Breast cancer recurrence is a second appearance of breast cancer, whether in the breast or another area of the body. It happens when cancer cells survive the first rounds of treatment, lying dormant – sometimes for years – before eventually multiplying and causing the cancer to reappear. While this is difficult news, additional treatment options are available to you. The right treatment plan depends on several factors, including where it recurred and how much cancer is present at the time it’s found.
What Causes Breast Cancer Recurrence?
While there may not be an exact reason that breast cancer recurrence happens, there are some things that could lead to it. Common reasons include:
- Incomplete removal or destruction of cancer cells during initial treatment.
- Biological characteristics of the cancer, such as aggressive tumor behavior or genetic mutations.
- Resistance to treatments, where some cancer cells adapt and survive therapies.
The likelihood of recurrence depends on whether it’s fast-growing as well as the stage at the time breast cancer was initially diagnosed. Faster-growing and later-stage breast cancer are more likely to recur.
Risk Factors for Breast Cancer Recurrence
Several factors can increase the likelihood of breast cancer returning. This includes the type of breast cancer found at the initial diagnosis, the stage at the initial diagnosis, and the size of the tumor that was initially found. The risk of recurrence also increases if lymph nodes were involved. Triple-negative breast cancer and inflammatory breast cancer are the most likely types to recur.
Some lifestyle choices can also increase the risk of recurrence, such as:
- Smoking
- Being overweight
- Being inactive
- Poor overall health
Risk is also impacted based on the treatments you used initially. Radiation therapy after a lumpectomy or endocrine therapy for hormone receptor-positive breast cancer after your initial diagnosis increases your recurrent cancer risk.
Types of Breast Cancer Recurrence
Breast cancer recurrence can be classified into three main types based on where the cancer reappears:
- Local Recurrence: refers to cancer that returns in the same location as the original tumor. This could be in the remaining breast tissue or chest wall if a mastectomy was performed.
- Regional Recurrence: occurs when cancer reappears in nearby lymph nodes or tissues.
- Distant Recurrence: also known as metastatic recurrence, happens when cancer spreads to other parts of the body, such as the bones, liver, lungs, or brain.
Symptoms of Recurrent Breast Cancer
Identifying the return of breast cancer involves recognizing the symptoms, which could look different based on where the cancer returns. Common signs include:
- Local Recurrence Symptoms: a new lump or thickening in the breast or chest wall, changes in breast shape or size, discharge from the nipple, and skin changes such as redness or dimpling.
- Regional Recurrence Symptoms: Swelling or lumps in the lymph nodes under the arm, near the collarbone, or in the neck. Pain or changes in the skin around these areas might also be observed.
- Distant Recurrence Symptoms: Persistent pain (especially in the bones), loss of appetite, unexplained weight loss, chronic cough, difficulty breathing, headaches, and seizures.
If you experience any of these breast cancer symptoms, it's important to consult your doctor right away for further investigation of what might be causing your symptoms.
Diagnosing Recurrent Breast Cancer
Diagnosing breast cancer recurrence involves a combination of evaluating symptoms, reviewing your history of breast cancer, and conducting diagnostic tests. Procedures may include:
- Imaging Tests: X-rays, MRI, CT scans, PET scans, or bone scans help visualize the location and extent of the recurrent cancer.
- Biopsy: Examination of suspicious cells to confirm recurrence. A biopsy involves taking a sample of tissue from the suspected recurrence site and analyzing it for cancer cells.
Factors that Determine Treatment for Recurrent Breast Cancer
Treatment for recurrent breast cancer is based on several factors, including:
- Overall Health: The patient's general health and ability to receive additional cancer treatments.
- Stage: The extent of the recurrence, whether it is local, regional, or distant, influences treatment options.
- Location and Size of the Recurrence: The specific location and size of the recurrent cancer will determine the treatment approach.
- Previous Treatments Received: The treatments previously used can impact what therapies may or may not be an option. If you received radiation therapy in the initial treatment plan, you might not be able to use it in a recurrent treatment plan.
- Personal Health Goals: Your preferences and goals for quality of life and treatment outcomes are also significant considerations to keep in mind.
Local Recurrence Breast Cancer Treatment
For local recurrences, treatment options often include some combination of the following:
- Surgery: To remove the recurrent tumor. This might involve a mastectomy if a lumpectomy was initially performed. Breast cancer surgeons may also remove lymph nodes if they were not removed before.
- Radiation Therapy: If not used during the initial treatment, radiation may be recommended to target residual cancer cells. If you experienced side effects with radiation following your lumpectomy, it is unlikely that your doctor will suggest radiation again.
- Hormone Therapy: If your type of cancer is hormone-receptor-positive, then it may be effective to use medications that block estrogen and progesterone from promoting the growth of cancer cells.
- Targeted Therapy: Targeted therapy drugs block the overgrowth of HER2 protein. The medication enters the bloodstream and can target all areas of the body.
- Immunotherapy: Some drugs are not available for first-line therapy but can be used when breast cancer recurs, using the body’s immune system to destroy cancer cells.
Regional Recurrence Breast Cancer Treatment
Regional recurrence typically means a tumor has developed and spread to the lymph nodes. In this case, surgery will include removal of the lymph nodes in addition to the tumor.
Radiation therapy can be used to eliminate residual cancer cells in the affected region after surgery if this wasn’t used in the initial treatment plan.
Systemic therapies such as chemotherapy, hormone therapy, or targeted therapy to address any returning cancer cells are likely to be used. To destroy any residual cancer cells that may be left after surgery.
Distant Recurrence Breast Cancer Treatment
Treating distant recurrences is more challenging, and options depend on where in the body breast cancer has returned. Surgery is not often an option for these patients. However, other treatments are available to give systemically, such as:
- Hormone Therapy: This type of treatment blocks the hormone receptors that help the cancer grow. It can be used before or along with chemotherapy.
- Chemotherapy: Some drugs are used in first-line therapy while other drug combinations are established to work for recurrent cancer. There are several options if one type of chemo no longer works for the patient.
- Targeted Therapy: This type of drug will likely be used for cancers with specific genetic markers, such as HER2-positive cancers. Additional targeted therapies are available for recurrent and late-stage breast cancer based on biomarker test results that show which, if any, genetic changes are found in the cancer cells.
- Immunotherapy: Boosts the body's immune response against cancer cells.
- Palliative Care: To manage symptoms and improve quality of life. This may include bone-building medications or radiation therapy.
Related reading: What You Need to Know About Metastatic Breast Cancer
Comprehensive Breast Cancer Treatment in Portland, Oregon
Whether you’ve been recently diagnosed with breast cancer or are facing a recurrence, Compass Oncology is here to help. We offer the latest treatments and therapies that offer our patients the best chances for success. Please contact us today to schedule a consultation to start your personalized treatment plan.
