If Breast Cancer Comes Back
If breast cancer comes back, it may return in the same place. This is called a recurrence, because it is not a new cancer. But a recurrence can also appear in a place not directly related to the first breast cancer. This is called a metastasis, and if cancer is detected in several areas, these are called metastases. If breast cancer comes back, it tends to show up in specific areas of the body: the breast or the area where the breast used to be, the chest wall, the lymph nodes, the bones, the lungs or around the lungs, the liver, or the brain.
Cancers from other parts of the body rarely spread to the breast or the chest wall. If you have a tumor in your lymph nodes, lungs, liver, bones, or brain, it probably is a regrowth or recurrence of the original breast cancer rather than a new and different cancer. In other words, if you had breast cancer and you now have cancer in your bones, liver, or other places, it’s probably not bone or liver cancer, but breast cancer that has spread to the bones or the liver. This is important because breast cancer – even when it has spread – is usually more treatable than a cancer that starts in the bones or liver.
The return of breast cancer can be especially shocking if you have passed the five-years-since-diagnosis mark.
Breast cancer that returns in other parts of the body is invasive cancer. However, cancer that comes back in the breast after surgery or radiation therapy can be either non-invasive or invasive.
If you have developed a cancer in the opposite breast from the one that was originally treated, it’s probably not a recurrence. Most cancers that develop on the other side represent a new cancer rather than a recurrence. Breast cancer can return in three general locations:
- Local, in the breast where it started or in the skin and underlying tissues where the breast used to be
- Regional, in the lymph nodes next to the breast
- Metastatic, in another part of the body, such as the lung, liver, bone, or brain, or in lymph nodes far from the breast
If you have symptoms or tests that suggest the cancer has returned, you probably feel scared about the future. It’s important to get help coping with your fear of recurrence, and not try to brave your way through it alone. You also probably have many questions that are very hard to ask: “How could this happen after I worked so hard to do everything right? I followed every doctor’s recommendation. I ate all the right foods and exercised regularly, even when I wanted to skip it.”
It is hard to make sense of this. This is particularly true if your original cancer was only in the breast; your chest X-ray, blood tests, and bone scan were all normal; and your surgeon assured you, “I got it all.” The return of breast cancer can be especially shocking if you have passed the five-years-sincediagnosis mark.
This is where the limits of tests for cancer become apparent. Tests can detect a growth of one-half to one centimeter or more. But they are not sensitive enough to detect a collection of single cancer cells. Cancer cells that somehow escaped destruction the first time can grow and spread. Eventually, the tumor is big enough to see on an X-ray, feel with your hand, or cause symptoms.
A lot of anger comes with this crisis – anger at the treatments you had and your doctors for their inability to cure you, anger at yourself for not beating the disease, anger at your body for betraying you yet again.
“Maybe I should have had the mastectomy.” “Why did I stop tamoxifen?” “How could I have waited so long when I felt that lump?” All this second-guessing gets you nowhere. But it’s not easy to let it go. You’re trying to make sense of something that makes no sense, pin blame where there is none.
The best thing to do is to remind yourself that recurrence is not a death sentence. Breast cancer that returns to just the breast or nearby lymph nodes may be treated effectively with an excellent outcome. Disease that has spread to other parts of the body may be put in long-term remission.
Also, keep in mind that you won’t have the same experience with recurrent or metastatic breast cancer as women you know who had it years ago. New treatments for recurring cancer have improved survival. One large recent study showed that over the past few decades, women diagnosed with breast cancer have had significantly improved survival. And new treatments that have been widely used only in the past few years might mean even longer survival in the years to come.
The likely course of the disease depends on where and how extensively the breast cancer has returned, the “personality” of the cancer that has come back, how long it’s been since you were last treated for breast cancer, which cancer treatments you’ve already had, any other medical problems you have, and your general health.
All of these facts need to be reviewed carefully. Only then can you and your doctors work out a plan of action.
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