How Is A Local Recurrence After Lumpectomy Diagnosed
After a diagnosis of early stage breast cancer, any remaining breast tissue should be evaluated annually with scans .
Most local recurrences within the breast after lumpectomy are detected on routine annual breast imaging, which usually takes the form of mammography and ultrasound, and on occasions MRI.
If you have a local recurrence or new primary breast cancer, you may find symptoms similar to an initial breast cancer. This includes:
- A new lump in the breast, armpit area or around the collarbone
- A change in breast size or shape
- Changes to the nipple, such as sores or crusting, an ulcer or inverted nipple
- Clear or bloody nipple discharge
- Changes to the skin including redness, puckering or dimpling
- Breast tenderness or pain
Once a local recurrence has been diagnosed, we do tests to see whether there are signs of cancer elsewhere in the body. These may include a chest X-ray, CT scan, bone scan or PET scan, and blood tests , then we have to figure out how best to treat the tumour in the breast. Usually in these cases we do a mastectomy, as the prior less drastic surgery and radiation didnt take care of it.
Findings From A Sentinel Node Biopsy
Lymph node status shows whether or not breast cancer has spread to the axillary lymph nodes.
- Lymph node-negative means none of the sentinel nodes contain cancer. So, its unlikely other lymph nodes have cancer. Surgery to remove more lymph nodes wont be needed.
- Lymph node-positive means at least one sentinel node contains cancer. More lymph nodes may be removed with a procedure called axillary dissection. The goals of axillary dissection are to check how many lymph nodes have cancer and to reduce the chances of cancer returning in the lymph nodes.
How Is Oral Cancer Treated
Oral cancer is highly treatable when detected early. Surgery and radiation therapy are the most often used treatment methods. More advanced malignancies are often treated with a combination of various therapy methods.
- Surgically, the abnormal mass in the oral cavity is removed along with a small portion of healthy tissue surrounding the tumor.
- Surgical reconstruction of the mouth after clinical therapy or removal of oral malignancies that have spread to other parts of the body, such as the neck, may be necessary.
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What Is A 5
A relative survival rate compares women with the same type and stage of breast cancer to women in the overall population. For example, if the 5-year relative survival rate for a specific stage of breast cancer is 70%, it means that women who have that cancer are, on average, about 70% as likely as women who dont have that cancer to live for at least 5 years after being diagnosed.
Testing Lymph Nodes For Cancer
A swollen lymph node can be felt with your fingertips and sometimes, and if large enough, can be seen. However, there are other areas of the body where lymph nodes are more difficult to find and dont present symptoms on the surface. The only way to confirm a cancer diagnosis in the lymph nodes is through a biopsy.
A biopsy is performed by using a long, thin needle to remove part of the lymph nodes or lymphatic tissue and reviewing it under a microscope to see if there are cancerous cells. The number of cancer cells will determine the course of treatment. There are additional tests to also determine how far cancer has spread and the cancer stage. All of this plays a part in the type, frequency, and outlook of treatment.
If you are wondering, is cancer of the lymph nodes terminal, understand that cancer spreadto the lymph nodes does not automatically determine which stage its in.3 Typically, if its traveled far from its originating tumor source, it could indicate a later stage, though there are several tests that can be performed to get a clearer picture. These include:
Not all of these tests are necessary to confirm cancer staging, but they each help deliver more information to make an accurate diagnosis. Furthermore, cancer staging is assigned at the time of diagnosis but can be restaged following treatment. This is based on if cancer has stopped its growth or metastasized to other areas of the body.
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Axillary Lymph Node Dissection
In this procedure, anywhere from about 10 to 40 lymph nodes are removed from the area under the arm and checked for cancer spread. ALND is usually done at the same time as a mastectomy or breast-conserving surgery , but it can be done in a second operation. ALND may be needed:
- If a previous SLNB has shown 3 or more of the underarm lymph nodes have cancer cells
- If swollen underarm or collarbone lymph nodes can be felt before surgery or seen on imaging tests and a FNA or core needle biopsy shows cancer
- If the cancer has grown large enough to extend outside the lymph node
- If the SLNB is positive for cancer cells after chemotherapy was given to shrink the tumor before surgery
What Are The Signs And Symptoms Of Breast Cancer
The signs and symptoms of breast cancer include:
- A new lump or thickening in or near the breast or in the armpit.
- A change in the size or shape of the breast.
- A dimple or puckering in the skin of the breast. It may look like the skin of an orange.
- A nipple turned inward into the breast.
- Nipple discharge other than breast milk. The discharge might happen suddenly, be bloody, or happen in only one breast.
- Scaly, red, or swollen skin in the nipple area or the breast
- Pain in any area of the breast.
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Can Breast Cancer Be Prevented
You may be able to help prevent breast cancer by making healthy lifestyle changes such as:
- Staying at a healthy weight
- Limiting alcohol use
- Limiting your exposure to estrogen by
- Breastfeeding your babies if you can
- Limiting hormone therapy
If you are at high risk, your health care provider may suggest that you take certain medicines to lower the risk. Some women at very high risk may decide to get a mastectomy to prevent breast cancer.
It’s also important to get regular mammograms. They may be able to identify breast cancer in the early stages, when it is easier to treat.
NIH: National Cancer Institute
Signs Breast Cancer Has Spread
Unfortunately, breast cancer spreads silently, so you wont know if its started spreading until you show signs or symptoms in the affected part of your body where its traveled.
For example, if your cancer has traveled to your lungs, you may experience consistent coughing, wheezing, shortness of breath or pain in your affected lung. If its spread to your bones, you may experience discomfort similar to arthritis in your hip or back. You may also experience an increase in bone fractures resulting from minor falls, or a sudden loss of appetite or weight.
If youre experiencing symptoms of metastasis or youre worried your breast cancer has spread to other areas of your body, you should notify your healthcare provider who can determine whether or not your cancer has spread and the most effective treatment available.
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Can A Swollen Lymph Node Be A Sign Of Cancer
Swollen or enlarged lymph nodes arent always a sign of cancer, but you should seek medical attention if symptoms persist or appear unusual. Your doctor may examine your medical history, perform a lymph node biopsy, or conduct imaging studies such as a chest X-ray or CT scan to further determine the underlying causes.
About Metastatic Breast Cancer
Cancer begins when healthy cells change and grow out of control, forming a mass or sheet of cells called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread. When breast cancer is limited to the breast and/or nearby lymph node regions, it is called early stage or locally advanced. Read about these stages in a different guide on Cancer.Net. When breast cancer spreads to an area farther from where it started to another part of the body, doctors say that the cancer has metastasized. They call the area of spread a metastasis, or use the plural of metastases if the cancer has spread to more than 1 area. The disease is called metastatic breast cancer. Another name for metastatic breast cancer is “stage IV breast cancer if it has already spread beyond the breast and nearby lymph nodes at the time of diagnosis of the original cancer.
Doctors may also call metastatic breast cancer advanced breast cancer. However, this term should not be confused with locally advanced breast cancer, which is breast cancer that has spread to nearby tissues or lymph nodes but not to other parts of the body.
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What Are The Treatments For Breast Cancer
Treatments for breast cancer include:
- Surgery such as
- A mastectomy, which removes the whole breast
- A lumpectomy to remove the cancer and some normal tissue around it, but not the breast itself
What Does It Mean If Theres Cancer In My Lymph Node
If cancer is found in one or more lymph nodes, it could mean that more tests are needed to know how far the cancer has spread. This information is used to determine the stage of your cancer and the best treatment options.
For more information on staging, see Cancer Staging, or find your cancer type for more detailed information.
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Symptoms Of Metastatic Breast Cancer
The symptoms of metastatic breast cancer may be different than those of early-stage breast cancer, but not always. Sometimes, there are no symptoms at all.
Patients should always speak with a doctor if new signs or symptoms arise, but here are some of the most common signs of metastatic breast cancer:
- Bone pain or bone fractures due to tumor cells spreading to the bones or spinal cord
- Headaches or dizziness when cancer has spread to the brain
- Shortness of breath or chest pain, caused by lung cancer
- Jaundice or stomach swelling
The symptoms of breast cancer metastasis may also vary depending on where in the body the cancer has spread. For example:
- If the breast or chest wall is affected, symptoms may include pain, nipple discharge, or a lump or thickening in the breast or underarm.
- If the cancer has spread to bones, symptoms may include pain, fractures or decreased alertness due to high calcium levels.
- If the cancer has spread to the lungs, symptoms may include shortness of breath, difficulty breathing, coughing, chest pain or fatigue.
- If the cancer has spread to the liver, symptoms may include nausea, fatigue, swelling of the feet and hands or yellowing skin.
- If cancer has spread to the central nervous system, which includes the brain or spinal cord, symptoms may include pain, memory loss, headache, blurred or double vision, difficulty with and/or movement or seizures.
Diagnosing Metastatic Breast Cancer
Getting a clear picture of where breast cancer has spread is essential for creating a personalized treatment plan. Your care team will likely use a combination of the following tests and tools to diagnose both localized and advanced breast cancer:
Ultrasound exam: With this imaging technique, sound waves create a picture of internal areas of the body.
Magnetic resonance imaging : This procedure produces detailed images using magnetic fields and radio waves.
Blood chemistry studies: A blood sample is taken to measure the amounts of certain substances that are released by your organs and tissues. A higher or lower amount of a particular substance may be a sign of disease.
Biopsy: A biopsy is the removal of cells or tissues so a pathologist may view them through a microscope. Your original breast cancer diagnosis was likely confirmed with a biopsy.
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When Is Axillary Dissection Needed
Some women with 1-2 positive sentinel nodes who have a lumpectomy and will have whole breast radiation therapy may not need axillary dissection .
Most people with one or more positive sentinel nodes who have a mastectomy will need an axillary dissection or radiation therapy to the axillary lymph nodes .
If you have a positive sentinel lymph node, talk with your health care team about whether you need an axillary dissection.
Secondary Cancer In Distant Lymph Nodes
Cancer cells can break away from the primary cancer and travel through the lymphatic system to lymph nodes further away from where the cancer started. These are known as distant lymph nodes. If cancer cells settle in the distant lymph nodes, it is known as secondary or metastatic cancer.
When the cancer cells in the distant lymph nodes are examined under a microscope, they look like cells from the primary cancer. For example, when a lung cancer has spread to distant lymph nodes, the cancer cells look like lung cancer cells.
The aim of treatment in this situation is usually to destroy as many cancer cells as possible. This can help control the cancer.
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What Happens When Breast Cancer Spreads
Breast cancer can spread to other parts of the body. This happens primarily through the lymph nodes, and a much smaller portion through the blood vessels. Here is a discussion of the role of the lymphatic system in breast cancer.
For a quick refresher, lymph nodes are kidney bean shaped organs that are scattered all over the body, but have 5 concentrated areas, one of which is the underarms. The lymph nodes in the underarms primarily take care of the breast and arm on the same side. They help to stimulate your immune system to fight off intruders. They also transport fighter cells to the bone marrow. When cancer cells are trapped in the lymph nodes, they may be destroyed by the immune system, or they may spread to other areas from there.
When there is breast cancer in your lymph nodes, you may not notice any symptoms at all. In fact, it is not until the lymph nodes are overloaded with cancer and swollen that you may notice a lump in the underarm or even swelling of the arm or breast on the same side.
Once breast cancer leaves the lymph nodes, it is considered metastatic, or stage IV.
There are times when breast cancer is metastatic, or spread to other organs, when it is first diagnosed. In these cases, breast cancer was not detected in the breast before it spread to other parts of the body.
When Cancer Goes Beyond Your Breast
If your doctor told you that your breast cancer has spread to other parts of your body, itâs at a more advanced stage than if itâs only in your breasts. How far it has spread is one of the things your doctor will consider when they tell you the âstageâ of your cancer. Itâs considered âmetastaticâ if it has spread far from your breasts. Every case is different. For some women, it becomes something they live with for a long time. For others, focusing on pain management and quality of life is the main goal.
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What Is The Prognosis For Invasive Ductal Carcinoma
Your doctor will discuss what you can expect based on the characteristics of the invasive ductal carcinoma and the effectiveness of your treatment.
Specialty centers such as Johns Hopkins Medicines Breast Health Services can offer integrated teams of breast cancer specialists who have skill and experience in surgery, breast reconstruction, chemotherapy, biologic targeted therapy, radiation therapy and other hormonal therapies.
Medical science is making great strides forward in treating breast cancer, allowing our surgeries to be less invasive and improving surgical outcomes and overall quality of life, Wright says.
Looking For More Of An Introduction
If you would like more of an introduction, explore these related items. Please note that these links will take you to other sections on Cancer.Net:
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ASCO AnswersFact Sheet: Read a 1-page fact sheet that offers an introduction to metastatic breast cancer. This free fact sheet is available as a PDF, so it is easy to print.
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ASCO AnswersGuide:Get this free 52-page booklet that helps you better understand breast cancer and its treatment options. The booklet is available as a PDF, so it is easy to print.
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