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Diseases & Conditions

Breast Cancer Recurrence

When and where do recurrences occur?

Breast cancer can recur at any time, from months to years after initial treatment. Breast cancer can come back as a local recurrence (in the treated breast or near the mastectomy scar), regional recurrence (in the lymph nodes or collar bone area on the affected side) or as a distant recurrence somewhere else in the body. The most common sites of recurrence include the lymph nodes, the bones, liver, or lungs.

How do I know there is a recurrence?

Women who have been treated for breast cancer should continue to practice breast self-examination, checking both the treated area and the other breast each month. A woman should report any changes to her doctor right away. Breast changes that might indicate a recurrence include:

  • An area that is distinctly different from any other area on either breast
  • A lump or thickening, in or near the breast or in the underarm that persists through the menstrual cycle
  • A change in the size, shape, or contour of the breast
  • A mass or lump, which may feel as small as a pea
  • A marble-like area under the skin
  • A change in the feel or appearance of the skin on the breast or nipple [dimpled, puckered, scaly, or inflamed (red, warm, or swollen)]
  • Bloody or clear fluid discharge from the nipples
  • Redness of the skin on the breast or nipple

In addition to performing monthly breast self-exams, keep your scheduled follow-up appointments with your oncology health care team. During these appointments, your health care provider will perform a breast exam and ask you about any symptoms you might have. Initially, these follow-up appointments may be scheduled every three to four months. The longer you are cancer-free, the less often you will need to see your oncology team. Continue to follow your health care provider's recommendations on screening mammograms (usually recommended once a year).

Prognostic indicators

Prognostic indicators are characteristics of a patient and her tumor that may help a physician predict a cancer recurrence. These are some common indicators:

Lymph node involvement — Women who have lymph node involvement are more likely to have a recurrence.

Tumor size — In general, the larger the tumor, the greater the chance of recurrence.

Positive or close tumor margins — One of the things that the pathologist reviews at the time of your surgery is that the tissue close to the edge of the sample is clear of any disease. If it is not clear, it may be recommended that you have a re-excision. The reason for this is that close or positive margins suggest that there may be some tumor still in the breast. It is important to treat that tumor either with additional surgery or consideration of radiation to the margin. Your oncology treatment team will determine the best approach for your individual case.

Lack of radiation treatment following a lumpectomy — A lumpectomy, or partial mastectomy, is usually always followed by radiation therapy. Lack of radiation following a partial mastectomy can increase the risk of local recurrence.

Nuclear grade — This is the rate at which cancer cells in the tumor divide to form more cells. Cancer cells with a high nuclear grade (also called proliferative capacity) are usually more aggressive (faster-growing).

Younger age — Younger women, particularly those under the age of 35, have a higher risk of recurrent cancer.

Inflammatory breast cancer — Inflammatory breast cancer tends to be a more aggressive cancer and has a higher risk of local recurrence. Typically, if you have an inflammatory breast cancer, recommendations for treatment will include a mastectomy followed by radiation to the chest wall.

Treatment team

Your treatment team will likely include, but is not limited to, a surgeon, medical oncologist and radiation oncologist. Together, these providers will determine the likelihood of the cancer recurring and will make treatment recommendations to decrease and treat this risk. Possible treatment options may or may not include surgery, chemotherapy, targeted therapy [trastusumab (herceptin)], radiation therapy and endocrine therapy (medications to be taken orally to block estrogen in hormone receptor positive tumors).

Treatment of breast cancer recurrence

The type of treatment for local breast cancer recurrences depends on the woman's initial treatment. If she had a lumpectomy, local recurrence is usually treated with mastectomy, since radiation therapy cannot be delivered twice to the same area. If the initial treatment was mastectomy, recurrence near the mastectomy site is treated by removing the tumor whenever possible, usually followed by radiation therapy. In either case, hormone therapy and/or chemotherapy may be used after surgery and/or radiation therapy. If breast cancer is found in the other breast, it may be a new tumor unrelated to the first breast cancer. Treatment would include a lumpectomy or mastectomy and, sometimes, systemic (chemotherapy and/or endocrine) therapy.

Women with distant recurrence involving organs such as the bones, lungs, brain, or liver, are treated with systemic therapy using chemotherapy, hormonal therapy, or both. Radiation therapy or surgery also may be recommended to relieve certain symptoms.

References

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 9/27/2013...#8328