Cancer Recurrence / Understanding Your Cancer A
cancer recurrence occurs when breast cancer cells reappear in the area
around the breast (local or regional recurrence) or in other areas of
the body (distant metastasis). These microscopic cancer cells
presumably moved through the bloodstream or lymphatic system before
your diagnosis and found a niche elsewhere in your body. These cells
can remain dormant for years. Then something happens to wake them up.
If we could figure out what puts these cells to sleep and then what
wakes them up, we'd be a long way toward eliminating breast cancer.
There are five different types of recurrences: Local recurrence after breast conservation Most
local recurrences after breast conservation surgery (lumpectomy) occur
in the area of the original tumor, on average three to four years after
the initial treatment. If your initial treatment was a lumpectomy
followed by radiation, the first sign of a local recurrence can be a
change in how your breast looks or feels. Any change that occurs more
than one or two years after the completion of radiation therapy should
always be looked into immediately. Cancer cells that survived your
first treatment cause this type of recurrence.
New cancer in the breast (new primary) This
type of recurrence typically occurs many years after the original
cancer and in an entirely different area of the breast. Its pathology
is often different—lobular instead of ductal, for example. These second
cancers are not too common, but they remain possible as long as you
have your breast. These should be treated as a completely new cancer,
much as with second cancers in the opposite breast.
Local recurrence after mastectomy A
local recurrence can also occur in the scar or chest wall after a
mastectomy. Actually, the term "chest wall" is inaccurate here, because
it implies that the cancer is in the muscle or bone. This type of
recurrence appears in the skin and fat sitting where the breast was
before; only rarely does it include the muscle. About 10 percent of all
women treated for breast cancer with a mastectomy will have this type
of recurrence. Ninety percent of these recurrences happen within the
first five years after the mastectomy.
Regional recurrence A
regional recurrence is one in the lymph nodes in the armpit (axilla) or
above the collarbone. Now that we are taking out fewer lymph nodes from
the armpit, it is possible that a cancerous node can be left behind.
This is rare, though, occurring only in about 2 percent of breast
cancers.
Distant recurrence (metastatic disease) When
a cancer spreads to a different organ, it's known as a distant
recurrence, or a metastasis. If a metastasis is detectable at the time
of first, or primary, diagnosis, the patient is described as being in
Stage IV. As hard as it is to face a local recurrence, metastatic
disease can be even more devastating. There are the same feelings that
go with any recurrence, compounded by the knowledge that the chance of
a cure is slim. The goal is to create the best quality of life for
yourself in the time you have and, at the same time, maintain hope.
Contrary to common belief, metastatic breast cancer is rarely an
immediate death sentence, and women with metastasis often live for a
number of years with good treatment, and with reasonable quality of
life.
Learn more about the treatments available to you if you have had a cancer recurrence in Treatment Decisions.
Metastatic Disease In
order to metastasize, cancer cells have to evade the body's immune
system, make new blood vessels, travel through the bloodstream, figure
out what organ to go to, break out of the blood vessel, get into the
new organ, and set up a new home. But even when early metastasis has
occurred, it doesn't necessarily spell doom. Let's say that the cell
has successfully made the journey to the lung. Once it arrives there it
has to establish a new home by making new blood vessels. It's possible
that other cells in the lung may be able to keep these invaders under
control. The cells then act normally until something happens—a change
in the lung's environment or a new genetic alteration occurs that
allows the breast cancer cells to grow in the lung. This might explain
why some women will have a recurrence of breast cancer many years after
the first diagnosis. Those cells were there from the beginning but were
dormant until the right conditions induced them to grow again.
It's
also possible for metastatic cells to go off and hide and hang out. One
such hiding place is bone marrow. We know this because researchers have
found cancer cells in the bone marrow of people who never got
metastases.As you see, metastasis isn't as simple a process as we once
thought it was. It isn't simply that the cells spread, then grow, and
then kill you. There are a whole lot of steps, and the steps may take a
relatively long time.
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Getting The Best Breast Cancer Care The Guide to Quality Breast Cancer Care, developed by the National Breast Cancer Coalition Fund, can help you to understand how to use medical evidence to make informed decisions and get the highest quality care.
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