What is Breast Cancer Recurrence?

Breast cancer recurrence is when the cancer comes back sometime after treatment. Breast cancer can recur months or years after treatment, during a time of remission. Remission is the period of time when tests show no signs of cancer, and you have no symptoms. There are 3 types of cancer recurrence: local, regional, and distant.

If you develop breast cancer in the opposite breast from the original breast cancer and the cancer is not found anywhere else in the body, you would be given a new breast cancer diagnosis. This is not the same as breast cancer recurrence. The chance of recurrence is dependent on the type, location, severity of the cancer, and what types of treatments you did. Radiation therapy or a combination of other treatments often helps to reduce the risk of recurrence.

There are multiple treatments for breast cancer recurrence, whether it is local, regional, or distant recurrence. Consult with your healthcare provider if you notice any of your symptoms of breast cancer returning.

Signs and Symptoms

Symptoms of breast cancer recurrence are dependent on the location of the breast cancer. Depending on if it is local, regional, or distant recurrence the symptoms may vary.

Symptoms of local recurrence

• A new lump in your breast or abnormal firmness in the breast
• Swelling in the chest, armpit, or around the collarbone
• Area of redness on the breast or inflammation of the breast skin
• Changes to the skin texture of your breast (puckering or dimpling, like an orange peel)
• Nipple discharge
• Inverted nipple or nipple that looks differently than normal
• Swelling in the arm or hand

If the local recurrence happens after a mastectomy, signs and symptoms appearing on the chest wall may include:

• One or more painless nodules on or under the skin of your chest wall
• New area of thickening near or along the mastectomy scar

Symptoms of regional recurrence

Signs or symptoms of regional recurrence may include:

• Chronic chest pain
• Difficulty swallowing
• Pain, swelling, or numbness in one arm or shoulder
• Swollen lymph nodes under the arm or near the collarbone or breastbone

Symptoms of distant recurrence

Distant (metastatic) recurrence means that the cancer has spread to distant organs or tissues in the body. Metastatic breast cancer usually spreads to the bones, lungs, brain, or liver. Symptoms include:

• Persistent and worsening pain in the chest, back, ribs, or hips (bone pain)
• Difficulty with breathing
• Persistent cough
• Dizziness or balance problems
• Extreme fatigue
• Unexplained weight loss
• Loss of appetite or nausea
• Persistent and worsening headaches
• Vision problems
• Seizure

Local Recurrence

Local recurrence is cancer that returns to the same breast or chest area that the breast cancer originated in. It recurs in the same breast or along the surgery scar. If you have undergone a lumpectomy, the cancer may recur in the remaining breast tissue. If you have undergone a mastectomy, the cancer may come back in the tissue that lines the chest wall or in the skin.

Regional Recurrence

Regional recurrence of breast cancer means that the cancer has returned near the original tumor in the lymph nodes, which are in the armpit or collarbone area. The cancer has not spread anywhere else in the body. People with regional recurrence breast cancer have a greater likelihood of the cancer cells spreading to other areas in the body.

Distant Recurrence

Distant recurrence is breast cancer that has spread from the primary cancer to other organs or tissue in the body. It is also referred to as secondary or metastatic cancer. It usually affects the bones, lungs, liver, or brain.

Causes

Recurrent breast cancer is caused by cancer cells from the original tumor. The recurrence happens when the original cancer cells hide in nearby tissue or another part of the body and survive against the original cancer treatments. Over time, these cancer cells may grow or spread. Sometimes cancer cells can remain inactive for years without causing harm, and then they can become activated, causing the cancer to grow and spread. There is no known cause for why cancer cells that are inactive for a time can reactivate.

Risk Factors

There are several risk factors for recurrent breast cancer. Risk factors include:

• Original breast cancer had spread to the nearby lymph nodes
• Larger tumor size
• Positive or close tumor margins
• Not getting radiation therapy following a lumpectomy
• Younger in age (under 35)
• Cancer type (inflammatory breast cancer and triple-negative breast cancer)
• Cancer stage at the time of diagnosis correlates with cancer recurrence
• Not receiving endocrine therapy for certain types of breast cancer
• Cancer cells that have certain characteristics (i.e., cells that lack receptors for estrogen or progesterone or have a lack of a protein called HER2)
• Obesity

Diagnosis

Recurrent breast cancer is diagnosed by using some of the same tests that were administered during your original diagnosis. Your doctor may also recommend additional tests such as a bone scan or X-rays to detect if the cancer has spread. More specifically, common tests for breast cancer recurrence include:

• Routine breast exam
• Mammogram
• Ultrasound
• MRI, CT scan, or PET scan
• Biopsy

Treatment

There are several treatment options for breast cancer recurrence. The treatment will depend on the cancer type, size, and location. There are some variations in treatment depending on whether the recurrence is local, regional, or distant.

Treating local recurrence

Treating local breast cancer recurrence depends on what treatment options were used on the original cancer. Treatment options include:

• If you had a lumpectomy for the original breast cancer, the breast cancer recurrence is typically treated with a mastectomy.
• If the original breast cancer treatment was a mastectomy, the cancer recurrence along the mastectomy scar is treated by surgically removing the tumor whenever possible. This is usually followed up with radiation therapy.

Treating regional recurrence

When breast cancer recurrence comes back in the surrounding lymph nodes (under the arm or near the collar bone), it is treated by removing the lymph nodes. Sometimes this will be followed by radiation therapy if it was not already administered in the same area during the original breast cancer. Additionally, other treatments such as chemotherapy, targeted therapy, or hormone therapy may also be considered post-surgery.

Treating distant recurrence

Treating distant recurrence is generally done in the same way as when the original stage IV breast cancer was diagnosed. The only difference being that treatments may or may not include previous treatments or drugs that were used during the original breast cancer. This may be discussed when certain cancer cells build a tolerance for drugs involved in chemotherapy. Distant recurrence can be difficult to treat, so make sure your doctor discusses all treatment options with you, including getting involved in clinical trials.

Prevention

Although there is no clear way to prevent breast cancer from recurring, there are several strategies that have been associated with a reduced risk of breast cancer recurrence. Strategies include:

• Hormone therapy
• Chemotherapy
• Radiation therapy
• Target therapy
• Bone-building drugs
• Maintaining a healthy weight
• Regular exercise
• Limiting alcohol
• Healthy and balanced diet

Complications

Breast cancer recurrence has potential to be harder to treat than the original cancer. This is because the same treatments are sometimes no longer effective. Tumors or cancer cells can build up a tolerance to treatments like chemotherapy. The good news is there are several different cancer drugs, alternative treatments, and new or developing cancer drugs in clinical trials.

Additionally, there are often side effects from cancer treatments. The most common side effects are pain, extreme fatigue, and weight loss. The specific complications depend on the treatments you are receiving. Chemotherapy treatment complications may include:

• Hair loss
• Fatigue
• Nausea
• Lymphedema (when the lymph fluid does not drain properly and causes swelling under the skin)
• Skin changes
• Pain