What Is Breast Cancer Recurrence?
Breast cancer is a deadly disease, though fear of 'recurrence' is common in patients even after the early intervention, it can be managed. Even after the cancer treatment and breast removal (mastectomy), cancer sometimes returns, and it is called breast cancer recurrence. It may reoccur in the same area where it was primarily diagnosed or turn up in any other area in the body.
What Are the Signs and Symptoms of Breast Cancer Recurrence?
The signs and symptoms depend upon the site of the recurrence of cancer which can be local, regional, or distant.
1) Local Recurrence:
Cancer appears in the same area as in the primary diagnosis. Suppose a lumpectomy was done and cancer developed in the remaining part of the breast tissue. If a mastectomy was done and cancer developed in the tissue lining of the chest wall or skin. The signs and symptoms, if the recurrence is within the same breast include nipple discharge, noticeable changes on the skin of the breast, redness, and swelling seen on the breast, and a palpable lump in the breast or areas of irregular firmness. The signs and symptoms, if the recurrence is along the chest wall or under the skin include painless nodules (one or more) seen under the skin of the chest wall and a new line of thickening above or below the mastectomy scar.
Treatment: Patients whose breast cancer has occurred locally depend on their initial treatment. For patients with an initial lumpectomy, local recurrence is treated by mastectomy. For patients with an initial mastectomy, local recurrence is treated by removing the tumor where possible, followed by radiation therapy if not given previously. In the above-mentioned cases, targeted therapy, immunotherapy, hormone therapy, and chemotherapy can be done alone or in combination after surgery or radiation. Medication can also be used if surgery and radiation are not options.
2) Regional Recurrence:
Regional recurrence means the original cancer develops in nearby tissues or lymph nodes. The signs and symptoms of regional recurrence include lump or swelling in the lymph nodes present in the arm, near, above, or below the collarbone, and in the neck.
The lymph nodes involved in breast cancer are the following:
- Axillary Lymph Nodes - Located under the arm.
- Supraclavicular Lymph Nodes - Located above the collarbone.
- Infraclavicular Lymph Nodes - Located below the collarbone.
- Internal Mammary Lymph Nodes - Located inside the chest near the breast bone.
Treatment: If breast cancer recurs in the nearby lymph nodes (under the arm, surrounding collar bone), it is treated by removing the lymph nodes, followed by radiation given in that area which was not given before. Chemotherapy, targeted therapy, and hormone therapy are preferred after the surgical removal of lymph nodes.
3) Distant Recurrence:
Also called metastatic recurrence, cancer cells travel to distant body parts like bones, liver, and lungs cancer has been found in tissues away from the original site.
Metastases: If cancer cells have spread to lymph nodes, traveled through the lymphatic system, and reached other body parts, the condition is said to be metastasized. Not all breast cancer patients with cancer cells in the lymph nodes develop metastases, and patients with no cancer cells in lymph nodes may also develop metastases later.
Signs and Symptoms: Fever, loss of appetite, losing weight without trying, headaches, seizures, continuous pain in the chest, back, and hip, persistent cough, and difficulty in breathing.
Treatment: Treatment for distant recurrence cancers (metastatic) is most challenging and pathetic, as breast cancer spreads to other organs. And these are considered stage IV cancers. Systemic drug therapies( chemotherapy, immunotherapy, targeted therapy, hormone therapy) are chosen individually or in combination
What Are the Causes of Breast Cancer Recurrence?
The causes of breast cancer recurrence include the following:
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When the cancer cells that are a part of the original breast cancer break away from the original site and hide in the breast or any other parts of the body, later, these hidden cells begin to grow again, causing recurrent breast cancer.
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However, chemotherapy, hormone therapy, targeted therapy, or other treatments are intended to kill all the remaining cancer cells after surgery. Still, sometimes these treatments fail to kill all the cancer cells leading to recurrence.
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In a few conditions, cancer cells remain dormant (sleeping) for many years, but later on, due to unknown factors, they get triggered, become active, grow rapidly, and spread to other parts of the body.
What Are The Risk Factors For Breast Cancer Survivors?
The risk factors for breast cancer survivors are:
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Involvement of Lymph Node: Finding a cancer site near the lymph nodes at the first or original diagnosis increases the chances of recurrence due to metastases.
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Size of the Tumor: The larger the size, the greater the risk of recurrence.
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Positive Tumor Margins: During a mastectomy, the whole lump of cancer is removed along with some healthy tissue surrounding the cancer. Then a small piece of this healthy tissue is sent for biopsy. If the borders of this healthy tissue seem to be cancer free, then the test is considered negative. In such conditions, the recurrence rate is decreased. But when the borders of healthy tissue sent for biopsy show cancer cells, it is considered positive, and the recurrence rate increases.
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Lack of Radiation Therapy After Lumpectomy: Lumpectomy should always be followed by radiation therapy; those patients who do not undergo radiation after lumpectomy are more prone to recurrence.
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Age: Younger the age at the time of first diagnosis, the more the chances for recurrence.
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Lack of Hormone Therapy: Also increases the chances of recurrences in hormone receptor-positive breast cancer and triple-negative breast cancer.
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Obesity and Lifestyle: Higher the body mass index, the more the recurrence.
How to Prevent the Recurrence of Breast Cancer?
The recurrence of breast cancer can be prevented by the following methods:
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Radiation Therapy: Patients with lumpectomy or mastectomy should choose radiation therapy for lower chances of recurrence.
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Hormone Therapy: Opting for this therapy in patients with hormone receptor-positive breast cancer may increase the life span without recurrence.
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Chemotherapy: Patients who receive chemotherapy live longer than those who do not.
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Targeted Therapy: If the cancer cells have extra protein HER2 (human growth factor receptor 2), then drugs should target the protein to prevent a recurrence.
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Maintaining a Healthy Weight: Exercising regularly, eating a healthy diet, and avoiding alcohol and smoking.
What Is the Success Rate in Treating Recurrent Breast Cancer?
The success rate depends upon the following factors:
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Type of cancer.
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When and where it recurs.
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The time gap between the original diagnosis and recurrence.
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How much it had spread (aggressiveness of cancer).
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The overall health of the patient.
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Depends on the patient tolerates the treatment
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Most important is the individual values and wishes of the patient.
What Is Triple-Negative Breast Cancer and how can it be diagnosed?
Triple-negative breast cancer (TNBC) accounts for only ten percent of breast cancer, and it refers to the fact that cancer cells do not have any estrogen or progesterone receptors (ER-PR) and do not make any protein called HER2.
Diagnosis can be made if the cancer cells test negative for all three tests mentioned below:
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Estrogen receptor (ER).
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Progesterone receptor (PR).
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HER2 protein.
Then it is considered triple-negative breast cancer. They are mostly seen in women less than 40 years of age. TNBC has the highest recurrence rate among all the types of breast cancer because it is aggressive, grows rapidly, and spreads faster.
Conclusion:
Breast cancer recurrence is hard to treat, and most patients fear recurrence or new cancer. It may reoccur from months to years after the initial treatment is completed. Therefore, patients should be under regular follow-up appointments and undergo screening tests to detect breast cancer recurrence as early as possible.
