Recurrent breast cancer
Recurrent breast cancer
Recurrent breast cancer is breast cancer that comes back after initial treatment. Although treatment is aimed at eliminating all cancer cells, a few may survive. These undetected cancer cells multiply, becoming recurrent breast cancer.
Recurrent breast cancer may occur months or years after your initial treatment. The cancer may come back in the same place as the original tumor, known as local recurrence. Or it may spread to other areas, typically your bones, liver or lungs, known as distant recurrence.
Learning you have recurrent breast cancer may be harder than dealing with the initial diagnosis. But having recurrent breast cancer is far from hopeless. Treatment may eliminate local, regional or distant recurrent breast cancer. Even if a cure isn't possible, treatment may control the disease.
Signs and symptoms of recurrent breast cancer vary depending on where the cancer comes back. It may show up as a lump in the breast, thickening of the surgical scar or a lump on the chest wall after a mastectomy. It may be detected in an abnormal finding on a mammogram of the breast where you had a lump removed (lumpectomy) earlier, or it may show up in a distant place in your body such as a bone, your liver or your lungs.
Signs and symptoms of local recurrence within the same breast may include:
Signs and symptoms of local recurrence on the chest wall after a mastectomy may include:
Distant (metastatic) recurrence
When to see a doctor
It's important to be aware of the signs and symptoms of recurrent breast cancer, such as:
If you experience any signs and symptoms that might suggest a recurrence, talk to your doctor.
Recurrent breast cancer develops from cells that originally came from the primary breast tumor. The cancer returns after the initial treatment and a period of time when no cancer was detected. This can happen because treatment did not fully destroy or remove all the cancer cells. Even with surgery, microscopic clusters of cancer cells may have been left behind that were too small to be detected with any available test.
If the cancer is aggressive, isolated cells may survive the rounds of chemotherapy, hormone therapy and radiation meant to prevent a recurrence.
Sometimes cancer cells may be dormant for years without causing harm. Then something happens that activates the cells, so they grow and make other cells. Not all of the growth factors for cancer have been found.
It's also possible to develop a new tumor, called a second or new primary tumor, in the same breast as the first tumor or in the other (contralateral) breast. This is not considered recurrent breast cancer. Women who've had breast cancer have a higher risk of developing cancer in the other breast than do women who've never had breast cancer. The risk of developing a new tumor in the second breast is higher if you have a strong genetic predisposition or hereditary breast cancer. Fortunately, most women who have cancer in one breast never develop cancer in the opposite breast.
Many women who have a cancer recurrence blame themselves. But, even when you do everything right, cancer can sometimes come back.
For breast cancer survivors, factors that increase the risk of a recurrence include:
In recent years, genetic tests designed to predict the risk of breast cancer recurrence have become available. These tests (MammaPrint, Oncotype DX) measure activity in up to 70 genes associated with breast cancer, a process known as gene expression profiling. The results are used to estimate the chance that a woman's cancer will come back. But so far these tests have a very limited role and are applicable only for women with estrogen receptor positive tumors that don't show any sign of spread to the lymph nodes. The tests have been used to plan treatment for primary breast cancer in a very small minority of women. More research is needed to determine whether these genetic tests might prove useful in predicting risk of recurrence on a broader scale.
Local cancer recurrences can cause swelling and discomfort in the area of the recurrence. Local recurrences can often be cured, but in some people who have a local recurrence, the disease later appears in a distant site in the body, such as a bone, the liver or a lung. Once a cancer has spread beyond the breast and nearby areas, the disease isn't usually curable.
Preparing for your appointment
Generally, people return to the doctor who treated the initial cancer. However, in some cases, you may decide to see a new oncologist. If you're seeing a different doctor than the one who treated your first breast cancer, make sure the new doctor has access to your medical records from the initial treatment.
What you can do
If you might have recurrent breast cancer, some basic questions to ask your doctor include:
What to expect from your doctor
Tests and diagnosis
If your doctor suspects recurrent breast cancer based on results of a mammogram or physical exam, or because of signs and symptoms, you'll likely need further imaging tests and a biopsy.
The following tests may be used to help diagnose recurrent breast cancer:
Treatments and drugs
To plan treatment for recurrent breast cancer, your doctor considers many factors, including the extent of the disease, its hormone receptor status and the type of treatment you received for your first breast cancer. Most women receive a combination of treatments for recurrent breast cancer that may include surgery, radiation, medications to destroy cancer cells (chemotherapy) and hormone therapy. Breast cancers that make extra amounts of the HER2 protein may be treated with a targeted therapy such as trastuzumab (Herceptin).
Treatment decisions for recurrent breast cancer are complex and individualized. Talk with your health care team to learn about your treatment options.
Treating a local recurrence
Treating a regional recurrence
If surgical removal isn't possible, radiation therapy may be used as the main treatment. Chemotherapy or hormone therapy also may be recommended as the main treatment or may follow surgery or radiation.
Treating a metastatic recurrence
In general, the goal of treatment for a metastatic recurrence isn't to cure the disease. Treatment may allow you to live longer and can help relieve symptoms the cancer is causing. Your doctor will try to achieve a balance between controlling your symptoms while minimizing toxic effects from treatment. The aim is to help you live as well as possible for as long as possible.
If the cancer has spread to other parts of the body, treatment for a metastatic recurrence usually involves whole body (systemic) therapy rather than local therapy such as surgery or radiation. Options for systemic therapy include hormone therapy, chemotherapy or targeted therapy. Because hormone therapy is less toxic than chemotherapy, your doctor might start with tamoxifen or an aromatase inhibitor. But if your cancer is fast-growing or has already spread to other organs such as the lungs and liver or if you have previously received hormone therapy, your doctor might recommend starting with chemotherapy.
If your cancer is HER2 positive, you may also be given a targeted therapy to attack the protein that's overproduced in these cancers. Targeted therapies include trastuzumab (Herceptin) or lapatinib (Tykerb).
Depending on where the cancer has spread and what symptoms it's causing, you may also have localized treatments, such as medications or radiation.
Lifestyle and home remedies
Eating well, exercising and managing stress are ways to promote your overall health and cope with cancer and treatment.
In addition, activities that require repetitive movement, such as swimming, can produce a mental state similar to that achieved with meditation. The same is true of yoga and other stretching exercises.
When people learn you have cancer, they may offer advice or tell you about someone they know who had breast cancer that was cured with an alternative treatment. It can be tempting to consider alternative treatments, especially when your options may be waning. However, no alternative treatments have proved to be effective cancer treatments.
Even when people decide to try an alternative therapy, many neglect to tell their doctors. But, it's important to let your doctor know about everything that you're taking to prevent any dangerous adverse reactions. Another concern about alternative treatments is that some people delay getting potentially lifesaving treatments to try an alternative first.
Coping and support
Finding out your breast cancer has returned can be equally or more upsetting than getting the initial diagnosis. The prospect of more disruptions, treatments and uncertainty is stressful. But, after the initial blow of the diagnosis, many women find their outlook improves.
As you sort through your emotions and make decisions about treatment, the following suggestions might help you cope.
Nothing can guarantee your breast cancer won't return. Most women who are treated for early-stage breast cancer remain free of disease. Many people who experience a cancer recurrence blame themselves for not eating right, missing a doctor visit or something else. It's important to realize that even if you do everything just right, the cancer might return.
Things that have been shown to reduce the risk of recurrent breast cancer are:
Research looking at specific aspects of diet — such as fruits and vegetables and fat — and risk of recurrent breast cancer hasn't been conclusive.
Last Updated: 2011-05-24
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