What Are The Signs That Breast Cancer Has Spread
The symptoms of MBC can vary, depending on where the cancer has spread.
- Breast cancer that has spread to the bones may cause pain, swelling, or bones that break or fracture easily.
- Lung cancer metastasized from the breast can cause shortness of breath, breathing difficulties, chronic cough, and chest pain.
- When breast cancer spreads to the liver, it can trigger abdominal pain, loss of appetite, nausea, unusually high levels of enzymes in the liver, and yellow skin due to jaundice.
- Brain or spinal tumors caused by breast cancer thats spread can lead to persistent headaches, blurred or double vision, nausea or vomiting, seizures, and behavioral changes.
Its important to keep in mind that while several nonspecific symptoms, such as fatigue, weight loss, and poor appetite, may be related to MBC, they can also be caused by other factors, like depression or medication.
If you have concerns about specific symptoms, talk with your doctor to make sure they arent related to MBC.
Treatment for stage 4 or metastatic breast cancer will depend on where it has spread. It will also vary depending on the following factors:
- the level of hormone receptors and/or HER2 in the tumor
- gene mutations in the tumor
- specific symptoms
- whether women are still menstruating
- overall health
For those with stage 4 breast cancer, the primary treatments are systemic or drug therapies. These options include chemotherapy, hormone therapy, immunotherapy, and targeted therapy, or some combination of the four.
How Can I Prevent Breast Cancer Recurrence
Healthcare providers dont know why some people experience breast cancer recurrence. A recurrence isnt your fault. You didnt do anything wrong to cause it or fail to do something more to prevent it.
Certain medications may reduce the risk of breast cancer recurrence in people who have early stage breast cancer. For estrogen-receptive breast cancer, hormonal therapies including tamoxifen or aromatase inhibitors block either the activity of estrogen or the bodys production of estrogen. Chemotherapy may also be recommended to reduce risk of breast cancer recurrence.
Early diagnosis may make it easier to treat a recurrence. Follow your healthcare providers recommendations for mammograms and other screenings. You should also perform regular breast self-exams. Get familiar with how your breasts look and feel so you can see your provider quickly if you notice changes. And remember that most breast changes occur for reasons other than cancer.
What Are The Breast Cancer Recurrence Statistics
Most of the time, local recurrences of breast cancer happen within the first five years after being diagnosed. After a mastectomy, when the lymph nodes have not been affected by cancer, the chance of local recurrence within the five-year period is only about six percent. If there was cancer in the lymph nodes at the time of the mastectomy, the risk increases to approximately 23% without radiation therapy after the surgery. Radiation can help decrease the risk to about 17%. It has also been shown that women that have tumors of 5cm have a 25% higher risk of having a recurrence after mastectomy.
For over 20 years, our team at Causenta has been using the latest, cutting-edge, non-toxic therapies to work with patients that have been diagnosed with breast cancer or breast cancer recurrence after mastectomy. Our oncologists work closely with naturopaths and physical therapists to provide an individualized cancer treatment plan for each patient. Patients from all over the world are finding relief as they work with our experienced team at Causenta. Is Causenta is right for you? Contact us today to schedule a free 30-minute consultation.
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.
Cancer Beyond The Breast Area
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:
- the chest wall
- 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.
Don’t Miss: When Is Chemotherapy Used For Breast Cancer
Local Recurrence After 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 and/or HER2-targeted therapy.
Recurrence Can Mean Different Things
For some women, a recurrence can be metastatic â the cancer has come back not in the breast , but elsewhere in the body as well. Thatâs a much more serious situation . Or, it may have come back much as the first time you were diagnosed, as a ânewâ 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.
âWhether itâs a recurrence of the original cancer or a new primary cancer in the other breast, in both cases we assume weâre dealing with a curable situation, and we attempt to think about those patients as we would anyone with a new presentation,â 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.
âThat woman will not only undergo surgery, but may well receive additional therapy that doesnât ignore the fact that she had a previous cancer, but recognizes that seven years out, her prognosis from the first cancer is excellent,â says Eric Winer, MD, director of the Breast Program at the Dana-Farber Cancer Institute in Boston.
Also Check: Where Is Breast Cancer Found
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
Circulating Tumor Cells At 5 Years Post
In addition, liquid biopsy for the presence of circulating tumor cells at five years post-diagnosis may also help predict late recurrence.
In a 2018 study published in the Journal of the American Medical Association , women who had cancer cells in their blood five years after diagnosis were roughly 13 times more likely to experience a recurrence as those who did not. The finding was significant only for women who had estrogen receptor-positive tumors, and none of the women who had circulating tumor cells in their blood but estrogen receptor-negative tumors experienced a recurrence.
Using liquid biopsies to predict recurrence is still in the investigational stage and not currently used when making decisions on whether or not hormonal therapy should be continued beyond five years.
That said, these findings, along with molecular subtyping offers hopes that doctors will be better able to predict who should receive extended hormonal therapy in the future.
Treatment Type And Breast Cancer Survival
Overall survival is the same for lumpectomy plus radiation therapy and mastectomy. This means both treatments lower the risk of dying by the same amount.
For a summary of research studies on lumpectomy plus radiation therapy and mastectomy in the treatment of early breast cancer, visit the Breast Cancer Research Studies section.
How Is A Local Breast Cancer Recurrence Or Metastasis Found
Breast cancer that recurs at the original site is called a local recurrence. Breast cancer that returns and spreads to other parts of the body is called a distant recurrence . This is metastatic breast cancer and may also be called stage IV or advanced breast cancer.
A local recurrence is usually found on a mammogram, during a physical exam by a health care provider or when you notice a change in or around the breast or underarm.
Metastasis is usually found when new and persistent symptoms are reported to a health care provider and follow-up tests are done.
If you have a local recurrence or metastasis, its not your fault. You did nothing to cause it.
Learn about follow-up care after breast cancer treatment.
Recommended Reading: Where To Find Breast Cancer Lumps
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.
What Are The Chances Of Breast Cancer Returning
Each persons risk of breast cancer recurrence is different and depends on many factors, such as the size, type, grade and features of the cancer and whether the lymph nodes were affected.
Your treatment team can tell you more about your individual risk of recurrence if you want to know this.
The risk of breast cancer recurring is higher in the first few years and reduces as time goes on.
However, recurrence can happen even many years after treatment, which is why its important to be breast and body aware, and report any changes to your treatment team or GP.
In the UK, the number of people surviving breast cancer has risen greatly over the past decade and most people diagnosed with primary breast cancer will not have a recurrence.
Read Also: How To Know If Breast Cancer Spread
How Is The Risk Of Recurrence Determined
Doctors determine a womans risk of recurrence after breast cancer surgery based on various clinical criteria:
- Involvement of lymph nodes: Has the cancer spread to lymph nodes? If so, how many lymph nodes?
- Hormone sensitivity: Does the tumor have receptors for hormones such as estrogen and progesterone ?
- Grade of differentiation: How different are the tumor cells to normal breast cells?
- Size of the tumor: How big is the tumor?
- Speed of tumor growth: How fast did the tumor cells grow ?
- Growth factors: Does the tumor have a lot of receptors for certain growth factors ?
- Age: How old is the woman? Has she already reached menopause?
A lot of these clinical criteria are determined based on a tissue sample taken from the tumor during surgery.
Doctors use special tables to help them estimate the risk of recurrence.
The risk of recurrence is a measure of how likely it is that a woman will get cancer again. Its not possible to predict whether the cancer will return in a particular woman.
In some women it also makes sense to do an oncotype DX test. This involves looking at other biological characteristics of the tumor in a laboratory.
How Long Before Recurrence Is Off The Table
Recurrence is a risk for up to 32 years after a first diagnosis of breast cancer, according to a recent study. Your risk of recurrence after 10 years of remission depends on a number of things like:
- The size of the tumor
- The number of lymph nodes with cancer
- Whether cancer is estrogen receptor-positive
In general, once you have a breast cancer diagnosis, even if you are years in remission, its a good idea to be watchful and consult your doctor for regular breast exams and other screenings they think are appropriate. Early detection is the best way to get the best outcome from treatment. Talk to your doctor about the best schedule of checkups for you.
Coping With Worries About Recurrence
Nearly everyone who has been treated for cancer worries about it coming back.
At first, every ache or pain can frighten you. But, as time passes, you may come to accept minor symptoms for what they are in most cases warning signs of a cold or flu or the result of over-exerting yourself.
Some events may be particularly stressful the days or weeks leading up to your check-ups, the discovery that a friend or relative has been diagnosed with cancer or the news that someone you met while having treatment is ill again or has died.
We all cope with such anxieties in our own way and there are no easy answers. But keeping quiet about them and not wanting to bother anyone is probably not the best approach.
Just as talking about your diagnosis and treatment may have helped you through the early days, talking about your fears relating to recurrence may help you later on.
Breast Cancer Nows Forum lets you share your worries with other people in a similar situation to you.
Risk Factors For Overall Recurrence
There are several risk factors that raise the risk of recurrence overall . These include:
- Tumor size: Larger tumors are more likely to recur than smaller ones both early and late.
- Positive lymph nodes: Tumors that have spread to lymph nodes are more likely to recur at any time than those that have not.
- Age at diagnosis: Breast cancer recurrence is more common in younger people.
- Treatments received and response to treatments: Both chemotherapy and hormonal therapy reduce the risk of recurrence in the first five years.
- Tumor grade: More aggressive tumors are more likely to recur than less aggressive tumors , especially in the first five years
There are also factors that do not appear to affect the risk of recurrence. Recurrence rates are the same for women who have a mastectomy or lumpectomy with radiation and are also the same for women who have a single vs. double mastectomy.
Also Check: How Many Cases Of Breast Cancer Per Year
What Questions Should I Ask My Healthcare Provider
You may want to ask your provider:
- What type of breast cancer recurrence do I have?
- Has the cancer spread outside the breast?
- What stage is the breast cancer?
- What is the best treatment for this type of breast cancer?
- What are the treatment risks and side effects?
- Should I look out for signs of complications?
A note from Cleveland Clinic
Most breast cancer recurrences respond well to treatments. You may be able to try new drugs or combination therapies in development in clinical trials. Your healthcare provider can discuss the best treatment option based on your unique situation.
Last reviewed by a Cleveland Clinic medical professional on 03/24/2021.