Controlling symptoms of secondary breast cancer

If your symptoms are not well controlled, ask to see a symptom control nurse, or palliative care nurse. These nurses are often based in hospital palliative care teams or local hospices. They can help anyone who has cancer symptoms and needs advice, even if they have only just been diagnosed. Your specialist, your GP, or your breast care nurse can refer you. Contact Macmillan Cancer Support to find out where your area team is based.

Many people with cancer don't have pain. But if you get pain, it can often be helped by cancer treatment. For example, an enlarged liver may cause pain in your right side or shoulder. The pain can be reduced by hormone therapy, chemotherapy or biological therapy that shrinks the cancer in the liver. Bone pain from bone secondaries can be treated with radiotherapy or chemotherapy or with drugs called bisphosphonates.

If you have pain that is not controlled with cancer treatment, there are many painkillers available. Pain can usually be well controlled. With good pain control, most people should be able to 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.

There is a section about pain and pain control on CancerHelp UK. The section contains detailed information about different types of pain and how pain can be relieved.

Breathing problems may be caused by cancer cells in the lung or fluid collecting around your lung. Fluid around the lung is called a pleural effusion. It is treated by draining off the fluid. If you have secondary lung cancer, you may also have a cough. This is more difficult to treat. But there are medicines you can try – ask your doctor or symptom control nurse.

With secondary breast cancer you may become constipated if

• You take certain painkillers (including morphine)
• There is too much calcium in your blood (hypercalcaemia)
• Your 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. Ask them to tell you how to prevent or relieve it.

There are books and booklets about preventing constipation, some of which are free. Look at the breast cancer reading list. It is important to know that if you have constipation with severe abdominal pain and vomiting, you should not take laxatives. Your bowel may be blocked. Contact your doctor or breast care nurse as soon as possible.

Treatment for sickness depends on what is causing it. Some painkillers can cause sickness. And so can some cancer treatments. You will also feel sick if you are constipated. Again, it is a good idea to talk this over in detail with a doctor or nurse. Then, you can get the 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 slowly sip ginger beer or ginger ale.

There is a section about sickness on CancerHelp UK. We have information about the causes of sickness in cancer patients, and on how to control sickness.

If you have cancer cells in your bone, calcium can be released from the damaged bone into your bloodstream. A high level of calcium in the blood is called hypercalcaemia and can cause

• Sickness
• Tiredness
• Confusion
• Irritability

If you have hypercalcaemia, you will need treatment from your specialist. You may have to spend a day or two in hospital to get your calcium levels down. You will be given a drug called a bisphosphonate. These medicines can help to control hypercalcaemia. They can be given by drip or as tablets. A drip helps to flush the extra calcium out of your system. Drinking plenty of fluids will help too, if you are able to. There is a section about hypercalcaemia in cancer patients on CancerHelp UK.

Secondary cancer in the bones often causes pain. It can also make the bones weaker and more likely to break. If the bone breaks due to the secondary cancer cells it is called a pathological fracture.

Your specialist may suggest that you have drugs called bisphosphonates. As well as lowering calcium levels, bisphosphonates can help with pain from bone secondaries and help to prevent breaks in damaged bones. Bisphosphonates can be given by drip into the bloodstream or you may have bisphosphonate tablets to take at home. The cancer treatments section of CancerHelp UK has information about bisphosphonates.

Sometimes your doctor may suggest radiotherapy to treat secondary bone cancer. The treatment kills off the cancer cells. Over a few weeks, the bone starts to repair itself and gets stronger again.

If a bone is very weakened before it is diagnosed, you may need to have surgery to strengthen it. While you are under a general anaesthetic, the doctor puts a metal pin into the centre of your bone and may also fix a metal plate to the weak part of the bone. This holds the bone firmly in place. The pin and plate stay in permanently and you may also have radiotherapy to the area. You will need to be in hospital for a week or two after your operation. But you can usually get up and start walking around within a couple of days of your surgery.

Swelling in the arm or around the site of your breast cancer is called lymphoedema. Lymphoedema develops because

• Your lymph glands have been removed or affected by your radiotherapy
• Cancer has blocked your lymph glands

There is detailed information about lymphoedema and breast cancer in this section of CancerHelp UK.

If you have cancer in your liver, fluid may collect in your abdomen, making it swell. This fluid is called ascites. There is information about ascites, why it develops, and how it is treated, in the about cancer section of CancerHelp UK.

Poor appetite is quite a common symptom. It can have a specific cause. Or it may just be that you are feeling too tired or fed up to bother eating much. You can have supplementary nutritional drinks if you can't face eating a proper meal. You can buy the drinks from a chemist and they are also available on prescription from your GP.

You may go off food while you are having radiotherapy, chemotherapy or biological therapy. It helps to try to gradually build up your diet after your treatment is over if you can. It may suit you better to eat very small amounts more often. A large meal can look very daunting if you are off your food. You may prefer to eat snacks little and often rather than stick to set meal times.

There is a section about coping with eating problems in CancerHelp UK.

Even when you feel tired you may find it hard to sleep. There are different reasons for this, including anxiety and having a lot on your mind. 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 or herbal remedies)
• A warm bath in the evening
• A relaxing body massage to relieve muscle tension
• A glass of brandy, port or whisky in the evening
• A little more exercise during the day, if you can manage it

The Royal College of Psychiatrists has an excellent leaflet called 'Sleep problems', which you can look at on their website.

Extreme tiredness is one of the most common symptoms that people with cancer have. You can be tired for many reasons. You may have low energy because of

• Your cancer
• Your treatment
• Difficulty eating
• Difficulty sleeping

Tiredness can be very difficult to cope with. You will have good days and bad days. You may want to stay as active as you can, but try not to push yourself too much on bad days. The secret is pacing your activity so that you have periods of rest in between. You can ask your doctor or nurse if there is an exercise programme that would be suitable for you. You can also plan your activity so that you do not have to make unnecessary trips upstairs, for example. Keep a phone handset within reach, so that you don't have to get up to answer the phone.

Make your life easier in all the ways that you can. For example, you could use a shopping trolley rather than carrying shopping home – or better still, get someone to do your shopping for you or have it delivered.

There is a section about tiredness in cancer patients on CancerHelp UK, which you may find helpful.