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While recurring breast cancer can be treated, it may return yet again. Accordingly, proper understanding of this condition and awareness of its early warning signs are imperative to stop recurrence.
Recurrent breast cancer happens when the treatment is unable to kill all the cancer cells.
Recurring breast cancer refers to a condition that keeps coming back after treatment. Breast cancer could recur months or years after the treatment concludes. While recurring breast cancer can be treated, it may return yet again. Accordingly, proper understanding of this condition and awareness of its early warning signs are imperative to stop recurrence.
Dr (Prof) Meenu Walia, Vice Chairman, Dept of Medical Oncology and Hematology, Max Super Speciality Hospital shares all you need to know:
Types of Recurring Breast Cancer
Recurrent breast cancer comprises three types:
Local: If the cancer recurs in the same region of the breast as per the initial diagnosis, it is categorized as a local recurrence.
Regional: If the breast cancer comes back in the chest wall and/or nearby lymph nodes, it’s a regional recurrence.
Distant: Also known as metastatic breast cancer or Stage 4 breast cancer, it happens when breast cancer cells shift away from the original breast tumour and travel to the body’s other regions via the lymphatic system or the bloodstream. The liver, lungs, bones and brain are common areas for metastasis.
However, if the cancer in one breast is eliminated after therapy but it develops in the other untreated breast, this tumour is deemed to be a new cancer and not recurring breast cancer. Oncologists may term this a second cancer.
According to one report, females with early breast cancer will often develop a local recurrence within five years following their treatment. On average, 7% to 11% of women having early breast cancer will have a local recurrence during this period. Higher recurrence is seen with aggressive breast cancer subtypes.
When the Risk of Recurrence Remains Higher
The American Cancer Society notes that inflammatory breast cancer and triple-negative breast cancer are more prone to recurring compared to other breast cancer types/subtypes. If breast cancer patients have a family history of the condition or BRCA1 or BRCA2 gene mutation, cancer recurrence rates will be higher. Also, the risk of discovering new cancers (like ovarian cancer) may be higher. Though recurrence is not so common, the specific recurrence rate hinges on factors such as the breast cancer stage and its treatment.
Generally, the more time elapses the lower the recurrence risk. Any recurrence will most likely happen within the first two years following the treatment. Once a person reaches the five-year milestone of living free of cancer after treatment, recurrence is relatively rare. Yet, recurrence may still be possible, which is termed late recurrence.
While much remains unknown regarding cancer recurrence, some patterns have been noted in recent years by researchers indicating why this happens. The factors possibly connected to a higher rate of breast cancer recurrence include high blood sugar, obesity, low consumption of fruits and vegetables as well as suffering a surgical site infection following surgery. Recurrence could also occur in women who develop breast cancer before the age of 35.
Symptoms of Breast Cancer Recurrence
Any cancer recurrence signs will depend on where the condition resurfaces. Most likely, a woman may not see or feel signs of any local recurrence. Even if she does, it would most probably be a minor change in or around her breast or the underarm area. Often, her doctor will be the first person who discovers some signs of a local recurrence when undertaking a physical exam or during a mammogram.
Typically, some symptoms could emerge in a distant recurrence. But since many breast cancer symptoms also occur with other health issues, it is difficult to know if these are because of a distant recurrence or due to another reason. However, a woman should have a close conversation with her cancer care team regarding any symptoms, particularly those lasting longer than a fortnight.
Special attention should be paid to the following symptoms, which may mean recurring breast cancer:
• Inexplicable weight loss
• Breathlessness or wheezing
• Fatigue
• Seizures
• Fever, chills or cough that doesn’t abate
• Yellow tinge in the eyes and skin (jaundice)
• Easy bruising/bleeding
• Headaches, bone pain and any new or unusual pain the patient cannot explain
• Difficulty in swallowing or digestive issues such as nausea, vomiting, loss of appetite and diarrhoea
• Blood in the stools or urine
• New lumps or swelling in some areas.
Besides these generic signs, the symptoms could vary depending on the cancer’s origins. Recurring local breast cancer could cause:
• Lumps in the breast or bumps on/under the chest region
• Nipple discharge or changes like a flattened nipple
• Swelling in the skin or skin that constricts near the lumpectomy region
• Thickening on/near the surgical scar
• Breast tissue that feels unusually firm.
Recurring regional breast cancer could cause:
• Trouble swallowing
• Enduring chest pain
• Pain, numbness or swelling in one arm/shoulder
• Swollen lymph nodes in the armpit or in/around the collarbone region.
Recurring distant or metastatic breast cancer could cause symptoms that vary as per the region where it has spread:
• Pain, including bone pain, where the breast cancer has spread
• Persistent dry cough
• Giddiness, balance problems or seizures
• Severe headaches
• Extreme tiredness
• Weight loss, nausea and loss of appetite
• Numbness or weakness.
Triggers for Recurring Breast Cancer
Recurrence of breast cancer occurs if the therapy fails to kill all the cancerous cells in the breast. Though cancer therapies are effective, cancerous cells in the breast can survive for varied reasons. For example, therapy can shrink cancerous tumours to the extent that tests fail to detect these weakened cancer cells. Nevertheless, as the cells are still present, over a period, they will return much stronger and start growing again, creating more tumours. While surgery may remove a tumour, it will not always be 100% effective. This is partly because cancerous cells in the breast may move to nearby lymph nodes and tissue or enter the bloodstream.
Why Prevention is Pivotal
Breast cancer that returns or spreads is tougher to treat since therapies that worked earlier may not be so effective the second time. Metastatic breast cancer is also challenging to manage since it has spread to other areas of the body. Given this scenario, one must focus on preventing recurrence.
Specific treatments may help lower the risk of some breast cancer subtypes that tend to recur. For instance, hormone therapy could curb the recurrence risk for women with early-stage oestrogen-receptive breast cancer. Similarly, undergoing chemotherapy after surgery (called adjuvant therapy) could lower recurrence risk.
Prevention is the best cure. Therefore, regular breast self-examinations and periodic follow-up screenings will help the oncologist find recurring breast cancer before it can spread or while the metastatic tumours are still comparatively smaller and easy to treat. As a result, a woman must consult her doctor as soon as she notices any signs or symptoms mentioned above.
Lifestyle changes are also crucial. Eat wholesome, nutritious meals that include vegetables, fruits, whole grains and lean protein. Exercise regularly to stay fit and reduce stress. Finally, always adhere to follow-up care, tests or screening schedules. In consultation with the cancer care specialist, it’s always possible to ensure better outcomes that help women lead near-normal lives.
