Local Recurrence

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Two-thirds of the breast cancers that come back in the same breast return to the same place, or right near the original cancer. The other third are new cancers. Breast cancer in a separate part of the same breast, or in the other breast, is usually a new cancer. It is not a REoccurrence, but a new FIRST occurrence.

About one-third of local breast cancer recurrences are found by mammography alone. Another third are found by physical exam (either a breast self exam or a doctor's examination) alone. And about one-third are found by a combination of mammography and physical exam. About 80% of women who develop a recurrence in the breast have no signs of the cancer elsewhere in their bodies

Local recurrence following lumpectomy and/or radiation

If you had a lumpectomy, with or without radiation therapy, you may have a local recurrence. Symptoms of such a recurrence are a new lump that gets bigger and doesn't go away, or an area of new thickening in the breast.

But don't panic if you find a lump in your breast at the site of the original tumor. This is probably one of three harmless things:

  • fatty tissue that has broken down as a result of your treatment
  • scar tissue wrapped around a little stitch your surgeon tied when sewing the area back together (a "suture granuloma")
  • scar tissue filling in the hole left by the breast tissue that was removed

Redness and swelling of the breast area can result from cancer recurrence, but usually it's related to something else. The entire breast area can look swollen and red for up to a few months after surgery and radiation. Over time, the redness usually fades to pink and then gets back to something close to your normal color. But that can take a long time.

If new redness develops months or years later in the breast area, especially if the breast also feels warm and tender, it's most likely a breast infection (mastitis). Breast infections require immediate medical attention so that you can start taking antibiotics right away. Antibiotics usually clear them up. If the antibiotics don't work within a week or so, and the breast area is still swollen and red, your doctor will probably want to do a biopsy.

Sometimes non-cancerous skin rashes (such as psoriasis, particularly in a woman with a history of psoriasis), can appear on the breast. It is possible, though, that redness and swelling of the skin are signs of cancer recurrence. The skin covering the breast area can thicken and looks something like the peel of an orange ("peau d'orange"), and may be reddish-pink.

Have your doctor evaluate any lump near your original tumor site. To help figure out if a lump in your breast is cancerous, your doctor may have you get a mammogram. Your doctor may suspect a local recurrence if a mammogram shows:

  • an increase in the size and irregularity of the site where your original cancer was removed
  • a new lump or irregularity
  • a new cluster of small white spots called microcalcifications

Your doctor may follow up a suspicious mammogram with more testing. You may have an ultrasound, an MRI, or a PET scan. If these tests suggest that you might have a recurrence, then your doctor will biopsy the lump.

Local recurrence after mastectomy

If you had a mastectomy, local recurrence may be felt or seen in or around:

  • the skin where the breast used to be
  • the soft tissues that remain on the chest wall
  • a reconstructed breast

In rare cases, a new breast cancer—unrelated to the first one—can appear after mastectomy. The new cancer grows from one of the few remaining normal breast cells. These cells were under the skin covering the breast, or in front of the muscle behind the breast. An experienced pathologist can usually tell if this breast cancer is a new cancer or a recurrence of the previous one by comparing the cells taken from this sample with your initial cancer specimen under the microscope. A new cancer may be easier to treat effectively than a recurrence of the former cancer.

Different types of lumps

If you had a mastectomy with tissue reconstruction, it's common to get harmless lumps or swellings called "fat necrosis." These are caused by scar tissue or deposits of dead fat cells. They are not cancerous lumps. Such changes are unlikely to happen with implant reconstruction alone. You may first feel fat necrosis lumps a month or two after reconstruction surgery, when the swelling of all the tissues has settled down. Over time, areas of fat necrosis stay the same size or get smaller. If there are several lumps together, they may shrink down and clump together as one big lump. If any one of the lumps starts to get bigger, let your doctor know. But it's likely that the increase in size is nothing to be concerned about.

If you notice new lumps within or under the skin, they may be cause for concern if they are:

  • irregular
  • firm-to-hard
  • pearly pink-to-red
  • not tender (although some may be tender)

If you had breast reconstruction with your own tissue (TRAM, GAP, or DIEP flap), a mammogram may help tell the difference between fat cell necrosis and new changes over time.

But if you had implant reconstruction, a mammogram will not be helpful because the silicone implant bag blocks the view. In this case, your doctor's physical examination of your breast is very important. An ultrasound and/or MRI may also be helpful if you have an implant. Occasionally a PET scan might be recommended if your doctor is very concerned about recurrence.

Different types of rashes

Sometimes non-cancerous skin rashes may develop (such as psoriasis, particularly in a woman with history of psoriasis).

Occasionally, however, a red velvety rash with swelling of the skin may appear. This could be an inflammatory breast cancer recurrence. If the rash has open sores that won't heal, it is almost certainly cancer.

If you had radiation therapy, it's common to have swelling, redness, soreness, and skin thickening on the area of the chest where the breast used to be. These changes progress slowly during radiation, peak one to two weeks after radiation is finished, and then usually get better over time (within one or two months after you've finished radiation).

But if you get these symptoms for the first time weeks after treatment is finished, they are most likely due to infection, and your doctor will probably give you antibiotics to clear them up. If you have had no skin abnormalities recently, you should bring any new changes to your doctor's attention.

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