Learn about symptoms that alert doctors to a breast cancer recurrence and strategies for treating cancer that comes back after initial treatment.
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.
Signs and symptoms of recurrent breast cancer vary depending on where the cancer comes back.
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:
Signs and symptoms of local recurrence on the chest wall after a mastectomy may include:
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:
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:
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.
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.
For breast cancer survivors, factors that increase the risk of a recurrence include:
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.
Strategies that have been linked to a reduced risk of breast cancer recurrence include:
If your doctor suspects you may have recurrent breast cancer based on results of a mammogram or physical exam, or because of signs and symptoms, he or she may recommend additional tests to confirm the diagnosis.
Tests and procedures may include:
Imaging tests. What imaging tests you'll undergo will depend on your specific situation. Imaging tests may include magnetic resonance imaging (MRI), computerized tomography (CT), X-ray, bone scan or positron emission tomography (PET).
Not every person needs every test. Your doctor will determine which tests are most helpful in your particular situation.
Removing a sample of tissue for lab testing (biopsy). Your doctor may recommend a biopsy procedure to collect suspicious cells for testing, as this is the only way to confirm whether your cancer has returned. Working in a laboratory, a pathologist examines the cells and determines the types of cells involved.
A pathologist can determine if the cancer is a recurrence of cancer or a new type of cancer. Tests also show whether the cancer is sensitive to hormone treatment or targeted therapy, since these may have changed since your original cancer diagnosis.
Your treatment options will depend on several factors, including the extent of the disease, its hormone receptor status, the type of treatment you received for your first breast cancer and your overall health. Your doctor also considers your goals and your preferences for treatment.
Treatment for a local recurrence typically starts with an operation and may include radiation if you haven't had it before. Chemotherapy and hormone therapy also may be recommended.
Surgery. For recurrent breast cancer that's confined to the breast, treatment usually involves removing any remaining breast tissue.
If your first cancer was treated with a lumpectomy, your doctor may recommend a mastectomy to remove all of your breast tissue — lobules, ducts, fatty tissue, skin and nipple.
If your first breast cancer was treated with a mastectomy and the cancer comes back in the chest wall, you may have surgery to remove the new cancer along with a margin of normal tissue.
A local recurrence may be accompanied by hidden cancer in nearby lymph nodes. For this reason, the surgeon may remove some or all of the nearby lymph nodes if they weren't removed during your initial treatment.
Treatments for a regional breast cancer recurrence include:
Many treatments exist for metastatic breast cancer. Your options will depend on where your cancer has spread. If one treatment doesn't work or stops working, you may be able to try other treatments.
In general, the goal of treatment for metastatic breast cancer isn't to cure the disease. Treatment may allow you to live longer and can help relieve symptoms the cancer is causing. Your doctor works to achieve a balance between controlling your symptoms while minimizing toxic effects from treatment. The aim is to help you live as well as possible for as long as possible.
Treatments may include:
Immunotherapy. Immunotherapy uses your immune system to fight cancer. Your body's disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that help them hide from the immune system cells. Immunotherapy works by interfering with that process.
Immunotherapy might be an option if you have triple-negative breast cancer, which means that the cancer cells don't have receptors for estrogen, progesterone or HER2. For triple-negative breast cancer, immunotherapy is combined with chemotherapy to treat advanced cancer that's spread to other parts of the body.
No alternative medicine treatments have been found to cure breast cancer. But complementary and alternative medicine therapies may help you cope with side effects of treatment when combined with your doctor's care.
For instance, many people diagnosed with cancer experience distress. If you're distressed, you may feel sad or worried. You may find it difficult to sleep, eat or concentrate on your usual activities.
Complementary and alternative treatments that can help you cope with distress include:
Your doctor can refer you to professionals who can help you learn about and try these alternative treatments. Tell your doctor if you're experiencing distress.
Finding out your breast cancer has returned can be equally or more upsetting than your initial diagnosis. As you sort through your emotions and make decisions about treatment, the following suggestions might help you cope:
Find someone to talk with. Find a good listener who is willing to listen to you talk about your hopes and fears. This may be a friend or family member. The concern and understanding of a counselor, medical social worker, clergy member or cancer support group also may be helpful.
Ask your doctor about support groups in your area. Or check your phone book, library or a cancer organization, such as the National Cancer Institute or the American Cancer Society.
If you have any signs or symptoms that worry you, make an appointment with your primary care doctor or family doctor.
Your doctor can recommend the necessary tests and procedures to confirm a diagnosis of recurrent cancer. Then you'll likely be referred to a doctor who specializes in diagnosing and treating cancer (oncologist).
If you might have recurrent breast cancer, some basic questions to ask your doctor include:
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to spend more time on. Your doctor may ask: