What Are The Types Of Breast Cancer Recurrence
If you develop cancer in the opposite, untreated breast , you receive a new breast cancer diagnosis. This isnt the same as breast cancer recurrence.
When breast cancer returns, it may be:
- Local: Cancer returns in the same breast or chest area as the original tumor.
- Regional: Cancer comes back near the original tumor, in lymph nodes in the armpit or collarbone area.
- Distant: Breast cancer spreads away from the original tumor to the lungs, bones, brain or other parts of the body. This is metastatic cancer, often referred to as stage 4 breast cancer.
Breast Cancer Recurrence: What And Why
When breast cancer comes backs, it is called recurrence. While those who have a recurrence are not in the majority, they are certainly not a rarity or an impossibility. Recurrences typically happen within the first five years after treatment but can occur at any time and have a few ways of returning. To help ease some of the worries of these first few cancer-free years, we want to give some clarity and explanation into what breast cancer recurrence is and what to look for.
Treatment For Locally Advanced Breast Cancer
Treatment for locally advance breast cancer is likely to include a treatment that affects the whole body .
This might be chemotherapy, hormone therapy or targeted therapy.
Chemotherapy
If you have previously had chemotherapy, you may be offered different chemotherapy drugs this time.
Hormone therapy
If the cancer is oestrogen receptor positive you may be offered hormone therapy.
If you were already taking hormone therapy when your cancer returned, your doctor may consider switching you to a different drug.
Targeted therapy
Targeted therapies are a group of drugs that block the growth and spread of cancer.
The most widely used targeted therapies are for HER2 positive breast cancer. However, other targeted therapies are available to treat locally advanced breast cancer that is HER2 negative.
Radiotherapy and surgery
You may be offered radiotherapy if cancer cells are found in the lymph nodes above or below the collarbone, under the breastbone or between the ribs. Its not usually possible to remove the cancer using surgery in this situation.
If the recurrence has affected the muscles on the chest wall, surgery may be offered as well as radiotherapy.
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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.
Supplements Linked With Increased Breast Cancer Recurrence
Related tags:Cancer, Antioxidants, omega-3, Iron,
This study, published in the Journal of Clinical Oncology, confirms previous medical guidance advising cautious use of any supplements, other than a multivitamin, for cancer patients undergoing chemotherapy.
Some evidence suggests antioxidants could interfere with the cancer-killing effects of chemotherapy because these chemical treatments cause oxidative stress, a chemically-triggered reaction in the body, which in turn kills cancer cells but antioxidants fight oxidative stress. While other researchers have found quite the opposite and suggested antioxidants could help the chemotherapy process.
What makes the recent study unique is that it is the first investigation of the effects of supplement use during breast cancer treatment, and only the second to investigate the effects of supplement use during any kind of cancer treatment. The first was conducted by Charles Fuchs, MD, MPH, the director of Yale Cancer Center, who found that vitamin C may be helpful for people undergoing chemotherapy treatment for colorectal cancer.
Lead researcher Christine Ambrosone, Ph.D., chair of the department of cancer prevention and control at Roswell Park, says: “Although this is an observational study and the number of users of supplements was fairly small, the results are compelling.
SWOG is a cancer clinical trials network funded by the National Cancer Institute through the National Institutes of Health.
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Breast Cancer Is A Heterogeneous Disease
Based on the presence or absence of the oestrogen receptor and progesterone receptor , and the expression and amplification of the human epidermal growth factor receptor type 2 , breast cancer can be divided into three clinical subtypes: hormone-receptor -positive , HER2-positive and triple-negative ., In the United States, 71% of breast cancers are HR+, 17% are HER2+ and 12% are TN. Following the discovery of five intrinsic molecular subgroups of the disease based on a 50-gene expression classifier luminal A, luminal B, HER2-enriched, basal-like and normal-likeit became apparent that a large degree of unappreciated molecular heterogeneity exists across and within each subtype of breast cancer. While TN and HER2+ patients often present with basal-like and HER2-enriched cancers, respectively, HR+ women are usually diagnosed with luminal A or luminal B tumours. However, despite sharing some common traits, luminal A cancers are generally ER+, PR high and Ki67 low, resulting in low-grade, slow-proliferating neoplasms, whereas luminal B tumours are typically ER+, PR variable and Ki67 variable, translating into more aggressive cancers with a higher proliferative rate.
Screening: A Preventive Measure For Cancer
Cancer detected at an early stage gives the best chance of survival. But when management is delayed, patients are more likely to face greater problems and higher costs of care.
If cancer is in your genes, or if you have a risk for certain type of malignancy, its best to do regular screening, advises Dr. Ladera. Screening and detecting cancer at the earliest stage offers your best chance for cure.
Compared to early diagnosis, screening is a totally different strategy that checks on illnesses that might be present, even if one is presumed healthy.
There are three Rs that need to be assed when doing cancer screening: risk factors, recommendations and rationale.
Unfortunately, many patients overlook the cancer screening process due to multiple factors.
Some are worried that they might test positive for cancer, others fear the procedure itself, some are unaware of where to go and how to book a screening schedule, and to a huge chunk of patients, they view screenings and checkups as another financial burden for their families.
The PGH Cancer Institute shared that pre-pandemic, the hospital would cater to an average of 120 patients daily. But in 2020 onwards, an average of 20 percent of cancer patients have not returned for their regular treatments, and some have already relapsed.
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How Is A Local Recurrence Or Metastasis Found
Breast cancer can recur at the original site . It can also return and spread to other parts of the body .
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 symptoms are reported to a provider.
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.
Symptoms Of Skin Metastases
Symptoms of skin metastases include:
- a change in the colour of the skin
- a lasting rash
- a firm, painless nodule or a number of nodules of different sizes
Sometimes the symptoms of skin metastases, such as redness and inflammation, may look like an infection of the skin called cellulitis.
Skin metastases can also cause lymphoedema, which is swelling of the arm, hand or breast area.
Other possible symptoms include:
- odour
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What Are Skin Metastases
Skin metastases are secondary breast cancers that form on or just below the skin.
Secondary breast cancer happens when cancer cells spread from the breast to other parts of the body. Sometimes breast cancer cells can spread to the skin. This can happen through the blood or lymphatic system.
The most common sites affected are the areas near where the original breast cancer was for example the skin of the chest wall or around the surgical scar. Less commonly, skin metastases can occur on other areas of skin, such as on the scalp, neck, abdomen, back and upper limbs.
About a fifth of people with secondary breast cancer will develop skin metastases.
This is not the same as having cancer that starts in the skin. The cells that have spread to the skin are breast cancer cells.
Its also different to local recurrence, which is when primary breast cancer has come back in the chest or breast area, or in the skin near the original site or scar.
Second Primary Tumors By Age At Diagnosis
We next analyzed risks for second primary breast cancers according to HR status and age at first cancer diagnosis . For women with a first HR-positive tumor, there was an inverse trend with age at diagnosis, with risk of any second primary cancer highest when cancer was first diagnosed before age 30 years , declining statistically significantly for age 3039 years and dropping to SIRs between 1.0 and 3.0 thereafter. This trend by age was observed irrespective of HR status of the second tumor.
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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.
Making Treatment Choices For Recurrent Cancer
If testing confirms that you have a recurrent cancer, your health care team will talk with you about your treatment options. This process is similar to planning treatment for a primary cancer. Your doctor will consider the following factors:
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Your personal goals for treatment
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The type of cancer, where in the body it came back, and the size
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Your overall health
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The type of treatment you originally received and how well it worked
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Side effects you experienced with the original treatment
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How long it has been since finishing treatment
Your doctor may also suggest a clinical trial. When deciding among treatments, it is important to consider the following:
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The goals and expected benefits of each treatment
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The possible risks and side effects
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How each treatment could affect your quality of life
During treatment, relieving symptoms and side effects remains an important part of your care. This may also be called palliative care or supportive care. Talk with your health care team about your symptoms, including any new symptoms or a change in symptoms.
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Ten Lifestyle Changes That May Help
All breast cancer survivors live with the concern about a recurrence or a new cancer. This fear is usually the biggest worry of all. Many women feel that their body has betrayed them and therefore it takes time to trust it again.
Learning how to cope with fears of recurrence is important. Though your body has gone through many changes as a result of a cancer diagnosis and treatment, most women become healthy, strong and optimistic once again.
Minimize The Risk Of Second Cancers
Keep Track of Your Health Care
- Keep a health journal.
- Write down everything you want to ask your health care team. Take notes and keep track of questions between visits.
- Make a list of your medications. Bring this information to the visit along with all of your medication bottles. This will help the health care team keep track of all the medications you are taking, including vitamins and over-the-counter medications.
- Take notes during health care appointments.
- Keep all of your health records together and bring this information with you to health care appointments.
- Bring extra copies of important documents to give to appropriate health care team members. You can also fax or mail these before your appointment. Having the health care team read your documents may be an easier way for you to communicate.
- Store pamphlets, information about medication side effects and important phone numbers in your notebook so that everything is in one place.
One of the most important things you can do is to follow-up with a health care team that is well-informed about survivorship care. Good medical care and screening can help detect second cancers early.
Also:
- Try to find balance with a healthy lifestyle.
- Know if your family has a history of cancer.
- Use a health journal to prepare for your next visit with a member of your health care team.
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Locally Advanced Breast Cancer
If breast cancer has spread to the chest wall or skin of the breast, or the lymph nodes around the chest, neck and under the breast bone, but has not spread to other areas of the body, its called locally advanced breast cancer. Sometimes breast cancer is locally advanced when it is first diagnosed.
People who have locally advanced breast cancer are thought to have an increased risk of cancer cells spreading to other areas of the body, compared to those with stage 1 or 2 breast cancers.
What Is A Gene
Each persons DNA contains the code used to build the human body and keep it functioning. Genes are the small sections of DNA that code for individual traits. For example, someone with naturally red hair has a gene that causes his or her hair to be red.
All inherited traits are passed down through genes. Each person has two copies of every gene: one gene from each parent. Since each parent passes down exactly half of their genes to each child, any of the parents genetic traits has a 50% chance of being passed on to their offspring.
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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
The Wide Window Of Relapse In Breast Cancer
In contrast with other solid tumours in which metastatic recurrence can occur within a few weeks or a few years following diagnosis, breast cancer is characterised by a wide window of relapse, spanning months to decades after surgery. The basis of this peculiar pattern of recurrence is still elusive, but is likely to be linked to the aforementioned molecular differences underlying each subgroup, with basal-like and HER2-enriched patients experiencing early relapses , as opposed to patients with luminal cancers characterised by a more favourable prognosis.,, Nonetheless, patients with luminal B tumours tend to have shorter survival times than luminal A patients. In addition to the contribution of the molecular subtype of the primary tumour, the risk and timing of recurrence is also influenced by other tumour-related factors that constitute the pillars of the TNM classification system: tumour size and spread , regional lymph node involvement and the presence of distant metastasis . Based on the premise that the chance of survival is intimately linked to the anatomic extent of the disease, the TNM staging system stratifies cancer patients at diagnosis into four stageswith patients with Stage I disease having a much better prognosis as opposed to patients with Stage IV diseasethus representing the gold standard tool for prognostication.
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What Is The Treatment
Once you notice that you have recurrent breast cancer symptoms, itâs time to start thinking about recurrent breast cancer treatment. The type of treatment youâll receive will depend upon what type of treatment you initially had.
You may have had a lumpectomy to remove abnormal breast tissue from your chest. If you have a local recurrence after a lumpectomy, youâll have a mastectomy. This procedure surgically removes the entire breast and sometimes some of the surrounding tissue as well.
Some doctors will perform a mastectomy right away. If you have recurrence near this area youâll have the tumor surgically removed. Often times, this surgery is followed by a course of radiation.
Regardless of whether youâve had a lumpectomy or a mastectomy, you will probably have either radiation, hormone therapy, or chemotherapy after your second surgery. In some circumstances, your doctor will use a combination of these things to treat you with.
When breast cancer is found in your other breast, it may be a new tumor that is in no way related to your first bout with breast cancer. In this case, breast cancer treatment is conducted as though youâve developed a whole new case of cancer. You will get either a lumpectomy or a mastectomy, followed by more treatment if your doctor feels that itâs necessary.