Signs Of Breast Cancer Recurrence
The signs of cancer recurrence depend on where the cancer resurfaces. You might not see or feel any signs of a local recurrence, and, if you do, it will probably be a slight change in or around your breast or underarm area. More often than not, your provider might find evidence of a local recurrence during a physical exam or mammogram.
A distant recurrence will typically produce some symptoms, but because many of those breast cancer symptoms are common to other health problems, it can be hard to tell if theyre due to a distant recurrence or something else. Have an open conversation with your cancer care team about any symptoms youre having, especially if they last more than two weeks.
Pay special attention to these symptoms, which could signal a cancer recurrence:
- Blood in your urine or stools
- Any new lumps or areas of swelling
Address Any Sleep Problems You Have
According to a 2017 study, cisgender women who experience regular sleep difficulties, as well as those who have a prolonged sleep duration have a greater all-cause as well as breast cancer mortality rate.
There are a number of different types of sleep disorders, and these, in turn, are often addressed in different ways. For starters, practicing good sleep hygiene habits can sometimes resolve minor sleep problems.
If problems persist, however, talking to a sleep expert may be in order. We often think of sleep as inconsequential , but given the link between sleep disturbances and survival it might be considered as important as some of the treatments we use to battle the disease.
Surgery After Previous Lumpectomy
If breast-conserving surgery was performed the first time breast cancer was diagnosed and a tumor has grown back in the same breast, the complete removal of the breast is usually recommended. This involves removing the entire mammary gland tissue and surrounding skin, but not the chest muscles. The nipple can also be spared if it doesn’t contain any cancer cells and immediate reconstructive surgery is also planned. Abnormal or cancerous lymph nodes are typically removed as well.
If the tumors are small and limited, a second lumpectomy might be an option. That will depend on the location of the tumor and how long ago the first was made. More radiotherapy may be needed after a lumpectomy.
It is often possible to reconstruct the breast after a mastectomy. This procedure can already be started during the operation , or it can be done at a later stage. Doing the procedure later gives you more time to think over the pros and cons of the various options. Having reconstructive surgery later on will mean another operation and another stay at the hospital.
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Fiber And Your Microbiome
A plethora of studies have recently looked at the role of gut bacteria in health. There is evidence that both the type of bacteria present in our guts, and the diversity of those bacteria, play a role in our everything from our ability to lose weight, our mood, and even how we do with cancer. This has given rise to a multitude of products to attempt to restore the microbiome called probiotics.
Unfortunately, at least for those who have not been on antibiotics, probiotics may not be the way to go and eating a healthy diet may be key. While we don’t have many studies looking specifically at breast cancer, the composition of the gut microbiome has been found to correlate closely with the response to immunotherapy drugs for cancer. What correlated the most with a response was the variety of bacteria rather than any particular strain, and it’s thought that probiotics may even reduce the diversity of gut bacteria via dilution. So where does this leave us?
The science on eating to improve the types of gut bacteria you have, as well as their diversity is relatively new. The one thing that seems to consistently help, however, is fiber. Fiber may be considered a “prebiotic” or the food that feeds the bacteria in our guts. Good choices include foods such as leeks, onions, properly prepared garlic, bananas, avocados, and other delicious foods.
Can I Lower My Risk Of Getting A Second Cancer
There’s no sure way to prevent all cancers, but there are steps you can take to lower your risk and stay as healthy as possible. Getting the recommended early detection tests, as mentioned above, is one way to do this.
Its also important to stay away from tobacco products. Smoking increases the risk of many cancers, including some of the second cancers that are more likely after breast cancer.
To help maintain good health, breast cancer survivors should also follow the ACS Guidelines on Diet and Physical Activity for Cancer Prevention:
- Get to and stay at a healthy weight.
- Keep physically active and limit the time you spend sitting or lying down.
- Follow a healthy eating pattern that includes plenty of fruits, vegetables, and whole grains, and limits or avoids red and processed meats, sugary drinks, and highly processed foods.
- It’s best not to drink alcohol. Women who drink should have no more than 1 drink per day.
These steps may also lower the risk of some other health problems.
See Second Cancers in Adults for more information about causes of second cancers.
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Early Detection Saves Lives
Melissa is one of the resource persons in the second episode of Tita Hope Talks: Tackling Access to Cancer Diagnosis and Navigation in the COVID-19 Era, a timely discussion on the importance of early diagnosis in cancer care with or without the pandemic.
An initiative by Hope from Within, a multi-stakeholder cancer advocacy campaign spearheaded by MSD in the Philippines, Tita Hope Talks seeks to remind the public to consult their doctor as soon as they spot something unusual and not to put off preliminary screening.
Hosted by broadcast journalist and health advocate Niña Corpus, Tita Hope Talks gathers experts and health stakeholders to discuss their perspective and provides their insights on various issues surrounding cancer care.
The sessions panel speakers included Dr. Beverly Ho, Disease Prevention and Control Bureau director of the Department of Health Dr. Jorge Ignacio, Cancer Institute director of the UP-PGH Dr. Guia Ladrera, Oncology Department section head of the Lung Center of the Philippines Melissa Ongsue-Lee,VP for sales and marketing of Hi-Precision Diagnostics Amiel Herrera, founder/CEO of Medcheck and Melissa de Leon, president of breast cancer support group Project Pink.
The role of cancer screening in early detection and its impact on survival is well documented in breast, cervical, lung and colorectal cancers.
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Maintain A Healthy Body Weight
Maintaining a healthy weight appears to lower the risk of breast cancer recurrence. If you’ve been frustrated in attempts to lose weight in the past, it may be encouraging to know that some other practices on this list are associated with weight loss, not just exercise, but intermittent fasting, and even upping the fiber in your diet to improve the diversity of the bacteria in your gut.
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Pathways To Breast Cancer Recurrence
Aamir AhmadAcademic Editor: Received
Breast cancer remains a deadly disease, even with all the recent technological advancements. Early intervention has made an impact, but an overwhelmingly large number of breast cancer patients still live under the fear of recurrent disease. Breast cancer recurrence is clinically a huge problem and one that is largely not well understood. Over the years, a number of factors have been studied with an overarching aim of being able to prognose recurrent disease. This paper attempts to provide an overview of our current knowledge of breast cancer recurrence and its associated challenges. Through a survey of the literature on cancer stem cells , epithelial-mesenchymal transition , various signaling pathways such as Notch/Wnt/hedgehog, and microRNAs , we also examine the hypotheses that are currently under investigation for the prevention of breast cancer recurrence.
1. Breast Cancer: The Problem
As mentioned previously, a breast cancer patient has very good chances of a disease-free survival if the cancer is caught and treated early. It is important to mention that the term early is very subjective. In many cases, the cancer is thought to have been treated early only to discover its reappearance years after the first intervention . This phenomenon is tumor recurrence and the subject of our discussion here.
2. Breast Cancer Recurrence
3. Cancer Recurrence in Breast Cancer Patients Undergoing Surgery
4.1. Cancer Stem Cells
Types Of Breast Cancer Recurrence
Women generally develop one out of three types of breast cancer recurrence:
Local breast cancer recurrence
This is when cancer develops in the same place as the primary tumour.Local recurrence can occur after breast-conserving surgery and, in rare cases, it can still come back following a radical mastectomy.
Regional breast cancer recurrence
This occurs in the chest, either in the pectoral muscles or in the nearby lymph nodes. The cancer cells are found under the breastbone, above the collarbone, and the neck.
This is the rarest type of breast cancer recurrence making up for only around 2% of cases.
Distant breast cancer recurrence
This occurs when the original cancer cells have spread to other parts of the body. This is also known as metastasis – it means that the cancer cells have gone beyond the breast and local lymph nodes.
The most common place for distant recurrence of breast cancer is the bone, which happens in 25% of cases.
Other common sites include the liver, lungs and, less commonly, the brain. The cells that make up the recurrent breast cancer are the same type as the primary tumour.
If a new, unrelated tumour forms in the same breast, or the other breast, this is not classed as breast cancer recurrence. It is treated as a new primary tumour.
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Hr Of The Ajcc Tumor Stage
From the 10 years of follow-up data, the hazard curves for annual HRs for the recurrence of breast cancer stratified by AJCC stage are shown in . The shape of the annual recurrence hazard curve over time reveals the dynamics of recurrence. Upon visual inspection, the HR showed a similar timing of peaks between 1 and 2 years of follow-up, with long-lasting tails manifesting for all stages in the observed women. All peaks started steep and decreased slowly. Women with initially diagnosed stage III disease showed evidence of the highest hazard and largest magnitude during the first 5 years of follow-up than women diagnosed with stage I or stage II . Beyond approximately 5 years, the hazard for all stages gradually decreased until the end of the 10 years of follow-up but never reached zero.
How Does Recurrence Affect Treatment
Itâs usually better if a recurrence remains in the breast . But the seriousness depends in part on how long it has been since the original cancer. If itâs been 7 years, your medical team may approach the new growth just as they would a new presentation of breast cancer. The new cancer cells may be the same as before or they could be a new type. Either way, if itâs been a while since the first cancer, your medical team will often treat it largely the same as it treated the first one. This often starts with surgical removal of the tumor.
If you have surgery, your doctor will likely want to follow up with some type of other therapy. Though radiation therapy often follows surgery, you may not be able to get it if the breast got radiation treatment after a prior surgery for breast cancer.
But there are other options that your doctor will likely consider:
- Hormone therapy
If the time since your last cancer is much shorter, say 6 months, your team may assume the tumor could soon spread . This may change their approach to include more chemotherapy or other pharmaceutical approaches.
But you may not be ready for aggressive chemo if youâve recently been through a round. So your medical team will have to work around that.
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Be Mindful Of Your Environment Including Household Chemicals
It’s long been suspected that environmental exposures, including the chemicals we are exposed to in everything from household cleaners to cosmetics, may play a role both in breast cancer risk and recurrence. While it’s difficult to study , we are learning that practicing caution is wise.
A 2017 review looked at the evidence to date connecting breast cancer and the environment. Some compounds, such as PCBs , may raise the risk of recurrence. Others may alter the regulation of genes involved in cell growth, apoptosis , and much more. Endocrine disrupting chemicals can mimic the function of hormones in our bodies, and it’s well known that the hormone estrogen should be avoided to reduce breast cancer recurrence, at least for people with hormone positive tumors.
There is a great amount of information out there of varying degrees of concern, but the important thing to note is that it’s relatively easy to avoid concerning chemicals . Most household cleaners can easily be replaced with baking soda, lemon juice, and vinegar .
The environmental working group has a website where you can search on thousands of personal care products . And adding a few houseplants to your home can help to absorb many indoor air carcinogens with indoor air thought to be more of a concern that outdoor air pollution.
What Is Breast Cancer Recurrence
Itâs when your cancer comes back after treatment. It can happen a year after you finish treatment for breast cancer, or 5, 10, even 20 years later. You find another lump, or a shadow appears on your mammogram. Is the cancer back?
Every person who’s had breast cancer knows that recurrence is possible. Sometimes — such as at follow-up visits with the oncologist — it might particularly be on your mind. It helps to know exactly what a recurrence might involve. And if your thoughts about recurrence start to become a worry, it’s a good idea to talk it over with your doctor, therapist, or support group.
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Local Recurrence After A Mastectomy
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.
Reducing Risk Of Recurrence
There are a number of myths regarding what may reduce the risk of breast cancer recurrence, as well as evidence-based information that is easily overlooked. We will look at measures that may reduce your risk based on credible studies, as well as practices that are unclear that you may wish to discuss with your oncologist.
In some cases, though the benefit on recurrence risk is still not clear, your quality of life may be improved. And living well with cancer is as important as extending your life with cancer.
Before talking about measures that may help lower recurrence risk, it’s important to not add to the stigma of the disease. Some people do absolutely everything right and their breast cancer recurs anyway. Similarly, some people eat poorly, smoke, and drink heavily and their cancer never recurs. While you may be able to decrease your risk of recurrence to a degree, dealing with breast cancer is dealing with a mutated clone of cells that doesn’t think or follow the rules.
For those who have a recurrence, it doesn’t mean they have done anything wrong. It simply means cancer is being cancer.
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Is Tumour Dormancy The Sole Explanation For Recurrence
In pondering the mechanisms of metastatic relapse among breast cancer patients, one obvious question is whether early recurrence is simply the consequence of direct metastatic outgrowth, whereas late relapses reflect a period of tumour dormancy. To address this query, it is imperative to consider how long it takes for a single cancer cell to grow into a clinically detectable metastasis. Pioneering measurements of breast tumour volume doubling time carried out by radiographic analysis on more than 800 women concluded that it takes ~12 years on average for a single cell with a 10-µm diameter to reach a clinically detectable mass of 1cm,, and that metastases can have a TVDT up to twofold higher than their matched primary tumours. However, these initial analyses focused on a small number of samples, without taking into account the vast heterogeneity among breast tumours or the effect that adjuvant therapies might have on their growth rate, as the subjects in this study were untreated.
Fig. 3: The puzzling timing of metastatic relapse in breast cancer patients.
How Can You Cope With Negative Feelings
New fears and disappointment about this setback to your health, anger about the unfairness of your situation or being envious of healthy people are all perfectly natural reactions and are nothing to feel bad about. In the long run, however, it might be better for your general wellbeing to learn how to deal with negative feelings and thoughts so that you still have space for other things as well.
Many women say that it comes as a relief to accept feelings of anxiety, worries and despair and to talk about them with people close to them. As well as talking to your partner, family and friends, professional counseling might also help. Religious organizations and hospitals also offer pastoral or spiritual support. Sharing your experiences with other women in a self-help group is another option.
It can sometimes help to put anxieties and worries aside for a while. Concentrating on pleasant things or activities can help reduce fears and tension to a manageable level.
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