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Can Cancer Come Back In The Same Breast

What If Cancer Comes Back

I Am a Breast Cancer Survivor. What Are the Chances of My Cancer Coming Back?

One of the most common fears for people who have had cancer is that it may return. When cancer comes back, it is called recurrence. Cancer can recur in the same spot or in a whole different area of your body. No one likes to think about having cancer again, but it is important to learn about recurrence so you can move on with your life despite the uncertainty.

Next Steps For Breast Cancer Survivors

Following a diagnosis of breast cancer, I always tell my patients to pace themselves. The journey after treatment can be long and challenging. The late, great Maya Angelou gave sage advice when she stated, My mission in life is not merely to survive, but to thrive, and to do so with some passion, some compassion, some humor, and some style.

These 5 steps can help you thrive in your overall health and cancer survivorship:

  • Take care of yourself emotionally. Seeking social support, developing strong personal relationships, accessing mental health services, and having a solid spiritual foundation are effective steps to manage lifes stressors and especially those unique to cancer survivorship.

  • Eat a healthy diet. Good nutrition supports overall health, such as eating a diet rich in fresh fruits, vegetables, and lean meats.

  • Maintain a healthy weight. Research shows that maintaining a healthy weight through a healthy diet and moderate physical activity lowers the risk of developing diabetes, high blood pressure, and other cancers and chronic diseases.

  • Stick with your follow-up care and other health screenings. Your routine oncology appointmentis a good time to talk about any concerns. If you notice any changes or new symptoms before your scheduled appointment, be sure to alert your health care provider. Also, take care of your entire body, including other recommended health screenings, such as Pap tests, general blood tests, blood pressure checks, and colonoscopy.

  • Local Breast Cancer Recurrence

    Local breast cancer recurrence is when the cancer has reoccurred close to or in the same place the first tumor was found within the breast. If you were treated with lumpectomy and radiation for your first occurrence, the breast tissue cannot be treated with radiation again. In that case, the standard of care for surgical treatment is mastectomy.

    If radiation was not part of your original treatment when lumpectomy was performed, then another lumpectomy followed by radiation may be recommended. If there is not adequate breast volume remaining for lumpectomy, mastectomy may be recommended. Depending on the medical oncologists evaluation, which is based on the prognostic factors of the tumor, he or she may recommend chemotherapy and/or hormonal therapy.;

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    Coping With Recurrent Cancer

    You may have many of the same feelings as when you were first diagnosed with cancer. Shock, disbelief, anxiety, fear, anger, grief, and a sense of loss of control are common emotions. All these feelings are normal responses to this difficult experience. Some people may even find this diagnosis more upsetting than the first one.

    Many people with recurrent cancer also experience self-doubt about their original treatment decisions or choices after treatment. Remember that you and your health care team based those treatment choices on the information available at the time. Neither you or your health care team could predict the future.

    Understandably, you may worry about having the strength to cope with another round of tests and treatments. But many people find that their previous experience better prepares them to face the challenges. For example, people with recurrent cancer have the following resources:

    • Knowledge about cancer, which helps reduce some fear and anxiety related to the unknown

    • Previous relationships with doctors, nurses, and clinic or hospital staff

    • An understanding of the medical system, commonly used words, and health insurance

    • Knowledge of cancer treatments and their side effects, as well as strategies to manage side effects

    • Where to go for support, including family and friends, support groups, and professionals trained in providing emotional support

    • Experience practicing stress-reducing methods, such as exercise, meditation, or spending time with friends

    How Long After Breast Cancer Treatment Do Recurrences Occur

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    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;

    • Spine
    • Pelvis
    • The long bones of the arms and legs

    Symptoms and Detection;


    Liver Metastases;

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    Cancers Linked To Radiation Treatment

    Lung cancer:;The risk of lung cancer is higher in women who had radiation therapy after a mastectomy as part of their treatment. The risk is even higher in women who smoke. The risk does not seem to be increased in women who have radiation therapy to the breast after a lumpectomy.

    Sarcoma: Radiation therapy to the breast also increases the risk of sarcomas of blood vessels , bone , and other connective tissues in areas that were treated. Overall, this risk is low.

    Certain blood cancers: Breast radiation is linked to a higher risk of leukemia and myelodysplastic syndrome . Overall, though, this risk is low.

    Breast Cancer Recurrence Many Years Later

    Lisa Schulmeister, MN, RN, ANCS-BC, OCN, FAANOncology Nursing News

    One of the great mysteries in oncology practice is the return of breast cancer many years after its initial diagnosis and treatment. And by many years, I mean 15 or even 20 years later, at a time when a woman least expects it to return.

    Lisa Schulmeister, RN, MN, APRN-BC, OCN®, FAAN

    Editor-in-Chief OncLive Nursing

    Oncology Nursing Consultant, Adjunct Assistant Professor of NursingLouisiana State Health Sciences Center in New Orleans, Louisiana

    One of the great mysteries in oncology practice is the return of breast cancer many years after its initial diagnosis and treatment. And by many years, I mean 15 or even 20 years later, at a time when a woman least expects it to return.

    Many women are shocked by a breast cancer recurrence, and often say, But I thought I was cured. Some of these women thought they were cured when they surpassed the 5-year mark and were even more confident that cancer would not recur when a decade had passed. However, we now know that cured is not the best word to use for breast canceror any other cancer for that matter, and instead we need to make note of the number of cancer-free years postdiagnosis.

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    Beyond The First 5 Years

    The risk of breast cancer recurrence is highest during the first 2 years after the initial diagnosis. As time passes, the risk of recurrence steadily decreases. Many survivors celebrate their 5-year cancer-free date because it is well known that the vast majority of patients who have not had a recurrence by that time have a relatively low risk of recurrence at all.

    A late recurrence of breast cancer is one that recurs after the 5-year milestone. Since the likelihood of recurrence is so low at this point, we must ask ourselves:

    • Who experiences a late recurrence?

    • What factors contribute to their risk?

    • Why do seemingly cured patients, like my mother, have to face their cancer again?

    Doctors, scientists, and researchers have identified factors that are related to the potential risks for late recurrence of breast cancer. Generally, these factors relate to the patients age, the cancers stage at diagnosis, hormone receptor status, genetic information, and lymph node involvement. Overall, the risk of a recurrence after 5 years is low, but breast cancer survivors with a higher risk of late recurrence are:

    • Survivors with the following receptor statuses

    • Estrogen receptor-positive tumor

  • Tumor larger than 2 centimeters

  • High number of involved lymph nodes

  • Postmenopausal survivors who are younger than 60 and had

  • Tumor larger than 2 cm

  • High number of involved lymph nodes

  • Postmenopausal women who are older than 60 and had

  • High number of involved lymph nodes

  • Why And How Cancer Recurs

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    Cancer recurs because small areas of cancer cells can remain in the body after treatment. Over time, these cells may multiply and grow large enough to cause symptoms or for tests to find them. When and where a cancer recurs depends on the type of cancer. Some cancers have an expected pattern of recurrence. A cancer may recur in the following ways:

    • In the same part of the body as the primary cancer, called a local recurrence

    • Near where the primary cancer was located, called a regional recurrence

    • In another part of the body, called a distant recurrence

    Recurrent cancer is named for the location where the primary cancer began, even if it recurs in another part of the body. For example, if breast cancer recurs distantly in the liver, it is still called breast cancer, not liver cancer. Doctors call it metastatic breast cancer. Metastatic means that the cancer has spread to another part of the body.

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    Can Breast Cancer Return After A Double Mastectomy

    During the course of breast cancer treatment, a woman may decide, after discussion with her doctors, to have both of her breasts removed.

    She might choose to have a double mastectomy in the hope that it will reduce the risk of breast cancer recurring in the remaining tissue or a new cancer developing in the opposite, unaffected breast.

    A woman who has had breast cancer does not inherently or automatically face an increased risk of being diagnosed with another type of cancer, says Ellis Levine, MD, Chief of Breast Medicine at Roswell Park Comprehensive Cancer Center.

    Unless they have an underlying hereditary genetic mutation, I do not consider them at exquisite risk to develop another type of cancer, he says. The cancer that is most often genetically linked to breast cancer is ovarian, due to mutations in the BRCA 1 or BRCA 2 genes.

    When mastectomies are performed, surgeons will remove as much of the cancerous tissue as possible. If a woman, in consultation with her doctors, decides to have a skin-sparing or nipple-sparing mastectomy, a small amount of healthy breast tissue may be left behind on the skin to allow for reconstruction of her breasts.

    Even if the full breast is removed, surgeons will not have removed 100% of the breast cells, explains Jessica Young, MD, a breast surgeon at Roswell Park. The risk of cancer recurring is lower if the whole breast is removed, but it is not zero percent.

    Breast Cancer Treatment

    Cancer Cells Can Hide

    There are a few theories that have been proposed to account for what seems to be a cancer cell’s ability to “hide” for an extended period of time. For example, 20% to 45% of estrogen-receptor-positive breast cancer recurrences occur years or even decades after cancer has been successfully treated.;

    • One theory is the idea of cancer stem cells, a subset of cancer cells.;These cells divide more slowly than regular cancer cells, which makes them more resistant to treatments such as chemotherapy. While cancer treatments may kill off many regular cells, stem cells could remain alive, ready to grow again.;
    • Another concept is dormancy. Sometimes cancer cells can lie dormant and, given the right circumstances, begin to grow again. These dormant cancer cells may remain inactive for long periods of time before entering a rapid growth phase.

    A strong immune system can help keep cancer cells dormant. If the immune system is not functioning well .

    Angiogenesis, which is the ability of a tumor to make blood vessels to feed it and allow it to grow, promotes cancer survival.

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    How Common Is Breast Cancer Recurrence

    Most local recurrences of breast cancer occur within five years of a lumpectomy. You can lower your risk by getting radiation therapy afterward. You have a 3% to 15% chance of breast cancer recurrence within 10 years with this combined treatment. Based on genetic testing, your provider may recommend additional treatments to further reduce your risk.

    Recurrence rates for people who have mastectomies vary:

    • There is a 6% chance of cancer returning within five years if the healthcare providers didnt find cancer in axillary lymph nodes during the original surgery.
    • There is a one in four chance of cancer recurrence if axillary lymph nodes are cancerous. This risk drops to 6% if you get radiation therapy after the mastectomy.

    Local And Regional Recurrence

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    Breast cancer that comes back in the treated breast, chest or scar is called a local recurrence. Having a local recurrence does not mean the cancer has spread.

    Breast cancer that comes back in the;lymph nodes;in the armpit, close to the breast bone, or lower neck, is called a regional recurrence. If cancer cells are blocking the lymph nodes in the armpit, fluid can build up in the arm and cause;lymphoedema.

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    Distant Breast Cancer Recurrence

    Distant breast cancer recurrence is when the cancer has spread to another organ within the body. Breast cancer that has spreadalso called metastatic breast canceris no longer curable and needs to be managed as a chronic disease. There are various treatment options to control the cancer and stop its progression, prolonging a patients life and improving quality of life. These treatments may include:

    • Chemotherapy
    • Small molecule inhibitors
    • Clinical trials

    Should I Have Regular Routine Scans Or Blood Tests To Check For Distant Breast Cancer Recurrence

    No. Routine scans to check for the presence of distant disease recurrence are not recommended in the absence of symptoms

    Given the ominous nature of stage 4 disease, the obvious question is, why dont we scan for spread regularly after a first diagnosis, so that we can detect it early if it does return? The reason we dont scan or test for metastasis is that there really is no early stage 4 disease, and thus no real opportunity to intervene earlier and increase the chance of cure. Its also important to know that with recurrence, one does not progress from one stage to the next: a woman who was originally diagnosed with stage 1 breast cancer does not recur as stage 2, because once cells have taken up residence elsewhere, she is immediately considered to have stage 4 disease. And with stage 4 disease, either you respond well to treatment and the disease regresses, or you dont and it doesnt. Studies have shown that getting frequent scans after a first cancer diagnosis does not lead to improved survival, which is why we dont scan for stage 4even if we wish we could.

    Current guidelines and evidence therefore recommend against routine CT or bone scans, or blood tests, to look for recurrence of cancer in patients who do not have any symptoms or other concerns that need to be followed up on.

    If you do have concerning symptoms , then you should bring them to the attention of your healthcare team to be checked out.

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    Treatment Of Local Recurrence After Previous Mastectomy

    Most commonly the lesion is removed surgically and followed by radiation to the chest wall if the woman has not previously had radiation Treatment of local recurrence after mastectomy can involve a variety of different approaches, including surgery to remove the recurrence if it is confined to a limited area. Other options for treatment include radiation, chemotherapy, and endocrine therapy, or a combination of these.

    Despite aggressive local treatment, many women with an isolated local recurrence following mastectomy eventually develop distant metastases. This is not because the local recurrence spreads, but rather because it is a sign that things have changed and dormant cells in other organs may also be waking up.

    Chemo Brain And Stress

    Breast Cancer Recurrence: It can be a threat to you

    Many people experience mental changes after chemotherapy treatment. This is sometimes called chemo brain. You may have problems such as poor memory, trouble finding words, difficulty focusing. This can affect parts of your life, including caring for your family and managing your job.

    Some things that help with chemo brain include keeping a calendar, writing everything down, and exercising your brain with puzzles and reading. Try to focus on 1 task at a time instead of more than 1 task. You can also work with an occupational therapist for cognitive behavioral rehabilitation. This is a treatment to help you if you have cognitive issues. Occupational therapists work in the Department of Rehabilitation Medicine, Occupational and Physical Therapy. For more information about cognitive behavioral rehabilitation, talk with your healthcare provider for a referral.

    Try to avoid having goals for yourself that are too high. This can add to your stress level and frustration. Most people say it takes 6 to 12 months after they finish chemotherapy before they truly feel like themselves again. Read the resource Managing Cognitive Changes: Information for Cancer Survivors for more information about managing chemo brain.

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