comscoreRecurrent Breast Cancer

Recurrent Breast Cancer

A breast cancer recurrence is breast cancer that has come back after treatment after a period of time when cancer couldn’t be detected. Recurrence can happen months or many years after the original breast cancer was treated.
 

A breast cancer recurrence is breast cancer that has come back after treatment after a period of time when cancer couldn’t be detected. Recurrence can happen months or many years after the original breast cancer was treated.

During surgery to remove the original breast cancer, the surgeon removes all the cancer that can be seen and felt. But tests for cancer aren't sensitive enough to detect single cancer cells or groups of a few cancer cells that may remain after surgery. It is possible for a small group of cells to survive radiation therapy and chemotherapy after surgery. Even a single cancer cell that remained after treatment may be able to multiply and grow into a tumor.

Cancer found in the opposite breast with no cancer in another part of the body is likely a new cancer, not a recurrence.

 

Local recurrence

Local recurrence means the cancer came back in the same breast or in the surgery scar.

Symptoms of local recurrence

The symptoms of a local recurrence are about the same as symptoms of invasive ductal carcinoma:

  • a new lump in the breast or the chest wall

  • an area of the breast that feels unnaturally firm

  • swelling of all or part of the breast

  • skin irritation or redness in the breast area

  • flattening or other nipple changes

  • skin pulling or swelling near the original breast cancer surgery site or thickening of surgery scars

After breast cancer surgery and radiation therapy, the breast area may be swollen and red for a few months after those treatments are completed. Still, if you have any concerns about any changes you notice in your breasts, talk to your doctor.

If you had a mastectomy and breast reconstruction, you may feel lumps caused by a build-up of scar tissue or dead fat cells in the reconstructed breast. These lumps usually aren’t cancer, but tell your doctor about any lumps you feel in your breast so they can be monitored.

Diagnosis of local recurrence

Diagnosing a local recurrence involves a combination of procedures and almost always includes:

Other tests that may be used are:

Staging local recurrence

The stage of a local recurrence is determined by the cancer’s characteristics, such as how large it is and whether or not it has hormone receptors. The stage of the cancer helps you and your doctor:

  • figure out your prognosis, which is the likely outcome of the disease

  • decide on the best treatment options for you

  • determine if certain clinical trials may be an option for you

Doctors know that the characteristics of a local recurrence may be different than the original breast cancer. For example, the original cancer may have been hormone receptor-negative and the local recurrence may be hormone receptor-positive.

This is why your doctor will do more tests on the local recurrence. These tests, as well as the results of your biopsy, make up the parts of your pathology report.

Information commonly collected as part of a pathology report includes:

  • size of the breast cancer

  • Nottingham grade of the cancer

  • tumor necrosis

  • tumor margins

  • lymphovascular invasion

  • lymph node status

  • hormone receptor status

  • HER2 status

  • rate of cell growth (Ki-67 levels)

Treatment of local recurrence

Depending on the characteristics of the cancer, treatments for a local recurrence may include:

Still, because you’ve received treatment for breast cancer before, you and your doctor will take your previous treatments into consideration when deciding on a treatment plan for the local recurrence.

If your original surgery was lumpectomy, your doctor will probably recommend mastectomy to remove the local recurrence. Doctors usually don’t recommend a second lumpectomy to treat local recurrence.

If the original surgery was mastectomy, a local recurrence near the mastectomy site is usually treated by removing the tumor.

If the local recurrence is in a reconstructed breast, your doctor may recommend removing the implant or tissue flap used to rebuild the breast. You can discuss options for reconstructing the breast again with your medical oncologist and plastic surgeon.

If you had radiation therapy as part of your original treatment plan, your doctor will consider the location of the local recurrence and the original dose of radiation you received when deciding if radiation treatment makes sense for the local recurrence.

If you had chemotherapy, hormonal therapy, targeted therapy, or immunotherapy as part of your original treatment plan, your doctor will consider the medicines used when deciding if any of these treatments make sense for the local recurrence.

 

Regional recurrence

Regional recurrence means the cancer came back in the lymph nodes in the armpit or collarbone area near where the original cancer was diagnosed, or in the chest wall or skin of the breast.

Symptoms of regional recurrence

The symptoms of a regional recurrence are:

  • a lump or swelling in the lymph nodes under the arm, above the collarbone or near the breastbone

  • pain, swelling, or numbness in one arm or shoulder

  • constant chest pain

Diagnosis of regional recurrence

Diagnosing a regional recurrence involves a combination of procedures and almost always includes:

Other tests that may be used are:

Staging regional recurrence

A regional recurrence is considered locally-advanced breast cancer and is usually considered stage III breast cancer.

Doctors know that the characteristics of a regional recurrence may be different than the original breast cancer. For example, the original cancer may have been hormone receptor-negative and the regional recurrence may be hormone receptor-positive.

This is why your doctor will do more tests on the regional recurrence. These tests, as well as the results of your biopsy, make up the parts of your pathology report.

Information commonly collected as part of a pathology report includes:

  • size of the breast cancer

  • Nottingham grade of the cancer

  • tumor necrosis

  • tumor margins

  • lymphovascular invasion

  • lymph node status

  • hormone receptor status

  • HER2 status

  • rate of cell growth (Ki-67 levels)

Treatment of regional recurrence

Depending on the characteristics of the cancer, treatments for a regional recurrence may include:

Still, because you’ve been treated for breast cancer before, you and your doctor will take your previous treatments into consideration when deciding on a treatment plan for the regional recurrence.

If the regional recurrence is in the lymph nodes in the armpit or the collarbone, your doctor will likely recommend surgery to remove the affected lymph nodes.

If you had radiation therapy as part of your original treatment plan, your doctor will consider the location of the regional recurrence and the original dose of radiation you received when deciding if radiation treatment makes sense for the regional recurrence.

If you had chemotherapy, hormonal therapy, targeted therapy, or immunotherapy as part of your original treatment plan, your doctor will consider the medicines used when deciding if any of these treatments make sense for the regional recurrence.

 

Survivorship care after local or regional recurrence treatment

Because of treatments they’ve received, many breast cancer survivors have a higher risk of developing other diseases as they age, including high blood pressure, heart disease, and osteoporosis. To make sure breast cancer survivors are regularly screened for these and other, experts have developed the idea of survivorship care planning.

Survivorship care plans are written documents made up of two parts.

The first part is a treatment summary, a record of all the breast cancer treatments you’ve received.

The second part is basically a roadmap of what you can expect in the years after treatment, including any late or long-term side effects you might have, and a schedule of how you’ll be monitored for these side effects and other health conditions. This part of the survivorship care plan usually includes:

  • the tests you’ll have

  • which doctors will order the tests

  • a schedule of when the tests will be done

  • healthy living recommendations

  • resources, if you need more information

Learn more at Before Treatment: Planning Ahead for Survivorship.

 

Metastatic recurrence

Metastatic or distant recurrence means the cancer came back in a part of the
body away from the breast, such as the liver, bones, or brain. Learn more at Metastatic Breast Cancer.

Reviewed by 1 medical adviser
 
Jenni Sheng, MD
Johns Hopkins University School of Medicine, Baltimore, MD
Learn more about our advisory board

— Last updated on January 20, 2022, 4:24 PM