Sites of secondary cancer
Advanced cancer is also called secondary, metastatic, or progressive cancer, and means the cancer has spread beyond its original site. Sites of secondary cancer include the bone, liver, lung and brain. Symptoms depend on the area involved, and treatments can often be given to relieve these.
Some people experience few or no symptoms, but secondary cancer in the bone can cause a constant aching pain. This pain may increase with activity and may also make sleep difficult.
Bone pain is caused by:
- cancer pressing on the bone
- cancer in the bone pressing on nerves
- fracture (breaking) of the bone.
A secondary cancer in the bone may gradually damage some of the bone tissue, causing the bone to become weaker. Early treatment by radiation treatment, drugs, and surgery may prevent fractures.
Hypercalcaemia (high levels of calcium in the blood)
Calcium sometimes seeps into the blood when bones are damaged by advanced cancer. Hypercalcaemia is diagnosed by a blood test and is usually easily treated.
Symptoms may include headache, nausea, increased urination, excessive thirst, dehydration, constipation, feeling disorientated and drowsy.
You may be admitted to hospital for short-term treatment with bisphosphonates. This quick treatment should make you feel much better within a couple of days. Treatment can be repeated as often as necessary.
Spinal cord compression
The spinal cord is the large nerve that runs from the base of the brain to the bottom of the back. It is protected by the bones of the spine (vertebrae). If advanced cancer is present in the vertebrae, it may cause pressure on the spinal cord.
Although advanced cancer in the vertebrae is quite common, only a small number of people will actually develop spinal cord compression.
Symptoms may include pain or damage to the nerves at the level of the compression. If the nerves are damaged in the lower part of the spine, this may lead to tingling or numbness, or loss of power and movement in one or both legs.
If damage is higher in the spine, there may be a loss of power and sensation in one or both arms or hands. Because the nerves of the spinal cord control the bladder and bowel, there may be difficulty urinating or changes in bowel function.
Spinal cord symptoms to report
Report any of the following symptoms to your doctor as soon as they occur:
- tingling or numbness in arm(s), hand(s), or leg(s)
- difficulty walking
- trouble passing urine
- constipation or diarrhoea.
Early treatment – usually steroids, radiation treatment, or surgery, or a combination of these – offers the best chance of avoiding permanent damage to the spinal cord.
Symptoms of liver secondaries may include:
- weight loss
- lack of appetite
- feeling sick
- jaundice (yellowing of the skin)
- discomfort or pain around the liver (the right side of the abdomen)
- swelling of the abdomen.
The liver is a large organ that can work efficiently, even when part of it is ‘out of action’. Many of the symptoms of secondary cancer affecting the liver may be relieved with appropriate therapy. Diagnosis is made by CT scan, ultrasound, or MRI scan.
Ascites is a swelling of the abdomen caused by fluid build-up.
The membranes lining the abdomen (peritoneum) produce a fluid that acts as a lubricant allowing the abdominal organs to glide smoothly over one another. Sometimes too much of this fluid can build up between the two layers and this is called ascites.
To relieve the ascites, fluid may be drained, or a drug may be used or, very occasionally, a shunt which helps remove the fluid may be used. A shunt is a plastic tube that drains the fluid from the abdomen.
Symptoms of lung secondaries may include:
- shortness of breath
- dry cough
- chest pain.
Cancer within the lungs or on the lining of the lungs may cause the above symptoms.
Cancer cells lodging on the outside of the lungs can irritate the lining that covers the lungs (the pleura). This may cause fluid to build up, which presses on the lungs (this is called pleural effusion). Some people notice a definite change in their breathing.
Seek medical attention immediately if you experience breathing problems or cough up blood. Medication can be put between the two layers to stop fluid building up again.
Symptoms of brain secondaries may include:
- headaches – such headaches do not go away and may gradually get worse
- feeling sick and vomiting
- weakness in an arm or leg
- unsteadiness while walking
- changes in vision
- confusion, disorientation, or personality changes (rare).
The brain is a large organ which, like the liver, will often work very well even when part of it is affected by advanced cancer.
Many of the symptoms described above can be treated with appropriate therapy. Diagnosis is made by CT scan or MRI.
Also see Advanced cancer - treatment and Advanced cancer - living with
Original material provided by the Cancer Society of New Zealand, 2008. Edited by everybody, August 2010.