Treatments for Local and Regional Recurrence

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There are many effective treatments for a local or regional recurrence of breast cancer.

Local treatments include surgery and radiation. Systemic (whole-body) treatments include chemotherapy, hormonal therapy, and targeted therapies, such as Herceptin (chemical name: trastuzumab). Find out about a test that may help decide which treatments are right for you.

Which local and systemic therapies you get, and how much, depends on many of the same factors that were important when you were first diagnosed. For starters, what treatments will work best for you depends, in part, on where the cancer comes back and its "personality" features.

Recurrence in the breast

Careful imaging, or pictures of areas inside the body, is critical in determining treatment options. Even if you have already had several imaging tests in order for your doctor to make a diagnosis, you may have more mammography, MRIs, CAT or PET scans, ultrasound, and if necessary, chest X-rays.

If the cancer has come back in the area of the original lumpectomy, but you have no signs of disease elsewhere, then your outlook is probably quite good.

If the cancer came back just as a small lump in your breast, you may need only local treatment. Local treatment is successful in 8 out of 10 women who have a breast cancer recurrence that is limited to the breast.

If your initial treatment was lumpectomy and radiation therapy, then the standard of care for a recurrence is complete removal of the breast (mastectomy). Another lumpectomy followed by radiation therapy is usually only an option if you haven't had radiation therapy before and your risk of cancer spread is very low. Here are some signs that your situation would be considered encouraging:

  • The breast cancer came back only at the place where it first appeared.
  • The cancer lump is at most four centimeters wide and can be completely removed.
  • The recurrent cancer is not invasive (DCIS [ductal carcinoma in situ]).
  • It's been a long time between when you were last treated and when the cancer came back.
  • The cancer does not appear to be very aggressive and has not spread to nearby lymph nodes.

If you already had lumpectomy and radiation therapy, you may be able to get into a study or clinical trial using partial breast radiation as an alternative to mastectomy.

If the cancer has some features that are less encouraging, your doctor may recommend some sort of systemic (whole-body) treatment. The purpose of this treatment is to get rid of any cancer cells that might be outside the breast but can't be seen on tests. Find out about systemic (whole-body) treatments here.

Recurrence in the chest wall

Cancer that returns after a mastectomy in the place where the breast used to be is called a chest wall recurrence. You might have surgery first to remove the tumor. But surgery is rarely recommended if you have:

If you have recurrence within a reconstructed breast, occasionally your doctor may recommend that the flap or implant be removed.

After you recover from surgery, radiation therapy is usually the next treatment given if you haven't had it before. If you have had radiation in the past, limited additional radiation therapy may still be an option. But in that case you will be more likely to develop significant side effects from the extra radiation, including:

  • a skin rash that doesn't heal
  • an increased risk of rib fractures
  • scarring and tightness of the muscles

To reduce side effects that can occur after repeat radiation, your doctor might make changes in your treatment. He or she might alter:

  • the amount of radiation in each dose
  • the frequency of each treatment
  • the size of the area treated

For example, your doctor might recommend smaller doses of radiation given twice a day.

If you haven't had radiation therapy before, your side effects will be less severe. You will probably just get a sunburn-like reaction that's red, sore, tight, and itchy and might peel and ooze. Your doctor may recommend one or a combination of things to help avoid, reduce, or relieve these problems, including:

  • Biafene
  • Jeans cream
  • Lindi Skin cream
  • aloe vera
  • Aquaphor
  • A & D ointment
  • Silvadene ointment
  • 1% hydrocortisone
  • a prescription steroid cream such as betamethasone

During your treatment, if the side effects on your skin and soft tissue get worse, your nurse or doctor might recommend a stronger combination of medicines.

You may also get twinges of pain or stiffness of the chest wall that can be relieved by Tylenol (acetaminophen) or anti-inflammatory medicines. In some women who have breast implants, radiation therapy may cause a hard capsule of scar tissue to form around the implant. This capsule can be painful and distort the shape of the breast.

Systemic (whole-body) therapy, such as chemotherapy, hormonal therapy, or targeted therapies, may be recommended after chest wall recurrence. About half the women who develop a chest wall recurrence have cancer cells that eventually spread beyond the chest area. Medicines that work on the entire body can help get rid of those cells.

But you may not need chemotherapy if ALL of these categories apply to you:

  • You are post-menopausal.
  • You have only one small, removable chest wall tumor.
  • Your recurrence developed 10 years or more after your first treatment for breast cancer.

The type of treatment that's recommended depends partly on what treatments you've had before. Sometimes, cancer comes back in the chest wall while you're on hormonal therapy. In this situation, your doctor will probably recommend that you switch to another type of hormonal therapy. The hormonal therapy itself did not trigger the occurrence. It's just that you have been on one medicine long enough so that it's stopped fighting the cancer adequately, and another hormonal therapy might be able to do that.

Regional Recurrence

If you develop breast cancer that recurs in lymph nodes near the breast, you probably will need both local and whole-body treatment.

Local treatment might include surgery to remove the affected lymph nodes, and possibly also radiation therapy. Whole-body treatment might include chemotherapy, targeted therapies such as Herceptin (chemical name: trastuzumab), and hormonal (anti-estrogen) therapy.

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