Recurrent Ductal Carcinoma
Recurrent Ductal Carcinoma is a recurrence of a certain form of breast cancer - ductal carcinoma - after initial treatment for the disease.
There are several ways in which cancer recurrence can occur in the breast area, and they mean different things.
Most commonly, it can come back in the area of the original cancer. If there has been a wide incision and radiation, it can come back in the breast itself. In this case, it is viewed not as a spread but as leftover cancer inadequately treated in the first place.
Studies of women who have had this type of reappearance of cancer in the breast itself show that that their likelihood of dying of the disease is not much greater than that of women who have not had this type of recurrence.
When a mastectomy is done, there is often an immediate reconstruction with a muscle flap. The skin has been irradiated and may not heal as well, so the added tissue from the back or abdomen, with its own blood supply, will not only give a good cosmetic result but also help healing. This type of local recurrence is not considered a metastasis and does not imply spread anywhere else in the body. In this way, it is very different from the type of recurrence that occurs after a mastectomy.
Another type of recurrence occurs in the lymph nodes under the arm. Further treatment to this area with either surgery or radiation will often take care of this problem.
Recurrence in lymph nodes elsewhere, such as in the neck or above the collarbone, has a more serious implication, since these are probably metastases. They are more akin to local recurrence after mastectomy and usually warrant a more aggressive approach.
If the local occurrence is on the scar or chest wall after a mastectomy, it is very serious.
The most telling sign is a lump in the neck area or collarbone that might indicate a lymph node. When breast cancer spreads to the bones, it is almost always in the big bones - hips, thighs and backbone, and not in the knees or elbows or ankles.
Other symptoms may indicate metastasis to the liver or lungs.
The first step to take if a local recurrence is detected is to repeat the staging tests to make sure that there is no sign of cancer anywhere else in the body.
If the tests are normal (and they usually are), then it is necessary to decide on the best way to eradicate the tumor from the breast. Usually in these cases, a mastectomy is performed since the less drastic surgery and radiation did not take care of it before.
If the cancer has spread, the first step is to repeat the initial staging tests in order to determine the extent of the problem. The treatments are basically the same as for the first occurrence. There are more limitations, however. You can only radiate a certain area once, so radiation will not be used again. Surgery can only be performed in limited conditions: a cancerous tissue that is easy to cut out without damaging other structures.
Even chemotherapy has its restrictions. Some drugs have severe side effects if more than a certain dosage is given. So the treatment must be tailored to the problem. The goal is also different: in adjuvant therapy, the physician is trying to achieve a cure; with metastatic cancer, the objective is to prolong life and alleviate the symptoms.
Where is the recurrence?
How extensive is it?
Will you do staging tests to determine the extent of the problem?
Is any metastasis involved?
What are treatment options?
What is the prognosis?