Q. I had breast cancer in the past, and I’m really scared of it coming back. What can you tell me about recurrent breast cancer?
A. Recur (“re-occur”) means the same breast cancer you initially experienced has returned. It may come back in your breast (the same one, if you had a lumpectomy; or the other breast); but it may also come back in another part of your body. The important thing to remember is recurrent breast cancer is the SAME cancer you had initially.
It’s possible for you to get breast cancer that’s entirely new; maybe you had DCIS the first time, and now you have ILC. These are different cancers. Or maybe you’ve developed cancer somewhere else in your body, cancer that’s not related to breast cancer. While this is obviously REALLY bad luck, it happens. The point is, it didn’t start with your original breast cancer.
Q. Why is that important, whether or not it’s related to my original breast cancer or not?
A. Because treatment can be very different. Breast cancer recurrence is generally more serious than a new breast cancer, as it indicates the cancer wasn’t knocked out by the initial treatment, and thus is inherently a “tougher” cancer. If you get a “new” breast cancer, one unrelated to your original cancer, you’ll probably get the same treatment as women who’ve never had cancer. But if your recurrence is in fact the return of your original cancer, the treatment will probably have to be more aggressive.
Q. I’ve heard of “local recurrence” and “regional recurrence” and “distant recurrence.” What’s the difference?
A. Local recurrence is cancer that comes back in the same breast. If it’s not invasive, it’s probably a “leftover” from your first cancer, cells the surgeon didn’t get or other treatment didn’t kill. This is almost like having a new cancer; your chances of dying aren’t very much greater than those of any woman with the same type of new cancer who had a mastectomy. Your treatment will probably involve surgery to remove the tumor (which can occur even if you’ve had a mastectomy, believe it or not; some breast tissue inevitably remains after surgery, and cancer can recur there, or even in your mastectomy scar). Further treatment, after surgery, will be determined once the pathologist has had a chance to examine the cancer cells.
If the cancer is invasive, it’s more serious; it means it’s had all the time between your initial treatment, and your second diagnosis, to spread; not only within your breast, but to other parts of your body. If you have invasive cancer in the same breast (or on the same side), you’ll probably have other tests to determine if the cancer has spread: mainly, bone scan, chest x-ray, and liver blood tests.
Regional recurrence is when cancer shows up in lymph nodes under your arm or above your collarbone, on the same side of your body as the original cancer. It’ll be treated more aggressively than a new cancer would be. While more serious than a local recurrence, this cancer is still not as life threatening as the one we all dread: distant recurrence, also known as metastasis.
Q. So, distant recurrence… that’s not good. Right?
A. Right. When breast cancer spreads to other parts of your body, via your bloodstream or lymphatic system, the four places it’s most likely to show up are in your bones, liver, lungs and, less commonly, brain. You don’t have bone cancer, liver cancer, lung cancer or brain cancer; you still have breast cancer, but in a new location. This is called metastatic breast cancer, and the sites where the cancer shows up are metastatic sites. Thus your treatment may be different that someone with one of these other cancers.
While a local or regional recurrence of breast cancer often responds well to surgery and other therapies, a distant recurrence is a difficult situation. Though it may respond to treatment, it’s not considered curable. Even so, about 10% of women with a distant recurrence live more than 10 years. And 1% to 2% of women with a distant recurrence are eventually considered cured; so don’t give up. If at some point you learn that your breast cancer has metastasized, hang in there; breakthroughs are happening every day.