Recurrent breast cancer

Overview

Recurrent breast cancer is breast cancer that comes back after initial treatment. Although the initial treatment is aimed at eliminating all cancer cells, a few may have evaded treatment and survived. These undetected cancer cells multiply, becoming recurrent breast cancer.

Recurrent breast cancer may occur months or years after your initial treatment. The cancer may come back in the same place as the original cancer (local recurrence), or it may spread to other areas of your body (distant recurrence).

Learning you have recurrent breast cancer may be harder than dealing with the initial diagnosis. But having recurrent breast cancer is far from hopeless. Treatment may eliminate local, regional or distant recurrent breast cancer. Even if a cure isn't possible, treatment may control the disease for long periods of time.

Symptoms

Signs and symptoms of recurrent breast cancer vary depending on where the cancer comes back.

Local recurrence

In a local recurrence, cancer reappears in the same area as your original cancer.

If you've undergone a lumpectomy, the cancer could recur in the remaining breast tissue. If you've undergone a mastectomy, the cancer could recur in the tissue that lines the chest wall or in the skin.

Signs and symptoms of local recurrence within the same breast 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.

Signs and symptoms of local recurrence on the chest wall after a mastectomy may include:

• One or more painless nodules on or under the skin of your chest wall.
• A new area of thickening along or near the mastectomy scar.

Regional recurrence

A regional breast cancer recurrence means the cancer has come back in the nearby lymph nodes.

Signs and symptoms of regional recurrence may include a lump or swelling in the lymph nodes located:

• Under your arm.
• Near your collarbone.
• In the groove above your collarbone.
• In your neck.

Distant recurrence

A distant (metastatic) recurrence means the cancer has traveled to distant parts of the body, most commonly the bones, liver and lungs.

Signs and symptoms 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.
• Seizures.

When to see a doctor

After your breast cancer treatment ends, your doctor will likely create a schedule of follow-up exams for you. During follow-up exams, your doctor checks for any symptoms or signs of cancer recurrence.

You can also report any new signs or symptoms to your doctor. Make an appointment with your doctor if you notice any persistent signs and symptoms that worry you.

Causes

Recurrent breast cancer occurs when cells that were part of your original breast cancer break away from the original tumor and hide nearby in the breast or in another part of your body. Later, these cells begin growing again.

The chemotherapy, radiation, hormone therapy or other treatment you may have received after your first breast cancer diagnosis was intended to kill any cancer cells that may have remained after surgery. But sometimes these treatments aren't able to kill all of the cancer cells.

Sometimes cancer cells may be dormant for years without causing harm. Then something happens that activates the cells, so they grow and spread to other parts of the body. It's not clear why this occurs.

Risk factors

For breast cancer survivors, factors that increase the risk of a recurrence include:

• Lymph node involvement. Finding cancer in nearby lymph nodes at the time of your original diagnosis increases your risk of the cancer coming back.
• Larger tumor size. People with larger tumors have a greater risk of recurrent breast cancer.

• Positive or close tumor margins. During breast cancer surgery, the surgeon tries to remove the cancer along with a small amount of the normal tissue that surrounds it. A pathologist examines the edges of the tissue to look for cancer cells.

  If the borders are free of cancer when examined under a microscope, that's considered a negative margin. If any part of the border has cancer cells (positive margin), or the margin between the tumor and normal tissue is close, the risk of breast cancer recurrence is increased.

• Lack of radiation treatment following a lumpectomy. Most people who choose a lumpectomy (wide local excision) for breast cancer undergo breast radiation therapy to reduce the risk of recurrence. Those who don't undergo the radiation therapy have an increased risk of local breast cancer recurrence.
• Younger age. Younger people, particularly those under age 35 at the time of their original breast cancer diagnosis, face a higher risk of recurrent breast cancer.
• Inflammatory breast cancer. People with inflammatory breast cancer have a higher risk of local recurrence.
• Lack of endocrine therapy for hormone receptor-positive breast cancer. In people who have a certain type of breast cancer, not receiving endocrine therapy can raise their risk of recurrence.
• Cancer cells with certain characteristics. If you had triple negative breast cancer, you may have an increased risk of breast cancer recurrence. Triple negative breast cancer cells don't have receptors for estrogen or progesterone, and they don't make too much of a protein called HER2.
• Obesity. Having a higher body mass index increases your risk of recurrence.

Prevention

Strategies that have been linked to a reduced risk of breast cancer recurrence include:

• Hormone therapy. Taking hormone therapy after your initial treatment may reduce the risk of recurrence if you have hormone receptor positive breast cancer. Hormone therapy may continue for at least five years.
• Chemotherapy. For people with breast cancer who have an increased risk of cancer recurrence, chemotherapy has been shown to decrease the chance that cancer will recur, and those who receive chemotherapy live longer.
• Radiation therapy. People who've had a breast-sparing operation to treat their breast cancer and those who had a large tumor or inflammatory breast cancer have a lower chance of the cancer recurring if they're treated with radiation therapy.
• Targeted therapy. If your cancer makes extra HER2 protein, drugs that target that protein can help decrease the chance of the cancer recurring.
• Bone-building drugs. Taking bone-building drugs reduces the risk of cancer recurring in the bones (bone metastasis) in people with an increased risk for breast cancer recurrence.
• Maintaining a healthy weight. Maintaining a healthy weight may help decrease the risk of recurrent breast cancer.
• Exercising. Regular exercise may reduce your risk of breast cancer recurrence.
• Choosing a healthy diet. Focus on including lots of vegetables, fruits and whole grains in your diet. If you choose to drink alcohol, limit yourself to one drink a day.

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