Treatment For Local Recurrence
Treatment for local recurrence will depend on a number of factors, including what treatments you have previously had.
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 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.
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.
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.
The most widely used targeted therapies are for HER2 positive breast cancer.
What Women Can Do Themselves
There are some things women can do themselves to lower their risk of late recurrence:
- Regular exercise is associated with a lower risk of death from breast cancer as well as death from all causes.
- It’s important for everyone to have their vitamin D level tested, although the role of vitamin D is still uncertain. Vitamin D deficiency is associated with bone loss, a concern for most people who have coped with breast cancer.
- Losing weight if you are overweight, or maintaining a healthy weight is important as well.
Risk Of Dcis Recurrence Following Lumpectomy
|0.3% or low risk||60% or high risk|
When a surgeon cuts around a tumor, he/she feels the lump and passes the scalpel somewhere outside the edge of the lump, cutting through the normal tissue. It is considered disadvantageous when this strip of normal tissue around the tumor is very narrow. A larger resection margin would mean that the scalpel cut was further away from tumor cells. When this margin is greater than 10 mm, the risk of recurrence of DCIS is greatly reduced, but when it is very small, often less than 1 mm, the risk of recurrence is quite high. Local recurrence of DCIS where the lesion is small, the resection margin large, and the histological type low to intermediate, can be as rare as 0.3 %.
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What Is A Breast Cancer Recurrence
Breast cancer recurrence means that the cancer was diagnosed when limited to the breast and/or armpit lymph nodes, then treated, and at some time later has come back.
This can occur in several ways:
- Local and/or regional recurrence: the breast cancer that was previously treated returns within the breast, chest wall or regional lymph nodes.
- New primary breast cancer: an unrelated new breast cancer occurs in one or the other breast. This actually isnt a local recurrence at allits a new cancer in the breast . This typically occurs many years after the original cancer and in an entirely different area of the breast. Its pathology is often different lobular instead of ductal, for example. Though they are often counted as recurrences in the statistics for breast conservation, they should be treated as completely new cancers, much as with new cancers in the opposite breast.
- Distant or systemic recurrence or metastasis is much more serious than local recurrence and is synonymous with stage 4 disease. For breast cancer patients, the most common areas of spread are the bone, liver, lungs and brain
Breast cancer recurrence occurs if:
- Cells from the original breast cancer diagnosis break away and hide nearby in the breast or spread elsewhere in the body
- Treatment, including surgery, chemotherapy, radiotherapy and/or hormone therapy have not gotten rid of all these cancer cells from the body.
Chest Wall Recurrence After Mastectomy
Oliver Eng, MD, is a double board-certified surgeon and surgical oncologist and an Assistant Professor of Surgery at the University of Chicago.
A chest wall recurrence is when breast cancer returns after receiving treatment. A chest wall recurrence may involve skin, muscle, and fascia beneath the site of the original breast tumor, as well as the lymph nodes.
When cancer recurs in the chest wall, it may be classified as local , regional or as a distant metastasis . In some cases, the term “locoregional” is used. This is a combination of “local” and “regional,” when recurrence affects either the preserved breast/chest wall or nearby lymph node areas.
If a chest wall recurrence is localized, it is referred to as a nonmetastatic breast cancer recurrence. Risk of recurrence can vary depending on several factors, including the type of breast cancer and types of treatment received.
This article will review symptoms and diagnosis of breast cancer recurrence, as well as potential treatment options and survival outlook with helpful coping tips.
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Why And How Cancer Recurs
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.
Introduction To Breast Cancer Recurrence
Breast cancer can recur at any time, but most recurrences occur in the first three to five years after initial treatment. Breast cancer can come back as a local recurrence or as a distant recurrence somewhere else in the body. The most common sites of recurrence include the lymph nodes, the bones, liver, or lungs.
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Type Of Breast Cancer
The type of breast cancer can affect the recurrence rate.
In a 2017 study, researchers found that people with estrogen-receptor positive breast cancer had a persistent risk of recurrence for at least 20 years after their original diagnosis.
According to Susan G. Komen, factors that influence recurrence can include:
- biology of the tumor
- treatment of the original tumor
- stage of the cancer at diagnosis
, treatment for recurrent local breast cancer depends on what treatment the person originally had.
If a person originally had a lumpectomy, a doctor may recommend a mastectomy.
If a person originally had a mastectomy, a doctor may try to remove the tumor and recommend radiation.
For either scenario, a doctor may also suggest hormone therapy, chemotherapy, or targeted therapy in addition to removing the tumor and using radiation therapy.
How Is Breast Cancer Recurrence Managed Or Treated
Your treatment depends on the type of cancer recurrence, as well as past treatments. If cancer develops in a reconstructed breast, your surgeon may want to remove the breast implant or skin flap.
Treatments for local and regional breast cancer recurrence may include:
- Mastectomy: Your surgeon removes the affected breast and sometimes lymph nodes.
- Chemotherapy:Chemotherapy circulates in blood, killing cancer cells.
- Hormone therapy:Tamoxifen and other hormone therapies treat cancers that thrive on estrogen .
- Immunotherapy:Immunotherapy engages your bodys immune system to fight cancer.
- Radiation therapy: High-energy X-ray beams damage and destroy cancer cells.
- Targeted therapy: Treatments target specific cancer cell genes or proteins.
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What Is Breast Cancer Recurrence
Its 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 woman who’s had breast cancer knows that recurrence is possible. Some may do a better job than others at keeping that worry at bay. But sometimes — such as at follow-up visits with the oncologist — it’s hard to avoid.
Treatment Of Recurrent Breast Cancer
For some women, breast cancer may come back after treatment sometimes years later. This is called a recurrence. Recurrence can be local , regional , or in a distant area. Cancer that is found in the opposite breast without any cancer elsewhere in the body is not a recurrenceit is a new cancer that requires its own treatment.
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Treatments And Recurrence: Early And Late
Treatments also play a role in both early and late recurrences. While chemotherapy can significantly reduce the risk of recurrence in the first five years, it has much less influence on the risk of late recurrence.
Hormonal therapy reduces the risk of recurrence in the first five years , but can also reduce the risk of late recurrences. It is this reduction in risk that has led to recommendations to extend hormonal therapy for people at high risk beyond five years.
Extending hormonal therapy from five years to 10 years has been shown to reduce the risk of late recurrence, but the risk of recurrence needs to be weighed against the side effects of continued therapy.
A 2019 study found that people with luminal A tumors continued to have significant benefit from tamoxifen therapy for 15 years post-diagnosis.
The addition of bisphosphonates to an aromatase inhibitor in post-menopausal women with early-stage breast cancer may improve survival, but it’s too early to determine the effect on late recurrences. Bisphosphonates reduce the risk of bone metastases, but the most common sites of distant late recurrence are the brain, liver, and lungs.
Local And Regional Recurrence
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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Can Breast Cancer Recurrence Happen After Mastectomy
Even though the whole breast is removed during a mastectomy, breast cancer can return to the chest region. This is known as local recurrence. It is also important to note that the more lymph nodes that were affected with cancer at the time of mastectomy, the higher the risk for having the cancer return. If the cancer returns, it is common to use radiation therapy to treat the cancer. Our doctors can help you determine the best options.
Changes To The Breast Or Chest Area
After breast-conserving surgery or a mastectomy, with or without reconstruction, be aware of any changes to either side, such as:
- swelling on your chest, in your armpit or around your collarbone
- a change in shape or size
- a change in skin texture, such as puckering or dimpling
- redness or a rash on or around the nipple or on the skin
- liquid that comes from the nipple without squeezing it
- the nipple has become inverted or looks different, for example changed its position or shape
- swelling in the arm or hand
- a lump or thickening that feels different
COVID-19 booster vaccinations
Some people report swelling in the armpit or to the lymph nodes under the arm after a COVID-19 booster vaccination. This seems to be more common with the Moderna booster vaccination. If you notice any swelling following your booster vaccination, it should disappear within about 10 days, if not, or you have any concerns, contact your GP or treatment team.
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Where Can I Get Support
Now that your breast cancer treatment is complete, youre likely experiencing a wide range of emotions. Before returning to your normal daily routine, its important to address these feelings.
Having a support group is important even after treatment. A support group can be a local group of people who meet in person or an online forum. Ask your doctor to refer you to one.
Treatment For Stage 3 Breast Cancer
Treatment for people with stage 3 breast cancer includes chemotherapy, surgery, and radiation. Typically, doctors administer the chemotherapy before performing the surgery in an attempt to shrink a tumor.
People with stage 3 breast cancer will probably need radiation therapy to kill off any remaining cancer cells. Doctors may also recommend hormone therapy, as well as additional targeted therapies, if necessary.
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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.
- The long bones of the arms and legs
Symptoms and Detection
Local Breast Cancer Recurrence
Breast cancer can return to the same area where it first appeared, Lange says. In this case, your doctor will base a treatment approach on how the first cancer was addressed.
If the original tumor was treated with lumpectomy and radiation, many patients may then need a bigger surgery, such as mastectomy, for the purpose of local control, she explains. If the original tumor was treated with mastectomy, then local resection of the recurrence should be considered. This is often followed by radiation therapy to the resection site.
Lange says an oncologist will evaluate a patient with recurrent breast cancer. Based on characteristics of the cancer cells and how they are behaving, the oncologist might recommend chemotherapy, hormonal therapy or a combination of treatments. For some patients, clinical trials of new therapies may be available.
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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
Keep Up With Your Health Screenings
After youâve finished your cancer treatments, you still need to go to your doctor for your follow-up screenings. Your health care team may meet with you every few months after your treatment. They do this so that they can keep a close eye on any changes that may show signs that your cancer has come back. After you reach 5 years since your last treatment, you may need to see your doctor only once a year.
If youâve had some of your breast removed as part of cancer treatment, you may need to get a mammogram, a scan that checks for breast cancer, every 6 to 12 months after treatment. You may need to continue the scans once a year after that. If you had both breasts removed, you may not need a mammogram.
Depending on the stage and type of cancer you had, the number of follow-ups may differ. Itâs important not to skip or miss your follow-ups as cancer is more likely to come back within 2 years after treatment.
During these visits, itâs a good time to ask your doctor any questions or concerns you may have about what to watch out for, treatment side-effects, or your overall health.
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