Breast Cancer Recurrence

Types and treatment of breast cancer recurrence Recurrence describes the return of breast cancer after primary treatment.1 There are three types of recurrent breast cancer:1 • Local recurrence occurs when cancerous cells reappear at the original tumour site over time. Local breast cancer recurrence is not considered to be a spread of the cancer but rather due to failure of the initial treatment. Even after mastectomy, portions of breast skin and fat remain, making local recurrence possible, albeit uncommon. Rather, it is women treated with breast-conserving therapy and radiation who are at slightly higher risk of this type of recurrence. Treatment of locally recurring breast cancer depends on the initial therapy undertaken at the time of first diagnosis. If breast conserving surgery was originally performed, recurrent breast cancer will usually be treated with mastectomy. • Regional recurrence is more serious than local recurrence because it usually indicates that the cancer has spread past the breast and underarm (auxiliary) lymph nodes. Regional recurrences of breast cancer can occur in the chest muscles, in the internal mammary lymph nodes under the breastbone and between the ribs, in the nodes above the collarbone and in the nodes surrounding the neck. The latter two sites of regional recurrence tend to suggest more aggressive cancers. Overall, regional recurrence is very common, occurring in approximately 2% 5% of all breast cancer cases. Treatment can be complex however, including surgery to remove the cancerous node, radiotherapy, chemotherapy and adjuvant endocrine therapy depending on the previous treatment used. • Distant recurrence, also known as metastasis is the most serious type of recurrence and is associated with significantly lower survival. Having left the confines of the breast tissue, the cancer usually spreads first to the axillary lymph nodes. In 65-75%2,3,4,5 of distant recurrences the breast cancer then spreads from the lymph nodes to the bone. More rarely, the breast cancer may metastasise to other sites including the lungs, liver, brain or other organs. Surgery is rarely an option for metastatic breast cancer because the cancer is not usually confined to one specific site on a given organ. Instead, treatment approaches include chemotherapy, radiation therapy or endocrine therapy.