What Are The Signs And Symptoms Of Local Recurrent Breast Cancer
Youll likely recognize the symptoms if you have a breast cancer relapse. They will be much the same as what you experienced with your original breast cancer diagnosis, with a few additional possible signs at the treatment areas:
- A new lump in the breast
- A new part of the breast that feels too firm
- Redness or swelling of the skin on your breast
- Abnormal changes to the nipple
- Pulling of the skin or swelling at the lumpectomy site
- Increased thickening on or near the mastectomy scar
Note that after a mastectomy and radiation, the entire area may be swollen and red for weeks or even months, so this may not be a recurrence sign. However, redness can also indicate infection, so its a good idea to get it checked out.
If you had a mastectomy and breast reconstruction, you might notice some lumps near the scar. These are caused by scar tissue or dead fat cells, and theyre harmless.
If symptoms arise, your clinician can monitor you by performing a clinical breast exam. They may also order an additional screening, such as an MRI.
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.
What Are The Signs Of Breast Cancer Recurrence
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
If your breast cancer has spread to other parts to the body, known as distant recurrence, there are a number of possible symptoms, including:
- Unexpected weight loss or change in appetite
- Severe or ongoing headaches
However, symptoms will vary depending on where the secondary cancer presents, and some primary and secondary cancers may not present any obvious symptoms. Sometimes recurrence is identified on a scan or blood test that was done for a reason other than breast cancer.
If you have any health concerns or symptoms that are new or persistent, speak with you GP or treating physician.
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What Is The Risk For Breast Cancer Recurrence
The risk of recurrence depends on the type of breast cancer and its stage. Timing matters, too: The highest risk of recurrence for breast cancer patients is during the first few years after treatment.
At the Johns Hopkins Breast Center, our team of breast cancer specialists monitors patients who are at risk of recurrence, Lange explains. The follow-up schedule depends on the stage of cancer, what kind of treatment has been received and prognostic factors. The risk of recurrence decreases as time goes on, but never gets down to zero.
Treating A Metastatic Recurrence
Many treatments exist for metastatic breast cancer. Your options will depend on where your cancer has spread. If one treatment doesn’t work or stops working, you may be able to try other treatments.
In general, the goal of treatment for metastatic breast cancer isn’t to cure the disease. Treatment may allow you to live longer and can help relieve symptoms the cancer is causing. Your doctor works to achieve a balance between controlling your symptoms while minimizing toxic effects from treatment. The aim is to help you live as well as possible for as long as possible.
Treatments may include:
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What Exactly Does Recurrence Mean
In simple terms, it means the return of the same cancer.
It could also mean the cancer has spread to other parts of the body. Doctors call this metastatic recurrence. This is generally more serious than a simple return of cancer cells to the breast itself, which is also a recurrence.
Though some people use recurrence and metastasis to mean the same thing, they are different. Recurrence is more general. It simply means that cancer has returned either as a metastasis or to the original breast. Metastasis is a specific type of recurrence. It means your original cancer has spread to other parts of your body.
Sometimes new cancer shows up in the opposite breast and nowhere else. Doctors consider this a new cancer diagnosis, not a recurrence.
Getting A Breast Biopsy
In a breast biopsy, the doctor takes out small pieces of breast tissue to check them for cancer cells. A biopsy is the only way to tell for sure if you have breast cancer.
There are many types of biopsies. Ask your doctor what kind you will need. Each type has risks and benefits. The choice of which type to use depends on your own case.
Sometimes, surgery is needed to take out all or part of the lump to find out if its cancer. This is often done in a hospital using local anesthesia . You might also be given medicine to make you sleepy.
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What About Other Treatments That I Hear About
When you have cancer you might hear about other ways to treat the cancer or treat your symptoms. These may not always be standard medical treatments. These treatments may be vitamins, herbs, special diets, and other things. You may wonder about these treatments.
Some of these are known to help, but many have not been tested. Some have been shown not to help. A few have even been found to be harmful. Talk to your doctor about anything youre thinking about using, whether its a vitamin, a diet, or anything else.
What Is Breast Cancer
Breast cancer is a type of cancer that starts in the breast. It starts when cells in the breast begin to grow out of control.
Breast cancer cells usually form a tumor that can often be seen on an x-ray or felt as a lump. Breast cancer is most common in women, but men can get breast cancer, too.
Breast cancer cells can spread to other parts of the body and grow there, too. When cancer cells do this, its called metastasis.
Cancer is always named based on the place where it starts. So even if breast cancer spreads to the bones , its still called breast cancer. Its not called bone cancer unless it starts from cells in the bone.
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Initial Abnormal Mammogram Results And Call
Following initial screening, a certain percentage of women may have a higher risk for breast cancer, even if the results are clear. In the case of high risk individuals follow-ups may be necessary more frequently.
These high risk factorsinclude:-
- Women with atypical ductal hyperplasia or lobular neoplasia. If biopsy shows either of these conditions, regular screening follow-ups are very important.
- A genetic predisposition for breast cancer. So, if a first or second degree family member has breast or ovarian cancer. Also, the risk increases if the family member has breast or ovarian cancer before the age of 40 years.
- If a molecular exam reveals a genetic predisposition for breast cancer. So, if a woman carries the BRCA1 and/or BRCA2 mutation the risk for breast cancer increases from between 40% to 80%. Specialists recommend follow-up mammograms every 6 months to a year.
Surgery For Breast Cancer
Most women with breast cancer have some type of surgery. Common types of breast surgery are lumpectomy, mastectomy, and taking out lymph nodes from the underarm. Women who have a mastectomy may also decide to have the breast shape rebuilt, either at the same time or later on.
Choosing between lumpectomy and mastectomy
Lumpectomy only takes out the lump and a little bit around it. It lets you keep most of your breast. The downside is that youll most likely need radiation treatment after surgery. But some women who have a mastectomy also need radiation afterward.
When choosing between a lumpectomy and mastectomy, be sure to get all the facts. At first you may think that a mastectomy is the best way to get it all out. Some women tend to choose mastectomy because of this. But in most cases, lumpectomy is just as good as mastectomy. Talk to your cancer care team. Learn as much as you can to make the right choice for you.
If you have a mastectomy, you may want to think about having your breast shape rebuilt. This is called breast reconstruction. Its not done to treat the cancer. Its done to build a breast shape that looks a lot like your natural breast.
If youre going to have a mastectomy and are thinking about having reconstruction, you should talk to a plastic surgeon before the mastectomy is done. Your breast can be rebuilt at the same time the mastectomy is done or later on.
Side effects of surgery
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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.
How Does The Doctor Know I Have Breast Cancer
A change seen on your mammogram may be the first sign of breast cancer. Or you may have found a lump or other change in your breast.
The doctor will ask you questions about your health and will do a physical exam. A breast exam is done to look for changes in the nipples or the skin of your breasts. The doctor will also check the lymph nodes under your arm and above your collarbone. Swollen or hard lymph nodes might mean breast cancer has spread there.
If signs are pointing to breast cancer, more tests will be done. Here are some of the tests you may need:
Mammogram: This is an x-ray of the breast. Mammograms are mostly used to find breast cancer early. But another mammogram might be done to look more closely at the breast problem you might have.
MRI scan: MRIs use radio waves and strong magnets instead of x-rays to make detailed pictures. MRIs can be used to learn more about the size of the cancer and look for other tumors in the breast.
Breast ultrasound: For this test, a small wand is moved around on your skin. It gives off sound waves and picks up the echoes as they bounce off tissues. The echoes are made into a picture that you can see on a computer screen. Ultrasound can help the doctor see if a lump is a fluid-filled cyst , or if it’s a tumor that could be cancer.
Nipple discharge exam: If you have fluid coming from your nipple, some of it may be sent to a lab. There, it will be checked to see if there are cancer cells in it.
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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.
What Is A Core
Core needle biopsy is the procedure to remove a small amount of suspicious tissue from the breast with a larger core needle. It is usually performed while the patient is under local anesthesia, meaning the breast is numbed. During the procedure, the doctor may insert a very small marker inside the breast to mark the location of the biopsy. If surgery is later required, the marker makes it easier for the surgeon to locate the abnormal area. Even if no further treatment such as surgery is needed, the marker allows a breast imaging radiologist to see on future mammograms where the biopsy was done.
The radiologist or surgeon performing the core-needle biopsy may use specialized imaging equipment to guide the needle to the desired site. As with fine-needle aspiration, this may involve ultrasound.
During an ultrasound-guided core needle biopsy, the patient lies down while the doctor holds the ultrasound against the breast to direct the needle. On the other hand, during a stereotactic-guided core-needle biopsy, the doctor uses x-ray equipment and a computer to guide the needle. Typically, the patient is positioned lying on the stomach on a special table that has an opening for the breast, and the breast is compressed, similar to a mammogram.
Occasionally, no imaging equipment is used, but this is typically only in cases where the lump can be felt through the skin. This type of procedure is called a freehand core-needle biopsy.
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Regional Breast Cancer Recurrence Can Cause A Lump Or Swelling In The Lymph Nodes
They are found in your underarms, neck, above your collarbone or around your breastbone. You may also experience pain, difficulty breathing or swallowing if the recurrence develops in your lungs or food pipe . If you have these symptoms, a physical examination, CT or MRI scan and biopsy will be able to give you a full diagnosis.
The Thresholds For Requesting Follow
It can be a challenge for radiologists to find a reasonable cutoff point in deciding whether a 6 month follow-up diagnostic mammogram is necessary. Secondly specialists must decide whether a biopsy is more appropriate, or not.
Generally speaking, if the first screening mammography results are highly suggestive of malignancy, then a core-needle biopsy should probably be the next step.
When the initial mammogram reveals an abnormality that is probably benign, then additional imaging is generally useful to help to decide whether to biopsy or not.
Specifically, the radiologist will want to determine whether the lesion is a solid mass or a cyst. In addition, the radiologist will also want to take a closer look at the margins. If all indications of the second imaging studies are for a benign or likely benign lesion, then subsequent follow up imaging studies in about 6 months is probably a reasonable approach, without the necessity of a biopsy.
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Can I Lower My Risk Of Getting A Second Cancer
Theres no sure way to prevent all cancers, but there are steps you can take to lower your risk and stay as healthy as possible. Getting the recommended early detection tests, as mentioned above, is one way to do this.
Its also important to stay away from tobacco products. Smoking increases the risk of many cancers, including some of the second cancers seen after breast cancer.
To help maintain good health, breast cancer survivors should also:
Am I Still At Risk Of Local Recurrence If I Have Had A Mastectomy
Yes. Local recurrence can also happen after a mastectomy, although the likelihood is usually low.
Some of the signs of local recurrence after mastectomy include
- A lump or raised bump in or under the skin, especially near the previous mastectomy scar
- Changes to the skin, including redness or thickening
After reconstruction a local recurrence can appear at the suture line of the flap or in front of the implant. When its in the skin itself, it is red and raised. Reconstruction rarely if ever hides a recurrence. With implants, the recurrences are in front of the implant. With a flap, the recurrences are not in the flap itself but along the edge of the breast skin.
Local recurrence after mastectomy is often described as a chest wall recurrence, which isnt entirely accurate because it implies that the cancer is in the muscle or bone. But usually such a recurrence appears in the skin and fat where the breast was before, and only rarely does it include the muscle.
Ninety percent of local recurrences following mastectomy happen within the first five years after the mastectomy. Approximately 20 to 30 percent of women with local recurrences after mastectomy have already been diagnosed with metastatic disease, and another 20 to 30 percent will develop it within a few months of diagnosis. Therefore, just as with local recurrences after breast conservation, tests should be done to look for distant disease.
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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.