An Introduction to Breast Cancer Recurrence: Part I
What happens when our greatest fear becomes reality?
"The cancer’s back.“ Those are words none of us ever wants to say aloud. We all picture it happening; there’s no way we can put breast cancer behind us forever. Only a saint would have the willpower to never imagine, never wonder” is it still in me? Will it come back? For many of us-all of us?–emotions outweigh statistics. The fear is always there.
And then, one day, your worst nightmare comes true. Cancer IS back. What do you do? How do you handle it?
Knowledge is power: start by finding out and understanding which of the three kinds of recurrence you have: local, regional, or distant. This SharePost covers local and regional recurrence. I’ll save distant recurrence, or metastasis, for my next entry.
Local recurrence occurs on the same side as the first tumor: usually in the breast, if you’ve had a lumpectomy; but in the skin, underlying tissue, or chest wall if you’ve had a mastectomy.
Two-thirds of breast cancers that occur in the same breast happen very close to where the original tumor was located; these are generally regarded not as a return of cancer, but as cancer that was never fully eradicated. The other third are usually new cancers, unrelated to the first incidence. (This is an important distinction; new cancers are often "easier" to treat successfully.)
A regional recurrence refers to cancer that reappears in your lymph nodes; 40% of women with a local recurrence will also experience regional recurrence at the same time. Only 2% of breast cancer cases are purely a regional recurrence: one that is nowhere else in the breast area, AND hasn’t spread to other parts of your body.
Very rarely, recurring breast cancer will be found in the lymph nodes under your opposite arm, the arm on the side not previously treated. But it’s most commonly found on the same side: under your arm, at the base of your neck, below your collarbone, or along your breastbone. Ever wonder what the oncologist is feeling for, when (s)he presses all around your neck and shoulders during your follow-up visits? (S)he’s feeling your lymph nodes.
With a local or regional recurrence, you’ll have a biopsy, just like your first time around. But this time, you’ll have additional tests to rule out cancer’s spread to other parts of your body (metastasis). You may have a bone scan, chest X-ray, CAT scan, MRI, and blood test. Thankfully, in 80% of women with a local recurrence, these tests all come back negative.
Treatment for Locally or Regionally Recurring Breast Cancer
Treatment for locally and regionally recurring breast cancer will depend on a number of factors: whether or not the cancer is invasive; whether you previously had a lumpectomy or mastectomy, and where the cancer is.
If you had DCIS and now you have invasive cancer in the same breast, you’ll probably have a mastectomy and may have to go through chemo. On the other hand, if you’ve had invasive cancer, and now you’re experiencing DCIS in the other breast, you might be able to get away with just a lumpectomy and radiation. With local and regional recurrences, every course of treatment is different, depending on your previous cancer experience.
_See An Introduction to Breast Cancer Recurrence, Part II: Distant or Metastatic Recurrence _
PJ Hamel is senior digital content editor and food writer at King Arthur Flour, and a James Beard award-winning author. A 16-year breast cancer survivor, her passion is helping women through this devastating disease. She manages a large and active online survivor support network based at her local hospital and shares her wisdom and experience with the greater community via HealthCentral.com.