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Breast Cancer Recurrence After Lumpectomy And Radiation

How Is A Local Recurrence After Lumpectomy Diagnosed

Timing Of Radiation After Lumpectomy

After a diagnosis of early stage breast cancer, any remaining breast tissue should be evaluated annually with scans .

Most local recurrences within the breast after lumpectomy are detected on routine annual breast imaging, which usually takes the form of mammography and ultrasound, and on occasions MRI.

If you have a local recurrence or new primary breast cancer, you may find symptoms similar to an initial breast cancer. This includes:

  • A new lump in the breast, armpit area or around the collarbone
  • A change in breast size or shape
  • Changes to the nipple, such as sores or crusting, an ulcer or inverted nipple
  • Clear or bloody nipple discharge
  • Changes to the skin including redness, puckering or dimpling
  • Breast tenderness or pain

Once a local recurrence has been diagnosed, we do tests to see whether there are signs of cancer elsewhere in the body. These may include a chest X-ray, CT scan, bone scan or PET scan, and blood tests , then we have to figure out how best to treat the tumour in the breast. Usually in these cases we do a mastectomy, as the prior less drastic surgery and radiation didnt take care of it.

Promising Results But Daunting Obstacles Remain

The studys results are considered preliminary, and further well-vetted research is needed to confirm its results. An additional barrier makes it difficult to translate these trial results to clinical practice: the reliability of the test used in the study to demonstrate that the cancers were slow-growing called Ki67 varies, and many hospitals dont routinely use it to assess breast tumors.

“It will help to assess the results of other studies omitting radiation to feel confident we have identified additional patients with invasive breast cancer for whom radiation can safely be omitted,” Dr. Tung says. “Some of these studies use molecular testing to assess features of the breast cancer, and we await those trial results as well.”

Types Of Recurrent Cancer

There are three types of recurrent breast cancer:

Local recurrence: When cancer returns to the same part of the breast as the initial diagnosis, the disease is classified as a local recurrence.

Regional recurrence: This type is diagnosed when the breast cancer is found in nearby lymph nodes and/or the chest wall.

Distant recurrence: Also called metastatic breast cancer, this occurs when cancer cells travel away from the original tumor in the breast to other parts of the body through the lymphatic system or bloodstream. Common metastatic areas include the bones, liver and lungs. Even when a metastatic breast tumor spreads to a different part of the body, it contains the same cancerous cells that developed in the breast.

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Mastectomy And Local Breast Cancer Recurrence

With mastectomy, the best predictor of local breast cancer recurrence is whether the lymph nodes in the underarm area contain cancer.

The risk of local recurrence is usually higher when there are more axillary lymph nodes with cancer than when there are few or no nodes with cancer .

Learn more about breast cancer recurrence.

Lumpectomy Plus Radiation Therapy And Local Breast Cancer Recurrence

Oncotype Test Could Reduce Overtreatment Of Early Stage Breast Cancer

For women who have lumpectomy plus radiation therapy, the chance of a local breast cancer recurrence in 10 years is about 3-15 percent .

The risk of local recurrence depends on tumor characteristics, including biomarkers .

It also depends on whether or not the tumor margins and the lymph nodes in the underarm area contain cancer cells. The chance of local recurrence is lower when :

  • Tumor margins do not contain cancer
  • Lymph nodes do not contain cancer

Chemotherapy, hormone therapy, HER2-targeted therapy and/or other drug therapies can lower the risk of breast cancer recurrence for people treated with lumpectomy plus radiation therapy .

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If All The Cancer Was Removed With Surgery Why Do I Need Any Additional Treatment

It has long been recognized that breast cancer is not always cured by locoregional treatment alone.

The goal of treating early breast cancer is to remove the cancer and keep it from coming back . Most people diagnosed with breast cancer will never have a breast cancer recurrence. However, everyone who has had breast cancer is at potential risk of recurrence, and that is why in most cases, there is a recommendation for treatment in addition to surgery, which is known as adjuvant therapy. The risk of recurrence can never be entirely eliminated, but the aim of adjuvant therapy is to reduce recurrence risk to the absolute minimum.

Treatment For Breast Cancer Recurrence

If your care team thinks you might have a cancer recurrence, theyll recommend diagnostic tests, like lab tests, imaging or biopsies, both to be sure the cancer has come back and to get more information to guide your treatment.

Treatment options depend on where the cancer has recurred and what breast cancer treatment youve had before:

  • Local recurrence is likely to be treated surgically first with a mastectomy if you didnt have one already or a surgical removal of the tumor if you did. After surgery, breast cancer chemotherapy and radiation are commonly used, as well as hormone therapy or targeted therapy if your kind of cancer will respond to one or both of them.
  • Regional recurrence is also typically treated first with surgery to remove affected lymph nodes. After the surgery, youll likely have radiation and possibly chemotherapy, hormone therapy and/or targeted therapy, too.
  • Distant recurrence is mainly treated with drug therapychemotherapy, hormone therapy, targeted therapy for breast cancer or a combination of these. Breast cancer surgery and/or radiation might be used, too, but only in cases where the aim is relieving symptoms.

Expert cancer care

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Deciding Whether To Have Breast Reconstruction

Choosing whether or not to have breast reconstruction is a very personal decision. Some women feel reconstruction is necessary to restore their confidence others prefer to wear an external breast form and some women choose not to have reconstruction and not to wear a prosthesis.

You may choose to delay your reconstruction, which can be a good option if you dont want to decide straight away. If you decide not to go ahead, this doesnt mean you wont be able to have one later.

Theres no right or wrong choice and its important to do whats best for you. It can be helpful to talk to other women who have had breast reconstruction before making your decision. Your breast care nurse may be able to arrange this. Breast Cancer Now can also put you in touch with someone who has had the type of breast reconstruction you are considering, through our Someone Like Me service.

Cancer Beyond The Breast Area

Radiation After Lumpectomy Reduced Mortality, Recurrence Risk

A locally advanced recurrence means that the breast cancer has spread beyond the breast and the lymph nodes under the arm . This includes areas near to or around the breast but has not spread to other parts of the body.

A locally advanced cancer might come back in one or more of the following:

  • lymph nodes under the breastbone or between the ribs
  • the nodes above the collarbone
  • lymph nodes around the neck

Symptoms can include, changes in the breast, and swelling in the lymph nodes above and below the collarbone, the neck, and around the breast bone.

The tests you might have are usually the same as for checking for a local recurrence.

Do speak to your nurse or doctor if you notice any of these changes.

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How Long After Breast Cancer Treatment Do Recurrences Occur

The risk of recurrence for all breast cancers was highest in the first five years from the initial cancer diagnosis at 10.4%. This was highest between the first and second years after the initial diagnosis. During the first five years after the initial diagnosis, patients with oestrogen receptor positive breast cancer had lower rates of recurrence compared with those with ER negative disease. However, beyond five years, patients with ER positive disease had higher rates of recurrence.

The late recurrence or relapse of breast cancer refers to cancers that come back after five years, but may not return for 10 years, 20 years, or even more. For people who have estrogen receptor-positive tumours, the cancer is actually more likely to recur after five years than in the first five years.

In contrast to the common belief that surviving for five years after cancer treatment is equivalent to a cure, with hormone-sensitive breast tumours there is a steady rate of recurrence risk for at least 20 years after the original diagnosis, even with very small node-negative tumours.

An awareness of the risk of late recurrence is important for a number of reasons. People are often shocked to learn that their breast cancer has come back after say, 15 years, and loved ones who dont understand this risk are often less likely to be supportive as you cope with the fear of recurrence.

Bone Metastases

  • The long bones of the arms and legs

Symptoms and Detection

Treatment

Liver Metastases

Treatment

Managing A Small Recurrence In The Previously Irradiated Breast

Michael P. Osborne, MD, MSurg, FRCS, FACSOncology

Breast cancer is the most common newly diagnosed malignancy among American women. In 2008, an estimated 182,460 new cases of invasive breast cancer, and an additional 67,770 cases of in situ cancer were diagnosed. Approximately 40,480 women will die from breast cancer each year.

ABSTRACT: Over the past 30 years, lumpectomy and radiation therapy has been the preferred treatment for early-stage breast cancer. With accumulating follow-up, we have an ever-expanding pool of patients with history of an irradiated intact breast. Routine use of every-6-month or annual screening in this population has identified an emerging clinical dilemma with respect to managing a small recurrence or a second primary tumor in the treated breast. Most women diagnosed with a second cancer in a previously irradiated breast are advised to undergo mastectomy. More recently, with an improved understanding of the patterns of in-breast failure, and with advances in the delivery of conformal radiation dose there is an opportunity to reevaluate treatment alternatives for managing a small in-breast recurrence. A limited number of publications have reported on patient outcomes after a second lumpectomy and radiation therapy for this clinical scenario. In this report, we review the controversial subject of a second chance at breast conservation for women with a prior history of breast irradiation.

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How Does Distant Recurrence Occur

Many patients find it hard to understand how they can be apparently cancer free one day and be diagnosed with recurrent cancer the next. If surgery got all of the cancer out and chemotherapy and radiation were supposed to have mopped up the rest, how can recurrence even happen?

In most cases, even the smallest breast cancer detected has been growing for some time before it was caught. During this period of growth, the cancer cells multiplied and divided over and over again, and some cancer cells may splinter off from the main tumour and escaped into the surrounding blood and lymphatic vessels. Cells that spread to lymph nodes can certainly be trapped in those lymph nodes and removed at the time of surgery, but cells can also go into the circulatory system. Even early-stage cancers that originally had no lymph node involvement can recur and develop metastatic disease.

While its less common, cancer cells can bypass lymphatics and lymph nodes and travel via surrounding blood vessels. Cancer cells can continue to circulate and go anywhere the blood vessels will take them, or they can home in on other organs in the body, where they take up residence and continue to grow and divide in that one particular spot.

If and when cancer comes back, the cancer cells that escaped the breast are to blame. Obviously if your recurrence is ten years after your diagnosis, we assume that the cells have been dormant all that time and missed the treatments aimed at dividing cells.

Local Recurrence After A Mastectomy

Skin recurrence in the radiation treatment of breast cancer

Even though the entire breast is removed in a mastectomy, breast cancer can still return to the chest area. If you notice any changes around the mastectomy scar, tell your health care provider.

The more lymph nodes with cancer at the time of the mastectomy, the higher the chances of breast cancer recurrence.

Local recurrence after a mastectomy is usually treated with surgery, and radiation therapy if radiation therapy wasnt part of the initial treatment.

Treatment may also include chemotherapy, hormone therapy, HER2-targeted therapy and/or other drug therapies.

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Treatment For Local Recurrence

Treatment for local recurrence will depend on a number of factors, including what treatments you have previously had.

Surgery

If you had breast-conserving surgery then you will usually be offered a mastectomy. For some people it may be possible to repeat the wide local excision.

If you previously had a mastectomy, surgery may be possible to remove the affected areas.

Nearby lymph nodes may also be removed.

Radiotherapy

Radiotherapy is usually only an option if you havent previously had radiotherapy in the same area.

The way radiotherapy is given for a recurrence is similar to how its given to someone newly diagnosed.

Radiotherapy may be offered if surgery isnt possible.

Hormone therapy

If the cancer is oestrogen receptor positive you may be offered hormone therapy.

Which treatment you are offered depends on whether you have gone through the menopause and any hormone therapy you have previously had or are currently taking.

Chemotherapy

Its not clear how much benefit chemotherapy will be to you if you have a local recurrence, but it might be offered in some cases.

If you have previously had chemotherapy then different chemotherapy drugs may be used.

Targeted therapy

The most widely used targeted therapies are for HER2 positive breast cancer.

Why Might I Have A Breast Reconstruction

Some women choose reconstruction for practical reasons such as not having to wear a prosthesis.

Surgery for breast cancer is likely to affect how you look and feel in some way. Some women find it harder than others to come to terms with losing one or both of their breasts. After breast surgery, you might be concerned about the shape of your body and how your breast area will look.

Like many women, you may choose breast reconstruction because your breasts are an important part of your body image, self-esteem and sexuality.

Some women choose to have a reconstruction as they think it will make a difference to their partner, or that it may help them feel more confident during intimacy and sex. However, any decision you make about having a reconstruction should be based on whether its right for you.

If youre not in a relationship at the time of your breast cancer surgery, you may be worried about meeting someone new in future. Breast reconstruction may help you feel more at ease in new relationships, and help you to talk about your breast cancer and feel more confident about showing your body to your partner.

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What’s The Risk Of Recurrence

Everyone who has had breast cancer has some risk of recurrence, but its typically low.

In general, the more time that goes by, the lower the risk of recurrence. Cancer is most likely to recur in the first two years after treatment, and once people get to five years of living cancer-free after treatment, its considered to be a significant milestone to be celebrated. Recurrence after that five year markrare, but possibleis called late recurrence.

Theres still so much that is unknown about cancer recurrence, but researchers have found some patterns in recent years that point to clues about why it happens. These factors might be linked to a higher risk of breast cancer recurrence:

  • Having high blood sugar
  • Not eating enough fruits and vegetables
  • Having had a surgical site infection after your surgery

Certain characteristics of your original cancer also might mean a higher risk of recurrence, such as:

  • A tumor of more than five centimeters across
  • Cancer cells that are HER2-positive
  • Cancer cells that are triple negative
  • Cancer cells in four or more axillary lymph nodes at the time of surgery
  • Cancer cells in the chest muscles or breast skin

You might be at higher risk for late recurrence if you had:

  • A tumor of more than two centimeters
  • A high number of affected lymph nodes
  • A hormone receptor-positive cancer
  • A HER2-negative cancer
  • Hormone therapy for only a short time after surgery

Breast cancer treatment: The care you need is one call away

What Are My Breast Augmentation Options After Radiation Therapy

Post Lumpectomy DCIS Probability, Can DCIS Return After A Lumpectomy?

After radiation therapy, many patients are curious as to their options for breast reconstruction. When your radiation therapy is completed, you and your doctor will want to consider the possibilities and weigh the pros and cons of breast reconstruction done both with, and without, breast implants. You will discuss two techniques for breast reconstruction, each of which have several sub options:

1. Breast Reconstruction With Implants

This option uses traditional breast implants of either saline or silicone. It is simpler to perform and easier to undergo and recover from, but is typically more prone to postoperative problems that may require correction some years later, or replacement of the implant 10 to 20 years after the surgery, when their lifetime has expired.

Some of the advantages of this method include its suitability for thinner patients who may lack sufficient fatty deposits to harvest from, that the required surgery is shorter and less complicated, and that it makes use of the existing mastectomy incisions rather than producing new ones.

2. Breast Reconstruction With Transplanted Tissue: Autologous or Flap Reconstruction.

Among the many flap options available for breast reconstruction after radiation include:

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