Intrinsic Subtypes And Late Recurrence
A number of different methods have been evaluated for the ability to predict late recurrence. Some of these include:
Higher expression of estrogen-responsive genes: A 2018 study found that people with ER+/HER2 negative breast cancers who had higher expression of estrogen-responsive genes and were not treated with extended hormonal therapy had a high risk of recurrence after five years.
Multigene assays: Several multigene assays may help predict late recurrence, but using this information to figure out when to extend hormonal therapy requires more research. A 2018 evaluation of an 18-gene, 10-year signature found that the information regarding prognosis was similar to other tests including Oncotype DX Recurrence Score, Prosigna PAM50 risk of recurrence score, Breast Cancer Index and IHC4.
What Are Metastatic And Recurrent Breast Cancer
Breast cancer occurs when abnormal cells grow out of control in one or both breasts.
- Metastatic breast cancer means that cancer has spread to other parts of the body.
- Recurrent breast cancer means that cancer has come back in or near the original site or in another part of the body.
For most women who have had breast cancer, their greatest fear is that the cancer will come back or spread. Finding out that this has happened can turn your world upside down. But there is hope. Some recurrent breast cancers can be successfully treated. Other recurrent breast cancers and metastatic breast cancer usually can’t be cured. But with treatment, some women live for many years.
What Are Risk Factors For Breast Cancer Recurrence
Anyone with a breast cancer diagnosis can have a recurrence. Your risk of cancer recurrence depends on several factors:
- Age: Women who develop breast cancer before age 35 are more likely to get breast cancer again.
- Cancer stage: Cancer stage at the time of diagnosis correlates with the risk of the cancer being able to recur. Several factors determine cancer stage: tumor size, cancer grade and cancer spread to lymph nodes or other parts of the body. Cancer grade indicates how unusual cancer cells look in comparison to healthy cells.
- Cancer type: Aggressive cancers like inflammatory breast cancer and triple-negative breast cancer are harder to treat. Theyre more likely to come back and spread.
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How Is It Treated
To plan your treatment, your doctor will consider where the cancer is and what type of treatment you had in the past. Your wishes and quality of life are also important factors. Treatment choices may include surgery, medicines like chemotherapy or hormone therapy, and radiation. Sometimes a mix of these treatments is used.
Treatments for breast cancer can cause side effects. Your doctor can tell you what problems to expect and help you find ways to manage them.
Your doctor may recommend that you join a clinical trial if one is available in your area. Clinical trials test new cancer treatments and may be the best choice for you.
If treatments don’t work, a time may come when the goal of your treatment shifts from trying to cure your cancer to keeping you as comfortable as possible. This can allow you to make the most of the time you have left.
What Is My Prognosis
This is a very common question that isnt always easy to answer. There are many factors involved in working out prognosis. Remember that a prognosis is just a figure at the point at which you receive it. For most people, the prognosis gets better with time.
Sometimes we use a five-year figure because we know that if cancer comes back, most of the time it comes back within five years. If the cancer has not come back within five years, then the chance of it coming back within ten years is quite low, and if it does not come back within ten years, then you have an almost normal life expectancy.
Its a bit like buying a second hand car. You dont really know how long its going to last, but if it lasts year after year without breaking down, then the car starts to look more and more reliable to make that long trip.
Working out prognosis can be difficult.
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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 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, 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 or a combination of these. Surgery and/or radiation might be used, too, but only in cases where the aim is relieving symptoms.
Expert
Cancers Can Become Resistant To Treatment
Sometimes cancer can become resistant to cancer drug treatment. Cancers develop from normal cells that have changed or mutated to become cancerous. The mutation happens in the genes of the cell. These gene changes make the cell behave differently to a normal cell. Cancer cells can continue to mutate so that they become more and more abnormal.
Some mutations can make the cells resistant to cancer drugs such as chemotherapy, targeted cancer drugs or hormone therapy. You can sometimes have a different type of treatment if this happens. But sometimes cancers develop resistance to many drugs at the same time. This is called multi drug resistance.
Scientists have found a group of genetic mutations that they think can cause drug resistance. These mutations mean that the cancer cell can keep the drugs out. The resistant cells have high levels of a substance called p-glycoprotein. P-glycoprotein is a protein found in cell walls. The protein acts as a pump and removes toxins from cells. Cells with high p-glycoprotein levels are very good at keeping cancer drugs out.
Researchers have been looking at drug resistance for almost as long as they have used cancer drugs. To make cancer drug treatment more effective, we need to find a way of overcoming resistance.
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What Is The Prognosis
Your prognosis will depend on many factors, including the grade and stage of your cancer, as well as your long-term care plans. Follow-up appointments and tests can help your doctor detect a recurrence of cancer or any other complications.
Like other cancers, ILC is staged on a 0 to 4 scale. Staging has to do with the size of the tumors, lymph node involvement, and whether tumors have spread to other areas of the body. Higher numbers represent more advanced stages.
Research shows that ILC often has a good prognosis because the cancer cells are generally low grade, and they respond well to hormone treatment.
This responsiveness to treatment is favorable to your prognosis. Most of these types of cancers are hormone receptor positive, usually estrogen positive. This means the cancer cells must have the hormone to grow. So medication that blocks the effects of estrogen can help prevent a return of disease and improve your prognosis.
However, ILC tumors can often spread aggressively. People diagnosed with ILC are on average 3 years older at diagnosis compared with those with IDC. ILC is also most often diagnosed at a more advanced stage.
Several studies demonstrate that the overall long-term outcome for people diagnosed with ILC may be similar to those diagnosed with other types of invasive breast cancer.
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 Recurrence
With mastectomy, the best predictor of local recurrence is whether the lymph nodes in the underarm area contain cancer.
The risk of recurrence is usually higher when there are more axillary lymph nodes with cancer than when there are few or no nodes with cancer .
- When the axillary nodes dont contain cancer, the chance of local recurrence in 5 years is about 6 percent .
- When the axillary nodes contain cancer, the chance of local recurrence in 5 years is about 23 percent following mastectomy without radiation therapy . Radiation therapy can reduce this risk to about 6 percent .
Learn more about breast cancer recurrence.
Take Care Of Your Emotional Needs
A breast cancer diagnosis can take quite a toll on your body, both physically and mentally. The treatments can affect each person differently. And the uncertainty that comes along with breast cancer may also affect your self-worth, identity, and your confidence.
After treatment, managing your new normal and coming to terms with all that has happened may feel challenging. Itâs important to take the time to heal and prioritize your overall emotional and mental health, in addition to your physical health.
- Make some time for self-care and put your needs first.
- Talk to a professional counselor or therapist if fears of breast cancer coming back start to interfere with your daily life.
- Connect with other people whoâve had breast cancer to gain a sense of community.
- Follow news on new treatments or findings.
- Practice mindfulness to reduce stress. Yoga, meditation, and other relaxation techniques can help you center yourself.
- Pick up a hobby that youâve enjoyed before, or explore new ones.
- Journal your feelings.
Keep in mind that if breast cancer does come back, it is not your fault and it can often be treated.
Johns Hopkins Medicine: âReducing Risk of Recurrence,â âEndocrine Therapy for Premenopausal Women,â âEndocrine Therapy for Postmenopausal Women,â âBreast Cancer Recurrence.â
Cleveland Clinic: â3 Reasons to Quit Smoking After a Cancer Diagnosis.â
American Lung Association: âTop Tips for Quitting Smoking.â
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Metastatic Breast Cancer Symptoms And Diagnosis
The symptoms of metastatic breast cancer can vary greatly depending on the location of the cancer. This section covers the symptoms of breast cancer that has spread to the bone, lung, brain, and liver, and the tests used to diagnose metastatic breast cancer.
Bone Metastasis: Symptoms and DiagnosisThe most common symptom of breast cancer that has spread to the bone is a sudden, noticeable new pain. Breast cancer can spread to any bone, but most often spreads to the ribs, spine, pelvis, or the long bones in the arms and legs. Learn more.
Lung Metastasis: Symptoms and DiagnosisWhen breast cancer moves into the lung, it often doesnt cause symptoms. If a lung metastasis does cause symptoms, they may include pain or discomfort in the lung, shortness of breath, persistent cough, and others. Learn more.
Brain Metastasis: Symptoms and DiagnosisSymptoms of breast cancer that has spread to the brain can include headache, changes in speech or vision, memory problems, and others. Learn more.
Liver Metastasis: Symptoms and DiagnosisWhen breast cancer spreads to the liver, it often doesnt cause symptoms. If a liver metastasis does cause symptoms, they can include pain or discomfort in the mid-section, fatigue and weakness, weight loss or poor appetite, fever, and others. Learn more.
Lisa Fought Breast Cancer For 8 Years Heres Her Story
In contrast to the common belief that surviving for five years after cancer treatment is equivalent to a cure, with hormone-sensitive breast tumors there is a steady rate of recurrence risk for at least 20 years after the original diagnosis, even with very small node-negative tumors.
Overall, the chance that an estrogen receptor-positive tumor will recur between five years and 20 years after diagnosis ranges from 10% to over 41%, and people with these tumors remain at risk for the remainder of their lives.
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 don’t understand this risk are often less likely to be supportive as you cope with the fear of recurrence.
While chemotherapy has little effect on the risk of late recurrence hormonal therapy does, and estimating this risk may help determine who should receive extended hormonal therapy . Finally, late recurrences can differ from early relapse with regard to sites of metastases and survival.
Factors such as initial tumor size, number of nodes involved, and receptor status play into the risk of late recurrence, but tumor biology appears to have the greatest effect, and research is actively looking for ways to look at gene expression and copy number to predict risk.
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Side Effects Of Treatment
Cancer and its treatments can be painful, but cancer pain can almost always be controlled. If you are having ongoing problems with managing pain, ask to see a pain specialist.
There are also many things you can do at home to help manage side effects of treatment. But talk to your doctor about any bothersome symptoms. Working together with your doctor can help you have the best possible quality of life.
You can find more information about treating breast cancer online at the:
- Canadian Cancer Society website at www.cancer.ca.
- U.S. National Cancer Institute website at www.cancer.gov.
Keep Up With Exercise
A recent study shows that if you regularly exercise even for at least 2.5 hours per week, you can improve your overall health. It may also lower the risk of your cancer coming back. Research also shows that if youâre overweight, cancer is more likely to come back. Physical activity can help you reduce or maintain your weight at a healthy range for your body type.
Exercise can include waking, running, cardio activities, strength training, and flexibility. Guidelines recommend:
- At least 150 minutes of moderate aerobic exercise per week or 75 minutes per week of harder physical activity like running.
- 2 days of muscle training with weights per week.
Thatâs a lot to do if youâre not active now. Take it one step at a time, starting with even a few minutes. Gradually, youâll be able to do more.
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Invasive Lobular Carcinoma Survival Rates
Survival rates for cancer are typically calculated in terms of how many people live at least 5 years after their diagnosis. The average 5-year survival rate for breast cancer is 90 percent, and the 10-year survival rate is 83 percent. This is an average of all stages and grades.
The stage of the cancer is important when considering survival rates. For instance, if the cancer is only in the breast, the 5-year rate of survival is 99 percent. If it has spread to the lymph nodes, the rate decreases to 85 percent.
Because there are many variables based on the type and spread of cancer, its best to talk with your doctor about what to expect.
Cancers Linked To Treatment With Tamoxifen
Taking tamoxifen lowers the chance of hormone receptor-positive breast cancer coming back. It also lowers the risk of a second breast cancer. Tamoxifen does, however, increase the risk for uterine cancer . Still, the overall risk of uterine cancer in most women taking tamoxifen is low, and studies have shown that the benefits of this drug in treating breast cancer are greater than the risk of a second cancer.
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What Are The Symptoms
The symptoms depend on where the cancer is and how large it is. The most common places for breast cancer to spread are within the breast or to the nearby chest wall or to the liver, lungs, or bones. Common symptoms include a lump in your breast or on your chest wall, bone pain, and shortness of breath.
Or you may not have any symptoms. Sometimes recurrent or metastatic breast cancer is found with an X-ray or a lab test.
Recurrence Can Mean Different Things
For some women, a recurrence can be metastatic — the cancer has come back not in the breast , but elsewhere in the body as well. That’s a much more serious situation . Or, it may have come back much as the first time you were diagnosed, as a “new” cancer, and is treated as such.
Be aware that many people talk about recurrence and metastasis in the same breath. But they are not the same thing. If you have had a local recurrence, when the cancer remains confined to your breast, the good news is that your prognosis is not necessarily any worse than it was the first time.
“Whether it’s a recurrence of the original cancer or a new primary cancer in the other breast, in both cases we assume we’re dealing with a curable situation, and we attempt to think about those patients as we would anyone with a new presentation,” says Clifford Hudis, MD, chief of the Breast Cancer Medicine Service at Memorial Sloan-Kettering Cancer Center in New York.
If, for example, you finished treatment for breast cancer seven or eight years ago, any recurrence or new cancer would be treated largely as an entirely new problem.
“That woman will not only undergo surgery, but may well receive additional therapy that doesn’t ignore the fact that she had a previous cancer, but recognizes that seven years out, her prognosis from the first cancer is excellent,” says Eric Winer, MD, director of the Breast Program at the Dana-Farber Cancer Institute in Boston.
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