Gynecology And Obstetrics-

Breast cancer recurrence

definition

Breast cancer relapse is a relapse of the cancer, i.e. a recurrence of the tumor. After an initially successful treatment, the cancer returns. It can manifest itself again at the original location in the breast (local recurrence), or it can also occur in other organs or lymph nodes through transport via the bloodstream - the tumor has then "spread". The cause of a relapse are cancer cells that have escaped treatment and which can continue to multiply even years after therapy and lead to a new cancer.

Causes of Relapse

The cause of a recurrence of breast cancer is that malignant cells remain in the body, which survived the initial therapy and can now grow again into a tumor. One reason for this may be that the surgical removal of the tumor is not radical enough. This allows individual, overlooked cancer cells to remain in the breast, which can multiply again over the years. For this reason, the breast is always irradiated after the surgical removal of the tumor to kill any remaining tumor cells.

Unfortunately, even this procedure is not a one hundred percent guarantee that all cancer cells in the breast will be killed. Another option is that the cancer has spread unnoticed before the treatment, so that the cancer cells that have emigrated can settle in every corner of the body and multiply there again. Chemotherapy is usually done to prevent this from happening. For various reasons, such as special defense mechanisms and mutations in the cancer cells, however, these can possibly evade chemotherapy and persist in the body. Even years later, breast cancer can recur and manifest itself in other organs such as the lungs, liver, bones or the brain.

Concomitant symptoms as an indication of a relapse

The symptoms that occur in the event of a relapse depend on its localization. A local recurrence in the breast can lead to the formation of a lump, which the patient can feel.

If the lymph nodes are affected, they can enlarge so that they can be felt in the armpit pits as firm, fixed painless nodes. A recurrence of breast cancer can also occur in other organs if the tumor cells here have survived the therapy.In this case, the symptoms that occur depend on the organ affected in each case; the breast cancer has metastasized.

If the skeleton is affected, bone pain and spontaneous fractures often occur without adequate trauma. The spine and the bony pelvis are particularly often affected. If the liver is affected, upper abdominal pain and jaundice, i.e. yellowing of the skin and eyes, can occur. If a relapse occurs in the lungs, symptoms such as shortness of breath or persistent coughing (up to coughing up blood) can occur. Breast cancer recurrence can also occur in the brain; a multitude of symptoms are possible here. In addition to headaches, epileptic seizures, numbness or paralysis, brain metastases can also lead to personality changes.

Regardless of the location of the tumor, general symptoms such as unwanted weight loss, fever and fatigue can occur.

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Diagnosis of breast cancer

For the early detection of a relapse, there is a follow-up program for breast cancer patients, which usually lasts 5 years after completion of therapy. This includes performing a mammography every six months in order to detect a relapse early. Certain tumor markers (CA 15-3, CEA) can also indicate a relapse if there is a significant increase. If there is a specific suspicion of a relapse, further examinations are carried out. This includes the (ultrasound) examination of the lymph nodes, as well as an ultrasound examination of the abdomen and a bone scintigraphy in order to rule out metastasis that has already occurred.

For more information on breast cancer diagnosis, see also:

Mammography
Tissue samples in breast cancer
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Likelihood of relapse

About 5 to 10% of breast cancer patients suffer a relapse. A relapse can occur several years after the end of therapy. How high the individual risk of a person affected depends on several factors. This includes the size of the original breast tumor and its expansion into the surrounding structures. Different stages of breast cancer have to be differentiated. The characteristics of the tumor such as its growth pattern, the formation of certain receptors, its malignancy and the involvement of lymph nodes or other organs have a decisive influence on the risk of recurrence.

Period of risk of relapse

In the case of many types of cancer, 5 years after completion of therapy and without the occurrence of a relapse, one can speak of a cure, since after this period a relapse is very unlikely. Unfortunately, this does not apply to breast cancer, so that a relapse can occur even after more than 10 years. However, the longer the time lag to the first tumor, the more favorable the prognosis, as this behavior indicates a less aggressive, slowly growing tumor. An early relapse, on the other hand, which occurs months after the end of treatment, indicates a usually aggressive and more malignant tumor.

You can also find more information at: Chances of recovery in breast cancer

Treatment and therapy

In the treatment of relapse, a local relapse (renewed tumor formation in the breast or the adjacent lymph nodes, i.e. the tissue initially affected) must be distinguished from metastasis to other organs such as the liver, lungs, bones or brain. Therapy for a local recurrence usually aims again at a complete healing. Although there is an increased risk of recurrence as a result, the chances of recovery are good in the early stages.

In many cases it is necessary to amputate the breast together with the tumor, insofar as this could be avoided in the original operation. In addition, chemotherapy and / or hormone therapy must often be repeated in order to kill cancer cells that have already spread.

If, on the other hand, a relapse occurs in other organs such as the liver, lungs, bones or brain, the treatment is usually palliative and the prognosis is therefore less good. Surgical removal of metastases (e.g. the lungs) or irradiation (e.g. the brain) can reduce pain and other complaints and, if necessary, extend survival. Chemotherapy and hormone therapy can also reduce tumor-related symptoms and extend survival time, so that they can also be used if the side effects are taken into account. In the case of metastasis, the therapy goal is primarily to make the remaining life as comfortable and pain-free as possible for the patient and to extend the life of the patient with acceptable side effects.

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Prognosis, chance of recovery and survival rate

If a recurrence occurs in the breast or in the adjacent tissue (local recurrence), renewed therapy is carried out with the aim of complete healing. In the early stages, i.e. with a small tumor without the involvement of other tissues such as the pectoral muscle or the lymph nodes, the chance of recovery is high.

This often requires a mastectomy and chemotherapy. It should be noted, however, that even after successful therapy, the risk of the cancer recurring is significantly increased in these patients. However, if a relapse occurs in other organs (often liver, lungs, brain or bones), this corresponds to metastasis. The cancer is no longer limited to the breast but has spread throughout the body, which unfortunately drastically reduces the chances of a cure. The primary aim of the treatment is not to cure, but to increase the quality of life (palliative). Here, too, forms of therapy such as surgical removal, radiation and chemotherapy are used in order to extend survival time with the best possible quality of life.

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Recurrence after mastectomy

A relapse is also possible after a mastectomy (mastectomy). The tumor can grow again in the scar tissue, adjacent tissue, or along the chest wall. In this case, an attempt should be made to surgically remove the tumor as completely as possible, which is possible depending on the extent of the affected structures. Subsequent chemotherapy is often necessary to increase the chances of recovery. However, after a mastectomy, relapse can occur in other organs such as the liver, lungs, bones, or brain. In this case one speaks of a metastasis, so that the chances of a cure are much worse. In most cases, the focus is now on improving the quality of life and, if necessary, extending survival time.

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Lung metastases in breast cancer

In addition to a local recurrence, a recurrence in breast cancer can also occur as a metastasis. The lungs are one of the organs most frequently affected.

Small lung metastases usually do not cause any symptoms; only larger metastases lead to shortness of breath, coughing up blood, weight loss and chest pain. The suspicion can be investigated by an X-ray, to confirm a biopsy of the suspicious focus is usually done. As a rule, the treatment of lung metastases is palliative, as the chances of recovery are greatly reduced by sowing the tumor cells. Chemotherapy, radiation and in some cases surgical removal of the focus can improve the quality of life and possibly extend the life span.

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Liver metastases in breast cancer

Breast cancer recurrence in the form of a metastasis often occurs in the liver. Individual small metastases often remain asymptomatic; symptoms only arise when there are multiple or extensive findings. A biliary blockage can cause yellowing of the skin and eyes, which is often accompanied by excruciating itching. The formation of ascites (ascites) is also possible; liver failure can occur in advanced stages. The metastases can usually be clearly shown on ultrasound, CT or MRI. There are several treatment options, including the surgical removal of individual small metastases, radiosurgery, chemotherapy, freezing or chemoembolization. In most cases, however, these procedures serve to improve the quality of life and extend survival time; a cure is often no longer possible.