Recurrent Breast Cancer

Last Modified: November 13, 2005

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Question

Dear OncoLink "Ask The Experts,"
I am looking for treatment options for women who have had breast cancer, had a mastectomy, radiation, and chemo, only to find two years later that a cancerous tumor has appeared in the other breast. My aunt is the patient, and I know she tested negative for carrying the cancer gene. Her mother died at a similar age as she is now from breast cancer. I am looking for as much information as possible on treatment options. Most articles do not talk about recurrence within two years and spreading to the other breast.

Answer

Carolyn Vachani RN, MSN, AOCN, OncoLink's Medical Correspondent, responds:

Unfortunately, despite all your aunt has gone through, breast cancer can reoccur, and does so in as many as 30% of patients (depending on the extent of their original tumor). Most recurrences occur within 2 years of the original diagnosis, but can also happen many years after therapy.

There are 2 ways this can happen:

• a recurrence of the original tumor, which can be local (in the same area as the original tumor), in nearby lymph nodes, or in other organs or bones (distant metastases).

• a new primary tumor, which is a second breast cancer that is unrelated to the first (typically in the opposite breast, and so, purely speaking, not a true recurrence, per se).

As you might expect, having one tumor does put you at risk for a second tumor. Treatment with tamoxifen after surgery, radiation, and/or chemotherapy in patients with hormone receptor- positive tumors (ER+/PR+) has been shown to decrease not only the risk of recurrence but also the risk of cancer in the opposite breast (contralateral breast). Tamoxifen has also resulted in improved overall survival. However, it is not an option for everyone, and so the risks and benefits should be discussed with your doctor.

Once detected, treatment options are based on whether it is a local recurrence, a second cancer, or a distant metastasis. Local recurrences or second cancers can often be treated similarly to the original cancer, with surgery and possible radiation , chemotherapy , or hormonal therapy . It can be, in a sense, like starting all over again. If it has been less than six months since chemo, the physician may choose a different type of chemotherapy, but if the treatment was some time ago, the same medications may still be effective.

As for distant metastases, these are not treated with surgery. If we can see tumor cells in one organ, we can assume there are some other cancer cells floating elsewhere in the body that have not grown enough to be detected on a scan. In order to have the best chance of catching these elusive cells, we need to give chemotherapy or hormonal therapy, since it can reach all areas of the body, unlike radiation or surgery. In addition, Herceptin can be an option for patients whose tumors are Her2-Neu positive (a marker determined by the pathologist), no matter what type of recurrence they have.



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