Treatment for secondary cancer in the brain includes:
It can be difficult to cope with breast cancer. It can be especially hard to cope with breast cancer that has spread. It might help to talk to a close friend or relative about how you feel.
For support and information, you can call the Cancer Research UK information nurses. They can give advice about who can help you and what kind of support is available. Freephone: 0808 800 4040 - Monday to Friday, 9am to 5pm.
ESMO Clinical Practice Guideline for the diagnosis, staging and treatment of patients with metastatic breast cancer
A Gennari and others
Annals of Oncology, 2021. Volume 32, Issue 12. Pages 1475-1495
Early and locally advanced breast cancer: diagnosis and management
National Institute of Health and Care Excellence (NICE), 2018. Last updated June 2023
Management of cancer pain in adult patients: ESMO Clinical Practice Guidelines
M. Fallon and others
Annals of Oncology, 2018. Volume 29, Issue 4, Pages 166–191
Diagnosis, assessment and management of constipation in advanced cancer: ESMO Clinical Practice Guidelines
P. J. Larkin and others
Annals of Oncology, 2018. Volume 29, Issue 4, Pages 111–125
The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. Please contact patientinformation@cancer.org.uk with details of the particular issue you are interested in if you need additional references for this information.
