Treating breast cancer recurrence

Being at high risk of being diagnosed with breast cancer is different to being at high risk of a recurrence of breast cancer.

Research shows that breast cancer is more likely to come back after treatment in women who have had:

•  Cancer in the lymph nodes under the arms.
•  A large tumour.
•  An aggressive type of cancer.
•  Negative oestrogen receptors.

Breast cancer can recur or come back in three ways:

•  The cancer can return at the original site. This is called a local recurrence.
•  The cancer can recur nearby, such as in the chest. This is called a regional recurrence.
•  The cancer can spread to a distant part in the body, such as lymph nodes, bone marrow or lungs. This is called a distant recurrence or a metastasis.

Your doctor will order more tests to see if the breast cancer has spread, beginning with a physical examination and often a biopsy. Your doctor is checking to see if cancer is present, and if so, if it is a recurrence of the same type of cancer or a completely new cancer (which is called a second primary cancer.)

If it is a recurrence, additional tests may include a bone scan, X-rays including CT scan, an MRI (which stands for Magnetic Resonance Imaging), blood tests and a PET (which stands for Positron Emission Tomography) scan.

Treatment will depend on whether the recurrence is local, regional or distant.

• Local recurrence can be treated with a mastectomy if a lumpectomy was originally performed.
• Regional breast recurrence is rare. Treatment may include a combination of surgery, medicine and radiation.
• Treating a distant recurrence of breast cancer that has spread (called metastastic) can include:
  • Hormone therapy and/or chemotherapy with or without trastuzumab, depending if you are oestrogen receptor (ER) positive or positive for the HER2 gene
  • Using radiation therapy to shrink tumours or surgery to remove tumours. This is done to relieve pain or reduce other symptoms
  • Enrolling in clinical trials for new chemotherapy or hormone therapy agents

Before treatment begins for metastatic breast cancer, you should understand all the options, including the risks and benefits of treatment. The focus of treatment for metastatic cancer is on extending life and having a good quality of life, rather than a cure.

Women are encouraged to continually re-evaluate their breast cancer treatment and talk with their doctor about whether treatment is helping their quality of life. During this time, women should take the best possible care of themselves by:

•  Eating properly
•  Getting enough rest
•  Seeking out emotional support when needed
•  Possibly making plans in the event their condition worsens