Which breast cancers are prone to recurrence?
Studies show that patients with the following breast cancers are more likely to have a recurrence after treatment:
- Metastasis in the axillary lymph nodes
- Large tumors
- invasive cancer
- Hormone receptor negative
- Human epidermal growth factor receptor-2 (HER-2) positive
What are the different types of recurrence?
Breast cancer can recur in three ways:
- Cancer recurs at the original site, which is called a local recurrence.
- Cancer that recurs in a surrounding area, such as the chest, is called a regional recurrence.
- Cancer can spread to distant locations in the body, such as the lymph nodes, bone marrow, or lungs, and is called a distal recurrence or metastasis.
How do doctors diagnose?
Doctors will need to determine if breast cancer has spread through additional tests, initially a physical exam, often requiring a biopsy. The doctor finds out if the cancer is present and, if so, makes sure it is a recurrence of the same type of cancer or a completely new cancer (called a second primary cancer).
If it is a recurrence, further tests may include bone scans, X-rays, CT, magnetic resonance imaging (MRI), blood tests, and PET scans (also called positron emission computed tomography).
How is it treated?
Treatment depends on whether the recurrence is local, regional, or distal.
- Local recurrence can be treated with mastectomy if the initial lumpectomy was performed, or with radiation therapy if a mastectomy was performed.
- Regional recurrence is rare. Treatment may include a combination of surgery, drugs, and radiation therapy.
- Treatment of distal recurrence of metastatic breast cancer includes.
- Endocrine therapy and/or chemotherapy with or without trastuzumab, depending on whether the cancer is HER-2-positive or hormone receptor-positive.
- Shrinking the tumor with radiation therapy or removing it with surgery may relieve pain or reduce other symptoms.
- Participation in clinical trials of new chemotherapy or endocrine therapy.
Before starting treatment for metastatic breast cancer, patients should be fully informed about their options, including the risks and benefits of treatment. The focus of metastatic cancer treatment is to extend life and improve quality of life, not to cure.
Patients may need to seek a second option at this time. Patients can re-evaluate their breast cancer treatment options and consult with their physician to determine if treatment will improve quality of life. During this time, women should take the best possible care of themselves:
- The right diet.
- Adequate rest.
- Seek spiritual support, if needed.
- May need to develop a plan to avoid worsening of symptoms.
Some times, a hospice plan may be recommended by the doctor. The focus of hospice care is to make the patient comfortable and to help make arrangements for the future.