Treatment of recurrent breast cancer
How to follow up after breast cancer surgery?
Follow-up interval: 2 years after surgery: once every 3 to 6 months
3 to 5 years after surgery: once every 6 months
More than 5 years after surgery: once a year
Follow-up doctor
Follow-up content: timely detection of recurrent and metastatic lesions and timely treatment; examination of the contralateral breast; adjuvant treatment; evaluation of new drugs and new protocols.
What is recurrence of breast cancer?
The spread of cancer cells, resulting in local recurrence and/or distant metastasis; 1/3 of breast cancer patients will have recurrence.
How to determine the recurrence of breast cancer?
Local recurrence
The rate of local recurrence after radical breast cancer surgery is 6.5-23.5% (110 cases of local recurrence out of 1683 cases in our hospital). The rate of local recurrence is related to axillary lymph node metastasis: 3-8% for negative axillary lymph nodes and 19-27% for positive ones.
Causes of local recurrence: implantation of cancer cells during surgery; residual dissemination of cancer emboli in the subcutaneous lymphatic vessels due to incomplete surgical excision.
Clinical manifestations: single or multiple implanted nodules, or multiple nodules in the form of patches with skin redness and edema – cancerous lymphangitis.
Differential diagnosis: Recurrent nodules tend to be hard in texture, poorly mobile with skin adhesions, and may be accompanied by skin reddening. It needs to be differentiated from the following: nerve stump, mostly with pressure pain; subcutaneous nodules, small and mobile may be cystic. Surgical biopsy helps to differentiate.
Recurrence after breast-conserving surgery: 5-10% at 5 years, 7-20% at 10 years, most recurrences are in the breast parenchyma and negative in the skin, lymph nodes, and chest wall; 1/3 are detected by physical examination and negative by mammography, 1/3 are detected by both physical examination and mammography, and the other 1/3 are detected by mammography; local recurrence is feasible with complementary radical surgery, and the long-term tumor-free survival rate is still 50%.
Regional lymph node recurrence
20-40%
Clinical manifestations: enlarged axillary lymph nodes, fusion into clusters, skin adhesions, axillary vascular and nerve involvement resulting in edema and pain in the upper extremities; raised masses in the second and third intercostal areas of the internal mammary region, with red, thin and shiny skin, hard and fixed masses, ulcers in advanced stages, and pain due to sternal invasion.
Distant metastasis
Lymphatic metastases: bilateral supraclavicular lymph nodes; contralateral axillary lymph nodes; inguinal lymph nodes and mediastinal lymph nodes are also present but less common.
Hematologic metastases: bone 20-60%, mostly in the pelvis, lumbar spine, thoracic spine, ribs, femur, upper humerus, scapula, skull, etc.; lung and pleura 15-25%; liver 5-15%; brain 5-10%; others (adrenal glands, ovaries, etc. are rare).
Clinical manifestations are symptoms and signs of each metastatic site.
In addition, the diagnosis can be made with the help of adjuvant examinations such as X-ray chest film, isotope scan, CT, B-ultrasound and the detection of tumor markers CA15-3, CEA, etc.
Treatment of recurrent breast cancer
There are more methods
Systemic treatment – depending on age, disease progression rate, menstrual status, hormone receptors, metastatic sites, etc.
1. chemotherapy: preferred for young age, rapid lesion progression, short interval between surgery and recurrence (TTP), and visceral metastasis
2, endocrine therapy: older, postmenopausal, ER and PR positive, longer TTP, slow lesion development, good efficacy for those with lymph node, soft tissue and skin recurrence
3, new drugs: good efficacy, expensive, recommended as second-line drugs.
Local treatment – according to the site of recurrence or metastasis, single or multiple, with or without symptoms, etc.
1.Surgical excision: local single recurrent nodule
2. radiation therapy: local recurrence (single or multiple)
Bone metastases (50% efficiency, 75% pain relief); Brain metastases (whole cranial irradiation)