Relapse of breast cancer is the re-development of the disease several months or years after the end of treatment (chemotherapy, radiation therapy, surgical treatment). Cancer develops both at the site of the primary tumor and remotely. This condition will appear as a new tumor if another breast or another area of the mammary gland is affected.
A recurrence of breast cancer, of course, frightens a woman. After all, it seemed that she had completely gotten rid of this illness, but it all came back again. The patient involuntarily has questions about the correctness of the diagnosis and the completeness of the treatment. In most cases, the reason is not violations of treatment technology, but the inability to identify and destroy absolutely everything malignant cells that have entered the surrounding tissues with the blood or lymph flow. The time criterion is important: if from the moment of completion combination treatment(surgery, radiation therapy, chemotherapy) more than 6 months have passed, and during this period no metastases were detected during control examinations, then such cancer is considered a relapse.
Cancer will be recurrent if it is detected in the same mammary gland as the original tumor lesion, as well as if the tumor focus is located in any area other than the mammary gland. In the case of a distant location, they speak of cancer metastasis from primary focus, and relapse of the underlying disease. The presence of relapse indicates in most cases the fact that individual tumor cells turned out to be insensitive to the treatment.
Most often, breast cancer recurrence occurs in the same areas as cancer metastases, including but not limited to nearby breast and chest tissue, as well as nearby and distant lymph nodes. In addition, when breast cancer recurs, the skeletal bones, lungs, liver, peritoneum, and brain can be affected.
Cancer recurrence can occur at any time, but most often relapses occur 3-5 years after treatment. They can be local (the tumor appears in the treated breast or near a mastectomy scar) or distant (the tumor appears in some other place).
Oncologists classify recurrent breast cancer as follows:
The most common areas of recurrence of breast cancer are the lymph nodes, lungs, liver and bones.
Local recurrence of breast cancer: about 1/3 of all cases of relapse are detected by routine self-examination, 1/3 by diagnostic mammography, 1/3 of relapses only by a combination of ultrasound and mammography. Local recurrence of cancer in 80% of patients is not accompanied by other symptoms.
If cancer recurrence is suspected, an extensive examination is performed, including MRI and PET scan, as well as a breast biopsy.
Cancer recurrence in regional lymph nodes: accounts for about 40% of all cases of cancer recurrence. It is usually observed in cases where limited resection of lymph nodes was performed - partial lymph node dissection. When enlarged lymph nodes are independently detected, a biopsy and histological examination are usually performed.
There are a number of prognostic indicators that allow the doctor to predict the recurrence of cancer:
After surgical treatment or radiation therapy, the oncologist assesses the situation for the likelihood of relapse.
One of the main ways to detect cancer early is self-examination and self-examination (palpation) of the mammary glands.
Breast changes that may indicate relapse:
It is very important to pass tests medical examinations, including diagnostic examinations- Ultrasound of the mammary glands, mammography, as well as laboratory examinations as prescribed by a doctor. Initially upon completion primary treatment examinations are scheduled once a quarter, and then less frequently. You must strictly follow the specialist’s recommendations and have a mammogram every year.
The main treatments for recurrent breast cancer include:
The type of treatment for relapse depends directly on the type of treatment for the original disease. If lumpectomy was performed initially, then mastectomy is used in case of relapse; If there was a mastectomy first, then in case of relapse, radiation therapy is used. Chemotherapy and/or hormone therapy is used in any case.
Finding cancer in another breast most likely indicates a new tumor that is in no way related to the first disease. In this case, lumpectomy or mastectomy is used, and in certain cases, systemic treatment (hormonal and/or chemotherapy) and/or radiation therapy.
Systemic therapy is used when recurrent disease occurs in the bones, brain or lungs. Surgery or radiation therapy is used to relieve certain symptoms.
Immunotherapy (possibly in combination with hormone therapy) is recommended for patients whose malignant cells have increased level HER2/neu protein. This method is also used when chemotherapy and hormonal therapy are ineffective.
It is not uncommon for breast cancer to recur several months or even years after treatment. In case of relapse, the tumor appears in the same place where the first tumor was or in a distant place. During development cancerous tumor in the second breast or in another area of the mammary gland, then oncologists consider such a tumor to be a new formation.
C50 Malignant neoplasm of the breast
C50.9 Malignant neoplasm of breast, unspecified part
The reappearance of a cancerous tumor frightens a woman; many assume that initially there was an incorrect diagnosis or the treatment was not complete enough. But in reality, everything is different; in the vast majority of cases, re-development of the tumor is provoked not by incorrect therapy, but by the inability to detect and kill everything cancer cells, which penetrated into adjacent tissues through the blood or lymph flow.
Oncologists note that if more than six months have passed after the main treatment and no metastases were detected during control examinations, then the development of a second tumor is considered a relapse.
Also, a recurrence of cancer is considered to be the growth of a tumor in the same breast as the first tumor, as well as if the tumor appeared in another organ. When a distant cancerous tumor develops (in another organ), experts talk about metastasis of the primary tumor.
Typically, the recurrence of cancer indicates that some cancer cells have become resistant to treatment.
Typically, re-development of the tumor occurs not only in the nearby tissues of the mammary gland, chest, and lymph nodes. Often with relapses there is damage to the bones of the skeleton, brain, lungs, abdominal cavity, liver.
Recurrence of breast cancer often occurs under certain circumstances, and oncologists identify several factors that suggest recurrence of the tumor:
After treatment is completed, the specialist will evaluate possible risks re-development of the tumor and will prescribe observation.
The development of a second tumor can occur at any time, but as practice shows, most often the re-development of cancer occurs 3-5 years after the course of treatment is completed.
Recurrence of breast cancer can be determined independently through regular self-examination (feeling the mammary glands). In addition, some changes may indicate the re-development of a cancerous tumor:
After treatment for breast cancer, it is important to regularly visit a mammologist, have an ultrasound, mammography, and undergo tests if necessary. After treatment of the primary tumor is completed, the doctor prescribes quarterly examinations; over time, you can visit the mammologist less frequently.
In oncological practice, it is customary to divide breast cancer recurrence as follows:
If the patient is suspected of having a recurrence of breast cancer, the specialist will prescribe a repeat examination (MRI, biopsy, positron emission tomography).
Regular mammograms and self-exams can help diagnose cancer development in early stages.
If a recurrence of breast cancer is suspected, the patient is prescribed an ultrasound, mammography, biopsy, and analysis to determine the level of tumor markers to confirm the diagnosis.
After this, a study is carried out to determine the stage of the cancer and detect metastases.
In the laboratory, a study is carried out to determine the level of tumor markers or tumor markers(proteins, the amount of which increases in the body during the development of cancer). However, increased levels of such proteins can be observed not only during the cancer process, so this diagnostic method is auxiliary.
Ultrasound examination complements the results obtained with mammography ( x-rays). Mammography allows you to identify a tumor, its location, and size.
A biopsy (examination of a small piece of tissue taken from the tumor using a puncture) allows you to more accurately diagnose the tumor and determine its stage oncological process.
In addition, magnetic resonance imaging or computed tomography may be used to diagnose cancer.
Once the cancer has recurred, your doctor may order an x-ray. thoracic, mammography of the second breast, densitometry (determination of bone density) if metastasis to bone tissue is suspected.
Recurrence of breast cancer is subject to certain basic therapeutic methods, including local treatment (tumor removal surgery, radiation therapy) and systemic treatment (hormonal, chemotherapy, targeted drugs).
Recurrent development of a cancerous tumor is assessed by specialists as a more aggressive form of the disease, therefore in most cases it is carried out complex treatment(local and systemic therapy), which is aimed at destroying all pathological cells that could penetrate other organs or tissues, but were not identified during the examination.
The treatment your doctor chooses depends on the treatment of the original cancer.
If the tumor was removed during the first incident of cancer surgical method(with preservation of the breast), then if the tumor develops again, surgery to remove the mammary gland is prescribed.
If the mammary gland was initially removed, then if the cancer develops again, radiation therapy is used. Hormonal treatment and chemotherapy is prescribed in both cases.
If a tumor is detected in the second breast, a new cancer is usually diagnosed, which is not related to the original one. In this case, the doctor may prescribe complete removal mammary gland or only tumor removal.
Systemic treatment is prescribed when cancer recurs in bone tissue, brain or lungs. Radiation therapy and surgery are prescribed to reduce some severe symptoms diseases.
Some patients who have pathological cells with increased levels of the HER2/neu protein are prescribed hormone therapy in combination with immunostimulants (this type of treatment is also used in case of negative dynamics after chemotherapy).
Targeted drugs are used primarily during clinical trials. New technology is aimed at destroying only pathological cells, while healthy cells remain untouched.
To prevent a recurrence of breast cancer, it is necessary to begin prevention immediately after the end of treatment. With breast cancer, the likelihood of cancer cells entering the lymph and blood is quite high. After treatment, the specialist will determine the possible risks of tumor re-development. If there is a high probability of relapse, the doctor may advise you to undergo a course of chemotherapy, which will help destroy cancer cells that were not detected during the examination, or prescribe tamoxifen (a drug that suppresses the effect of estrogen).
Recurrence of breast cancer often develops even after treatment full course therapeutic therapy. At the same time, the disease does not always resume its course again a year after complex therapy - sometimes symptoms of relapse of breast cancer can be noticed 10-20 years after treatment. In this condition, the tumor can appear again in the same place, or form in another breast.
What to do if the disease reoccurs? In this case, it is necessary to immediately begin treatment for cancer to stop the growth malignant neoplasm and maintain breast health.
Recurrence of cancer after a mastectomy, medication, radiation or other type of therapy is a malignant tumor. Recurrence and metastases of breast cancer can affect the same mammary gland, nearby lymph nodes, or distant tissues of the gland.
If the cancer has recurred in the other breast, the oncologist treats the disease as a separate tumor and creates a new treatment plan. However, its metastasis to bone tissue is also considered as breast cancer and is not a separate pathology.
Thus, there are 3 options for the development of cancer:
If the tumor manages to recur, it will develop more quickly and aggressively, which, of course, will negatively affect the woman’s health.
When does a tumor manage to recur?
|
Risk of relapse |
Factors |
| Short | Breast cancer has not affected nearby lymph nodes and vessels, and the size of the tumor is relatively small - up to 2 cm. The patient's age is up to 35 years. Several therapeutic options have been attempted. |
| Moderate | The affected area exceeds 2 cm, and the pathology spreads to nearby blood vessels. The Her2/neu gene was detected or 1-3 lymph nodes were affected. |
| High | Breast cancer was discovered on late stages. 1-4 or more lymph nodes are affected and vascular network near the tumor, the Her2/neu gene was detected, the patient’s age is over 35-40 years. The disease is aggressive and has metastasized; the rate of division of malignant cells is increased. One treatment option was undertaken. |
If the patient consults a doctor in a timely manner, which will allow timely initiation of complex therapy for the disease, the survival rate in this case is 60%.
When a tumor in the chest develops again, it frightens the patient even more than the previous disease. The woman begins to think that the disease cannot be cured completely, and, despite the measures taken, it will continue to occur.
Basically, the manifestation of a neoplasm occurs when, during treatment of breast cancer, doctors fail to completely destroy cancer cells, especially if they have managed to penetrate healthy breast tissue or spread along with the blood to another organ. During surgery, it is difficult to assess the extent of spread of malignant cells, since without their active growth it is impossible to identify a new location of the tumor.
According to oncologists, if more than 6 months have passed after the main therapy, and no metastases were detected during testing, then a repeated exacerbation of the disease is considered a relapse. If in postoperative period new ones were identified tumor cells This means that the pathology was not completely cured.
The appearance of a malignant neoplasm in another organ can also be called a relapse. In this case, the tumor cells were transported throughout the body along with the bloodstream, which caused a new focus of infection. Doctors call this phenomenon metastasis of the primary tumor.
The appearance of metastases in a woman’s body suggests that some malignant cells were insensitive to it during therapy. This indicator requires urgent reoperation or conservative therapy, which will preserve the health of the affected organ.
Recurrence of breast cancer in women often occurs as a result of specific circumstances. Today, oncologists know a number of factors that serve as the beginning of the recurrence of the disease:
After completion of treatment, the doctor will assess the risk of recurrence of the cancer process, and will also inform the woman about the need for an annual breast examination.
As a rule, symptoms of relapse of the disease can be noticed at any time after therapy, but often the disease begins to develop again 3-5 years after the end of the treatment course.
To avoid breast cancer, you need to know which groups of women are most susceptible to developing the pathology.
As statistics show, most often the disease is diagnosed in women 35-45 years old, but sometimes the disease occurs in younger representatives of the fair sex who have reached the age of 25 years.
To begin with, the risk group includes those women who have hereditary predisposition to the disease. If breast cancer has been observed in the female line, the disease develops in 50% of cases.
This usually depends on the type of previous therapy (meaning that only one treatment option was attempted, and not a combination of them):
Thanks to scientific research, it was found that women who have cancer genes in their blood should also be included in the risk group. These genes look like this: BRCA-II on chromosome 13 and BRCA-I on chromosome 17. In this case, metastasis can increase the risk of developing the disease by another 10%.
If breast tumors are not cured in time, the disease will progress rapidly. In 10% of patients who consult a doctor, the disease is already accompanied by metastases. The difficulty of treatment lies in the fact that such patients cannot be subjected to surgery, since they have active growth of metastases or general exhaustion of the body has been identified.
The main danger of the disease is the high mortality rate of women for whom treatment did not help or doctors did not have time to perform the operation. The probability of a complete cure of the disease is only 30%, while in other cases a relapse of the disease is possible.
How does the spread of cells that are not destroyed during treatment? Together with lymphatic fluid or blood flow, malignant cells can penetrate many organs. These include:
In this case, the therapy is carried out more comprehensively, which will completely destroy the cancer cells.
Cancer – dangerous pathology, which develops rapidly in the body, therefore early detection symptoms will help prevent the development of a large tumor that can lead to death in the patient.
A recurrence of a cancerous tumor can be detected independently - to do this, it is enough to carefully palpate the breast and visit a doctor annually. If the disease is completely cured, the mammary gland will be soft and without hard tubercles or lumps.
The following signs usually indicate the development of a relapse:
As a rule, these are the symptoms that indicate repeated metastasis, the treatment of which must be carried out in short terms. To avoid relapse after tumor therapy, you should visit your doctor regularly (especially the first couple of years) so that the disease can be detected in time.
To determine the prognosis of the disease, a woman should undergo all diagnostic measures, which will allow you to put accurate diagnosis, as well as to identify the structure and degree of malignant neoplasm.
A doctor will be able to identify breast cancer by examining the patient and listening to the symptoms that worry her. You will also need to undergo a mammogram to confirm the diagnosis.
If using such diagnostic methods If the disease cannot be confirmed, the patient will need to undergo the following research methods:
If a woman has previously undergone surgical treatment, she will need to examine the scars, since it is in them that a recurrent tumor most often develops.
A biopsy is necessary to distinguish between the formation of a new isolated tumor or the recurrence of an old one. When analyzing a biopsy, it will be possible to identify the sensitivity of cancer cells to targeted and hormonal treatment.
In the postoperative period and as a preventive measure for breast cancer, it is necessary to visit a mammologist. If he detects oncology in a woman, the doctor will refer the patient directly to an oncologist, since only a specialist will help carry out complex treatment.
If the disease has metastasized to other organs, for example, to the uterus and ovaries, then the woman will also be observed by a specialist in the relevant field - a gynecologist.
Radical treatment of the disease is carried out using several methods. These include:
As a rule, more often the patient is prescribed local treatment for severe course diseases. If cancer develops on initial stage, systemic therapy will be required. Also, the type of treatment depends on the frequency of relapses, because sometimes they can occur frequently - this depends on the incomplete destruction of cancer cells, which over time form a new tumor.
If the disease is detected in a woman for the first time, they can help overcome it medicines. However, the benefit of such therapy will only be if the patient strictly follows the instructions for use of the drugs, does not violate the dosage, and also follows the doctor’s advice.
Often, the reappearance of the disease indicates the aggressiveness of cancer cells, which are not so easy to destroy. In this case, the patient is prescribed complex therapy(both local and systemic), which will completely overcome all pathological cells that could enter the patient’s organs, tissues or lymph nodes during the first treatment.
Repeated therapy carries a greater chance of full recovery, because the doctor conducts a thorough examination to understand exactly where the cancer cells have spread in the female body. But if the patient does not visit the doctor in a timely manner, breast cancer can affect a large part of the breast - as a result, its removal (partial, complete, with excision of part of the lymph nodes) is required.
What can be done to avoid recurrence of the disease? To prevent a relapse, it is necessary to carry out prophylaxis that will avoid the recurrence of the pathology.
As a rule, preventive measures it is necessary to carry out immediately after therapy, since cancer cells can enter the bloodstream, thereby causing recurrent disease.
Preventive measures include:
How much medication do you usually need to take? To avoid reinfection, you should take the medications for six months.
With a local relapse after a mastectomy, during which the lymph nodes were not affected, the survival rate of patients is 75%. In this case, cured patients will be able to live more than 5 years. If metastases are found in the breast, the life expectancy of women is 3 years. Detection of the disease at an early stage allows the disease to be completely cured.
After therapeutic treatment the patient needs to carry out prevention, as well as monitor the condition of the breast - if growths, burning, thickening, peeling appear on it, it is necessary to visit a doctor, since such signs indicate the development of a malignant tumor. In this case, only a doctor can give a correct assessment this state. He will also examine the scar to understand what kind of disease the patient is developing and will give directions for tests. (No ratings yet)
Breast cancer in some cases re-develops at the original site (relapse) or spreads to other organs and systems (metastasis).
In this article we'll talk about the reasons for the development of recurrent breast cancer after surgical treatment, risk factors for the recurrence of cancer, as well as about the diagnosis and prevention of recurrent breast cancer.
Repeated cancer breast cancer develops in the same area as the primary cancer site. In patients who have undergone lumpectomy ( partial removal breast tissue), local relapse forms in previously healthy mammary cells. After a mastectomy (complete excision of the mammary gland, regional lymph nodes and parts muscle tissue) some women experience the development of oncological pathology along the chest wall or on the skin of the chest.
Signs of recurrent cancer with initial localization:
Symptoms of local recurrence on the chest wall after mastectomy include:
After breast surgery Cancer can re-develop in nearby lymph nodes, which are located in:
Deleted malignant tissue can cause metastases in distant areas of the body. Most often, such lesions are localized in the tissues of bones, liver and lungs.
Distant relapse is manifested by the following symptoms:
Breast surgery involves the complete removal of mutated cells that form a malignant tumor. In some cases, cancer cells can break away from the primary lesion and become fixed in nearby breast tissue. As a result, it is from such cellular elements that repeated postoperative lesions can form, that is, repeated breast cancer.
Some patients, after the initial diagnosis of breast cancer, are prescribed chemotherapy, radiation or hormonal therapy to destroy malignant tissue. But sometimes such treatments are not able to completely neutralize cancer cells.
Latest scientific research prove that modified cells human body can remain at rest for many years without causing any subjective health complaints in the patient. Subsequent activation of such structures can lead to distant relapses of the disease and the development of a malignant tumor.
If a gynecologist, during a follow-up postoperative examination, suspects the presence of repeated malignant breast lesions, he may prescribe additional methods research. The diagnosis is clarified using magnetic resonance imaging, computed tomography, bone tissue scanning and positron emission diagnostics.
The final diagnosis of the presence or absence of relapse after breast cancer surgery is established after histological analysis of biological material taken directly from the area of pathological tissue. This analysis is carried out during a biopsy.
Treatment of relapses begins with surgery and includes the use of radiation therapy, if it has not been done before. Also, if breast cancer returns after surgery, the cancer patient may be recommended chemotherapy and a course of hormonal drugs.
Methods and treatments that oncologists use today:
Exercise reduced the death rate from breast cancer recurrence by 40 percent
The results of the work were published in the Canadian Medical Association Journal (Hamer, Warner, Lifestyle modifications for patients with breast cancer to improve prognosis and optimize overall health).
Breast cancer is the most common cancer in women, accounting for about a quarter of all women. malignant tumors. Thanks to modern methods screening, primarily mammography, up to 90 percent of breast cancer cases in developed countries are detected at an early stage and successfully operated on, but up to a quarter of patients later die from metastases and relapses. Numerous studies have shown that certain aspects of lifestyle may influence the risk of relapse, but integral large-scale comparisons of their effects have not yet been carried out.
To find out the role various factors on the risk of recurrent breast cancer, two researchers at the Sunnybrook Health Sciences Center in Toronto conducted a meta-analysis of 67 high-quality large studies (including reviews and previous meta-analyses) on the topic.
It turned out that greatest influence the risk of relapse is influenced by regular physical exercise: 150 minutes moderate loads evenly distributed throughout the week, or 75 minutes of intense exercise per week, including two to three strength training, involving all major muscle groups. Such physical activity is associated with a 41 percent reduction in breast cancer mortality after treatment.
The second most important factor was normalization of body weight - overweight increased the risk of cancer death after treatment by 11 percent, and obesity by 35 percent. The various components of the diet did not significantly affect mortality.
How exactly is it implemented? beneficial effect exercises, it’s hard to say. According to one of the authors of the work, Ellen Warner, one possible explanation could be a reduction in inflammation, which damages cells and increases the risk of cancer spreading.
Annie McTiernan of the Fred Hutchinson Cancer Research Center, who was not involved in the work, noted that the results should be treated with caution. Study participants self-selected their exercise regimen, and women with undiagnosed breast cancer recurrence may have exercised less due to increased fatigue. To clarify the possible role of this factor, randomized controlled trials are needed, McTiernan said.
Recently charitable organization Cancer Research UK has awarded multi-million pound grants to two laboratories to basic research breast cancer The University of Cambridge will have to take microscopic photographs of tumor sections to build VR models of them, which should facilitate training of doctors and conducting research. The Netherlands Cancer Institute will analyze histological and clinical data from thousands of patients and use it to create an algorithm that can predict when an early form of breast cancer, ductal carcinoma in situ, which responds well to treatment, will develop into an invasive malignancy.
July 20, 2011Breast cancer detected in its early stages is curable in almost 90% of cases.
read February 19, 2010IN medical literature There is growing evidence that regularly taking aspirin reduces the likelihood of developing various forms cancer and the risk of disease progression and fatal outcome for breast cancer. But the Ministry of Health warns...
