Cancers Can Become Resistant To Treatment
Sometimes cancer can become resistant to cancer drug treatment. Cancers develop from normal cells that have changed or mutated to become cancerous. The mutation happens in the genes of the cell. These gene changes make the cell behave differently to a normal cell. Cancer cells can continue to mutate so that they become more and more abnormal.
Some mutations can make the cells resistant to cancer drugs such as chemotherapy, targeted cancer drugs or hormone therapy. You can sometimes have a different type of treatment if this happens. But sometimes cancers develop resistance to many drugs at the same time. This is called multi drug resistance.
Scientists have found a group of genetic mutations that they think can cause drug resistance. These mutations mean that the cancer cell can keep the drugs out. The resistant cells have high levels of a substance called p-glycoprotein. P-glycoprotein is a protein found in cell walls. The protein acts as a pump and removes toxins from cells. Cells with high p-glycoprotein levels are very good at keeping cancer drugs out.
Researchers have been looking at drug resistance for almost as long as they have used cancer drugs. To make cancer drug treatment more effective, we need to find a way of overcoming resistance.
Screening Dense Breast Tissue
Dr. Tom Miller: Okay. Could you talk about the density of breast tissue? I think there’s a higher call-back rate on women that have higher breast density. Is that true? Can we talk about that a little bit?
Dr. Nicole Winkler: That is true. That is true. Women with more heterogeneously dense breast tissue and baseline screening mammograms, those women tend to get called back a little bit more than women that have completely fatty breast tissue. That’s because there’s just more going on in the breast. There’s more tissue in there that can obscure a potential cancer. It also reduces the sensitivity of the mammogram. So if we think, ‘Well, there’s some very dense tissue in there and there could be something in there,’ sometimes we might call you back so we can look at that area a little bit better.
What Are The Complications Of Breast Cancer Recurrence
Breast cancer that comes back can be harder to treat. The same therapy isnt always effective again. Tumors can develop a tolerance to certain treatments like chemotherapy. Your healthcare provider will try other therapies. You may be able to try drugs under development in clinical trials.
If breast cancer spreads to other parts of the body, your healthcare providers still treat it like breast cancer. For instance, breast cancer cells that move to the lungs cause breast cancer in the lungs not lung cancer. Metastatic breast cancer is more difficult to treat than cancer in only one part of the body.
You may feel stressed, depressed or anxious. A mental health counselor and support groups can help.
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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.
What Is My Prognosis
This is a very common question that isnt always easy to answer. There are many factors involved in working out prognosis. Remember that a prognosis is just a figure at the point at which you receive it. For most people, the prognosis gets better with time.
Sometimes we use a five-year figure because we know that if cancer comes back, most of the time it comes back within five years. If the cancer has not come back within five years, then the chance of it coming back within ten years is quite low, and if it does not come back within ten years, then you have an almost normal life expectancy.
Its a bit like buying a second hand car. You dont really know how long its going to last, but if it lasts year after year without breaking down, then the car starts to look more and more reliable to make that long trip.
Working out prognosis can be difficult.
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Signs Of Breast Cancer Recurrence
The signs of cancer recurrence depend on where the cancer resurfaces. You might not see or feel any signs of a local recurrence, and, if you do, it will probably be a slight change in or around your breast or underarm area. More often than not, your provider might find evidence of a local recurrence during a physical exam or mammogram.
A distant recurrence will typically produce some symptoms, but because many of those symptoms are common to other health problems, it can be hard to tell if theyre due to a distant recurrence or something else. Have an open conversation with your cancer care team about any symptoms youre having, especially if they last more than two weeks.
Pay special attention to these symptoms, which could signal a cancer recurrence:
- Blood in your urine or stools
- Any new lumps or areas of swelling
If All The Cancer Was Removed With Surgery Why Do I Need Any Additional Treatment
It has long been recognized that breast cancer is not always cured by locoregional treatment alone.
The goal of treating early breast cancer is to remove the cancer and keep it from coming back . Most people diagnosed with breast cancer will never have a breast cancer recurrence. However, everyone who has had breast cancer is at potential risk of recurrence, and that is why in most cases, there is a recommendation for treatment in addition to surgery, which is known as adjuvant therapy. The risk of recurrence can never be entirely eliminated, but the aim of adjuvant therapy is to reduce recurrence risk to the absolute minimum.
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Getting Support And Information
It can be very difficult to cope with the news that your cancer has come back. At first, you are likely to feel very upset, frightened and confused. Or you may feel that things are out of your control.
It is very important to get the right information about your type of cancer and how it is best treated. People who are well informed about their illness and treatment are more able to make decisions and cope with what happens. Your doctor or breast care nurse can give you information.
It can help to talk to family and friends about how you feel.
You can also contact one of the breast cancer organisations. They have free factsheets and booklets they can send to you. They might also be able to put you in touch with a support group.
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.
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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.
How Can You Handle Your Feelings About Having Breast Cancer Again
It’s common to have a wide range of emotions. It may be hard to stay hopeful when you are fighting cancer for the second or third time. These ideas may help:
- Get the support you need. Spend time with people who care about you, and let them help you.
- Take good care of yourself. Get plenty of rest, and eat nourishing foods.
- Talk about your feelings. Find a support group where you can share your experience.
- Stay positive. Do things each day that will help you stay calm and relaxed.
If your emotions are too much to handle, be sure to tell your doctor. You may be able to get counselling or other types of help.
You may want to think about planning for the future. An advance care plan lets doctors know what type of life-support measures you want if your health gets much worse. You can also choose a substitute decision-maker to make decisions in case you aren’t able to. If you put your wishes in writing, you can make it easier for your loved ones and others to know what you want.
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Can I Lower My Risk Of Getting A Second Cancer
There’s 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:
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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Side Effects Of Treatment
Cancer and its treatments can be painful, but cancer pain can almost always be controlled. If you are having ongoing problems with managing pain, ask to see a pain specialist.
There are also many things you can do at home to help manage side effects of treatment. But talk to your doctor about any bothersome symptoms. Working together with your doctor can help you have the best possible quality of life.
You can find more information about treating breast cancer online at the:
- Canadian Cancer Society website at www.cancer.ca.
- U.S. National Cancer Institute website at www.cancer.gov.
My Mammogram Came Back Abnormal Now What
It can be scary when your doctor says she found something on your mammogram. Does this mean breast cancer? Dr. Tom Miller and Dr. Nicole Winkler discuss what it means when you get the call to come back for more tests. They also talk about what the findings might mean and the realistic chances of developing cancer.
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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
- firmness in new areas of the breast
- redness or swelling of the breast after the area has healed from surgery and radiation
Getting Help And Support
You may find it helpful to talk to other people in the same situation if you are finding it hard to cope with the fact that you have had cancer. Or you could talk to a trained counsellor. This can help you to find ways of dealing with the fear and worry.
You can get in touch with a counsellor by contacting one of the counselling organisations.
You can phone the Cancer Research UK nurses if you would like to talk to someone outside your own friends and family. Talk to the Cancer Research UK nurses on freephone 0808 800 4040, from 9am to 5pm, Monday to Friday.
You can also look at our section about coping emotionally with cancer.
Or you can share your experiences with other people and find out how they coped by using our online forum, Cancer Chat.
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Treatment For Breast Cancer Recurrence
If your care team thinks you might have a cancer recurrence, theyll recommend diagnostic tests, like lab tests, imaging or biopsies, both to be sure the cancer has come back and to get more information to guide your treatment.
Treatment options depend on where the cancer has recurred and what treatment youve had before:
- Local recurrence is likely to be treated surgically first with a mastectomy if you didnt have one already or a surgical removal of the tumor if you did. After surgery, chemotherapy and radiation are commonly used, as well as hormone therapy or targeted therapy if your kind of cancer will respond to one or both of them.
- Regional recurrence is also typically treated first with surgery to remove affected lymph nodes. After the surgery, youll likely have radiation and possibly chemotherapy, hormone therapy and/or targeted therapy, too.
- Distant recurrence is mainly treated with drug therapychemotherapy, hormone therapy, targeted therapy or a combination of these. Surgery and/or radiation might be used, too, but only in cases where the aim is relieving symptoms.
Expert
Metastatic Breast Cancer Symptoms And Diagnosis
The symptoms of metastatic breast cancer can vary greatly depending on the location of the cancer. This section covers the symptoms of breast cancer that has spread to the bone, lung, brain, and liver, and the tests used to diagnose metastatic breast cancer.
Bone Metastasis: Symptoms and DiagnosisThe most common symptom of breast cancer that has spread to the bone is a sudden, noticeable new pain. Breast cancer can spread to any bone, but most often spreads to the ribs, spine, pelvis, or the long bones in the arms and legs. Learn more.
Lung Metastasis: Symptoms and DiagnosisWhen breast cancer moves into the lung, it often doesnt cause symptoms. If a lung metastasis does cause symptoms, they may include pain or discomfort in the lung, shortness of breath, persistent cough, and others. Learn more.
Brain Metastasis: Symptoms and DiagnosisSymptoms of breast cancer that has spread to the brain can include headache, changes in speech or vision, memory problems, and others. Learn more.
Liver Metastasis: Symptoms and DiagnosisWhen breast cancer spreads to the liver, it often doesnt cause symptoms. If a liver metastasis does cause symptoms, they can include pain or discomfort in the mid-section, fatigue and weakness, weight loss or poor appetite, fever, and others. Learn more.
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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.