Breast Cancer Stage

Recurrent and Metastatic Breast Cancer

Recurrent and Metastatic Breast Cancer

Recurrent breast cancer refers as the name suggests to any cancerous growth which comes back post first removal/ treatment. The treatment is directed to removing and destroying each and every malignant cell but still a few may evade the treatment and survive. These may find nutrition again, attach themselves to healthy cells and multiply. This growth is recurrent breast cancer. This recurrence of the cancer is not time bound and may come back in months or years. This may be a local recurrence when it comes back to the first original incidence site or it may be in other parts/organs of the body- distant recurrence. Recurrences can be treated, and even it is not possible to treat the disease completely, it can be controlled with therapy and medication.

The recurrence is usually captured or detected in post treatment routine follow ups as an abnormal cell growth detected in a mammogram. Also sometimes the surgical scar thickens after mastectomy – surgical removal of the cancer. Then there may be development of lump in the breast also it may show in other parts of the body.

Local recurrence is referred to the case where the cancerous growth reappears in the original site of the primary tumor. This is most common in women who got lumpectomy done when the recurrence in the remaining breast. Also in women with mastectomy done, it may occur in chest wall or skin. the symptoms in lumpectomy are new thickening or lump formation in the breast, dimpling around the lumpectomy skin, tightening of the skin and nipple changes. In mastectomy recurrence the symptoms include thickening of tissue around the mastectomy scar with nodules under the chest wall skin which may be painless.

Regional recurrence is referred to the cancerous growth which is seen in the lymph nodes of the collar bone region or the armpit. the symptoms may be swelling of the arm, of lymph nodes in the color bone, armpit with loss of sensation in the affected arm.

Distant (metastatic) recurrence is referred to the cancerous growth which affects the distant/ other parts of the body like lungs, liver and bones. The most common symptoms are difficulty in breathing, pain in the chest or the bones, presence of dry cough, headaches, nausea, fever, appetite loss, chills and weight loss.

Diagnosis and Tests

Usually it is diagnosed in the follow up care, or the patient herself may detect it during routine physical examination. It is followed by imaging tests. Breast ultrasound is done followed by mammography. Mammography will show any abnormal growth of cells. Ultrasound wis commonly used for women with lumpectomy. MRI is another imaging test which uses mgnet nd radio waves to film bnormal areas. These can be within the breast, chest wall, lymph node areas. Also blood vessels and nerves around the breast and armpit. The following tests may be used to help diagnose recurrent breast cancer: this will pin point the affected area with the tumor growth for biopsy. Another imaging test called CT scan may be done on head, pelvic bones, abdomen area for distant metastatis. This will help detect spread of cancer to internal mammary lymph nodes. X-rays of the chest and bones may be done to detect if an recurrence has occurred in the lungs or the bones. In addition to bone X-ray, bone scan can also be done. In a bone scan a radioactive dye is injected in the bloodstream which is absorbed in higher quality by the cancer cells. These are then highlighted in the scan. A similar nature PET scan may also be used to detect an recurrecnce in the whole body. A biopsy is an essential pathological examination which s invariably done. In this a tissue is removed for pathological examination to give conclusive results on the cancer growth. Also this tissue will undergo hormone and HER2 protein receptor tests to chech for the positive or negative promoter of cancer cells. Also a complete LFT (liver function test) and blood count may be performed for better treatment plan.

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