Overview
Recurrent breast cancer is breast cancer that comes back after initial treatment. It occurs when some cancer cells were not entirely eliminated during the initial treatment and grow again, sometimes months or years later. Recurrent breast cancer can be local (in the same area as the original cancer), regional (in nearby lymph nodes), or distant (in other parts of the body). Symptoms and signs depend on the location of the recurrence, but may include new lumps, skin changes, nipple discharge, or pain. It is essential to follow up with your doctor for regular exams and reporting any unusual symptoms to ensure early detection and appropriate treatment.
Understanding the disease
Symptoms
The symptoms of recurrent breast cancer depend on where the cancer comes back:
- Local recurrence: Signs and symptoms may include a new lump in your breast or irregular area of firmness, changes to the skin of your breast, skin inflammation or area of redness, nipple discharge, or painless nodules on or under the skin of your chest wall.
- Regional recurrence: Signs and symptoms may include a lump or swelling in the lymph nodes located under your arm, near your collarbone, in the groove above your collarbone, or in your neck.
- Distant recurrence: Signs and symptoms may include persistent and worsening pain, such as chest, back, or hip pain, persistent cough, difficulty breathing, loss of appetite, weight loss without trying, severe headaches, or seizures. It is essential to follow your doctor's follow-up schedule and report any concerning symptoms or signs to ensure prompt detection and appropriate treatment.
Risk Factors
Risk factors for recurrent breast cancer include lymph node involvement, larger tumor size, and positive or close tumor margins at the time of the original diagnosis.
Development
Recurrent breast cancer develops when cancer cells that were part of the original breast cancer break away from the tumor and grow in other parts of the body. These cells may have remained undetected after the initial treatment, and they multiply over time, eventually causing a recurrence. Recurrent breast cancer may occur locally, meaning the cancer comes back in the same place as the original cancer, or it may be a distant recurrence, where the cancer spreads to other parts of the body. Factors that increase the risk of recurrent breast cancer include lymph node involvement, larger tumor size, positive tumor margins, lack of radiation treatment following a lumpectomy, younger age, and certain types of breast cancer like inflammatory breast cancer or hormone receptor-positive breast cancer without endocrine therapy.
Assessment and Diagnosis
Triage
If recurrent breast cancer is suspected, you should make an appointment with your doctor. Recurrent breast cancer may occur months or years after initial treatment, and the cancer may come back in the same place as the original cancer (local recurrence) or spread to other areas of your body (distant recurrence). Early detection and intervention are crucial in managing recurrent breast cancer. Your doctor will perform an examination and determine the appropriate course of action, which may include further diagnostic tests, such as imaging scans, blood tests, or biopsies.
Diagnosis
To diagnose recurrent breast cancer, your doctor may recommend additional tests, depending on the results of a mammogram or physical exam and any signs and symptoms you may have. These tests may include imaging tests such as magnetic resonance imaging (MRI), computerized tomography (CT), X-ray, bone scan, or positron emission tomography (PET). Your doctor will determine which tests are most helpful in your specific situation. A biopsy procedure may also be performed to collect suspicious cells for laboratory testing, which can confirm whether the cancer has returned. A pathologist will examine the cells to determine the types of cells involved and whether the cancer is sensitive to hormone treatment or targeted therapy.
Management and Treatment
Complications
Potential complications of recurrent breast cancer may include:
- Spread of cancer: Recurrent breast cancer may spread to other parts of the body, causing additional health issues and reducing the chances of successful treatment.
- Impaired quality of life: The presence of recurrent breast cancer can negatively impact a person's emotional, physical, and social well-being, affecting their overall quality of life.
- Limited treatment options: In some cases, recurrent breast cancer may be challenging to treat, especially if multiple treatments have already been tried and been unsuccessful.
- Treatment side effects: Treatments for recurrent breast cancer, such as chemotherapy or radiation therapy, can cause side effects like fatigue, nausea, hair loss, and an increased risk of infections.
- Financial burden: The ongoing medical costs associated with recurrent breast cancer, including treatments, medications, and follow-up care, can create a financial burden for both patients and their families. It is essential to work closely with a healthcare team to address these potential complications and develop a personalized treatment plan.
Treatment
Treatments for recurrent breast cancer may include chemotherapy, radiation therapy, targeted therapy, bone-building drugs, and maintaining a healthy lifestyle.
Preparing for medical consultation
To prepare for an appointment regarding recurrent breast cancer, you should:
- Gather your medical history: Make a list of any benign breast conditions you've been diagnosed with, any radiation therapy you've received, and any family history of breast cancer, especially in first-degree relatives.
- List your medications: Create a list of all prescription, over-the-counter medications, vitamins, supplements, or herbal remedies you're currently taking. If you've taken hormone replacement therapy or have previously taken it, inform your doctor.
- Bring a support person: Consider bringing a family member or friend to the appointment. They can help remember information and provide emotional support.
- Write down questions: Prepare a list of questions to ask your doctor. Some questions to ask might include:
- Has my cancer returned?
- Are there other possible causes for my symptoms?
- What kinds of tests do I need? Do these tests require any special preparation?
- What are the hormone receptor status and the HER2 status of the cancer recurrence?
- What treatments are available to me at this stage, and which do you recommend?
- What types of side effects can I expect from treatment?
- Are there any alternatives to the approach that you're suggesting?
- Are there any clinical trials open to me? By being well-prepared and asking relevant questions, you can ensure a more productive and informative appointment.