Recurrent breast cancer
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When breast cancer recurs after initial treatment (mastectomy, chemotherapy, or other treatments), it is called recurrent breast cancer. A few cancer cells may have evaded treatment and survived, despite the initial treatment’s goal of eliminating all cancer cells.
Finding out you have recurring breast cancer could be more difficult to deal with than receiving the initial diagnosis. However, there is still hope if breast cancer returns. Treatment can get rid of local, regional, or distant recurrent breast cancer. Even if a cure is not feasible, medication may give the illness long-term control.
The breast cancer recurrence may not be the same as the initial diagnosis. The following are types of recurrent breast cancer:
- Local recurrence: the recurrences of the cancer at the same location as the initial diagnosis.
- Regional recurrence: recurrence near the original location, either at the lymph nodes at the armpit or at the collarbone area.
- Distant recurrence: this type of breast cancer spreads outside of the initial location to the bones, brain, lungs, or other organs (metastasis). This type is known as stage 4 breast cancer.
Symptoms
The location of the cancer recurrence affects the signs and symptoms of recurrent breast cancer.
- Local recurrence
- Development of a new lump in the breast
- Unusual firmness of breast
- Skin changes at the breast
- Redness or inflammation of the skin
- Nipple changes or discharge
- Few painless nodules on or under the skin of the chest wall
- Thickening at a new location along or close to the surgical scar.
- Regional recurrence
- Chest pain
- Difficulty in swallowing
- Lump or swollen lymph node under the armpit
- Lump or swollen lymph node near the collarbone
- Lump or swollen lymph node at the neck
- Distant recurrence
- Constant and escalating pain at the hip, back, or chest
- Persistent dry cough
- Difficulty breathing
- Loss of appetite
- Unexplained weight loss
- Severe headaches
- Seizures
- Dizziness
- Fatigue or weakness
The specialist will recommend a follow-up checkup and examinations after the initial breast cancer treatment. Specialist will assess for any signs and symptoms of breast cancer recurrence during the follow up checkup.
If patient notice any persistent signs and symptoms, they need to have an appointment with their specialist.
Causes
When cancerous cells from your primary breast tumor separate and are still present nearby in the breast or another area of your body, this cell may grow over time and develop into recurrent breast cancer.
In order to eradicate any cancer cells that could have remained after surgery, patient may have to undergo chemotherapy, radiation, hormone therapy, or other forms of treatment after being initially diagnosed with breast cancer.
However, there are cases that these therapies are unable to completely eliminate the cancer cells. It is however possible for cancer cells to remain dormant for years without harming anyone.
Risk factors
Factors that increase the risk of a recurrence for breast cancer include:
- Lymph node involvement: risk of the cancer returning is increased if patient was initially diagnosed with cancer and further found cancer in the surrounding lymph nodes.
- Tumor size: Recurrent breast cancer is more likely in people with larger tumors.
- Positive margins: A negative margin is one in which, when inspected under a microscope, the borders are cancer-free. The likelihood of breast cancer returning is higher if the border contains cancer cells (positive margin) in any location or if the tumor margins are nearby the surrounding healthy tissue.
- Lacking radiation therapy: To lower the chance of recurrence, most patients who choose for a lumpectomy (wide local excision) for breast cancer also receive breast radiation therapy and those who did not undergo radiation are more likely to experience a localized breast cancer recurrence.
- Age: Younger persons have a higher risk of developing recurrent breast cancer, especially if they were under 35 at the time of their initial diagnosis.
- Inflammatory breast cancer: Greater risk of local recurrence occurs in patient with inflammatory breast cancer.
- Lack of hormone receptor-positive breast cancer. Not getting hormonal therapy can increase the chance of recurrence in patients with a specific kind of breast cancer.
- Obesity: Chances of recurrence increases with a higher body mass index.
- Cancer cells with specific characteristics: Higher chance of breast cancer recurrence may exist if you had triple negative breast cancer. The HER2 protein is not overproduced in triple negative breast cancer cells, nor are they filled with estrogen or progesterone receptors.
Diagnosis
The doctor may suggest additional investigation to confirm the diagnosis if they have reason to believe that the patient has recurrent breast cancer based on the findings of a mammogram or physical examination, or signs and symptoms.
Specific investigation and procedures could be the following:
- Imaging tests: To determine the extent of the tumor, the specialist may recommend imaging tests.
- Magnetic Resonance Imaging (MRI)
- Computerized tomography (CT)
- Positron emission testing (PET) scan
- Biopsy: The only method to determine whether your cancer is recurrent is through testing suspicious cells with a biopsy. The pathologist will examine if the cancer is a new type of cancer or a recurrence. The tests will also help to determine whether the malignancy is responsive to hormone therapy or targeted therapy.
Additionally, tests determine if the cancer is responsive to hormone therapy or targeted therapy because they may have changed since your initial cancer diagnosis.
Treatment
Treatment will vary depending on the severity of the condition, whether it has hormone receptors, the type of treatment that patient had for the initial breast cancer, and the general health will all affect the treatment options. The doctor also takes into consideration the patient treatment choices and goals.
Treatment for local recurrence
Operation is usually the first step in treating a local recurrence, though radiation therapy may also be used if you’ve never had it. Additionally, hormone treatment and chemotherapy might be suggested.
- Surgery: Surgical removal of the breast tissue is recommended if the cancer is located only at the breast.
- Mastectomy: the doctor may advise a mastectomy to remove all of your breast tissue, including the lobules, ducts, fatty tissue, skin, nipple and some or all of the lymph nodes, if your initial malignancy was treated with a lumpectomy.
- Radiation therapy: this treatment uses high-energy beams, such X-rays or protons to kill cancer cells. The doctor might suggest radiation therapy if the patient didn’t receive it for the initial breast cancer. However, due to the danger of adverse effects, radiation is typically not advised to treat a recurrence if the patient had radiation after a lumpectomy.
- Chemotherapy: drugs are used in chemotherapy to kill cancer cells in order to lower the risk of developing another cancer recurrence.
- Hormone therapy: if the cancer is hormone receptor positive, medication that inhibits the growth-promoting actions of estrogen and progesterone will be recommended.
- Targeted therapy: medication that targets HER2 will likely be recommended if testing reveals that the cancer cells produce an excessive amount of the protein.
Treatment for regional recurrence
Regional breast cancer recurrence may be treated with:
- Surgery: the suggested course of treatment for a regional recurrence is surgery to remove the malignancy. If any lymph nodes are still present under the arm, then the surgeon may recommend removing them.
- Radiation therapy: After surgery, radiation therapy may occasionally be performed. Radiation therapy may be the primary treatment for the regional breast cancer recurrence if surgery is not an option.
- Drug treatments: In addition to being suggested as the primary course of treatment, chemotherapy, targeted therapy, or hormone therapy may be given after radiation or surgery.
Treatment for distant (metastatic) recurrence
There are options for treating metastatic breast cancer. The choices that the patient have will depending on how far the cancer has spread. The purpose of treatment for metastatic breast cancer is to help the patient live longer and relief their current cancer symptoms, not to completely cure them. The goal is to make sure the patient lives as long and as comfortably as they can. Treatment for distant recurrence may include:
- Hormone therapy: This therapy is helpful if the cancer has hormone receptors. Hormone therapy is usually the primary course of treatment for metastatic breast cancer since it has fewer adverse effects than chemotherapy.
- Chemotherapy: If the cancer lacks hormone receptors or if hormone therapy is no longer effective, the doctor might advise chemotherapy.
- Targeted therapy: The doctor may prescribe these this type of medications if the cancer cells exhibit characteristics that make them susceptible to targeted therapy.
- Immunotherapy: Cancer cells produce proteins that help them hide from immune system cells, your body’s disease-fighting immune system may not attack your cancer. Immunotherapy makes use of your immune system to combat cancer. Patient with triple negative breast cancer (breast cancer cells that does not have any of the hormone receptor), the treatment may be immunotherapy combined with chemotherapy.
- Bone-building drugs: to minimize bone fracture or lessen any potential bone discomfort, the doctor may prescribe a bone-building medication if case that cancer has spread to the bones.
