Breast cancer recurrence after chemotherapy. Prevention of recurrence of breast cancer

Breast cancer in some cases develops again at the original site (relapse) or spreads to other organs and systems (metastasis).

• Relapses are usually identified with a mammogram after a routine physical examination.
• Metastases are mainly diagnosed with the development of specific symptoms of the disease.

This article will discuss the causes of breast cancer recurrence after surgical treatment, risk factors for the recurrence of cancer, as well as the diagnosis and prevention of recurrent breast cancer.

What is breast cancer after surgery?

Recurrent breast cancer develops in the same area as the primary cancer. In patients who have undergone lumpectomy (partial removal of breast tissue), a local recurrence is formed in previously healthy mammary cells. After a mastectomy (complete excision of the breast, regional lymph nodes and part of the muscle tissue), some women experience the development of oncological pathology along the line of the chest wall or on the skin of the breast.

Signs of recurrent cancer with initial localization:

• The formation of a new subcutaneous lump or the presence of a heterogeneous structure of the tissues of the chest region.
• Determination of morphological changes in the skin.
• Development inflammatory processes skin and associated redness of the affected area.
• Formation of specific secretions from the nipple.

Symptoms of local recurrence on the chest wall after mastectomy include:

• The occurrence of one or more painless nodules in the chest wall.
• The manifestation of seals on certain areas of the surface of the skin along postoperative scars.

1. Regional recurrence:

After breast surgery cancer can re-develop in nearby lymph nodes, which are located in:

• Axillary area.
• Circumclavicular region.
• Subclavian deepening.
• Neck department.

1. Distant recurrence:

Removed malignant tissue can cause metastases to distant sites in the body. Most often, such lesions are localized in the tissues of the bones, liver and lungs.

Distant relapse is manifested by the following symptoms:

• Persistent and increasing pain in the chest or right hypochondrium.
• Persistent irritable cough that does not respond to conservative treatment.
• Difficulty breathing, predominantly nocturnal.
• Loss of appetite and, consequently, weight loss.
• Frequent paroxysmal headaches that do not undergo traditional therapy.
• Convulsive states of the body. Computed tomography of such conditions does not determine the lesions of brain tissues.

Breast cancer after surgery: causes of recurrence

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 be fixed in nearby breast tissues. As a result, it is precisely from such cellular elements that a repeated postoperative lesion, that is, a repeated breast cancer, can form.

Some patients, after the initial diagnosis of breast cancer, are prescribed chemotherapy, radiation or hormone therapy to destroy malignant tissues. But sometimes these treatments are not able to completely neutralize cancer cells.

Recent scientific studies prove that mutated cells human body can be at rest for many years without causing any subjective health complaints in the patient. Subsequent activation of such structures can lead to the formation of distant relapses of the disease and the development of a malignant tumor.

Risk factors for recurrent breast cancer

• Primary involvement in the malignant process of a large number of regional lymph nodes.
• The large size of the tumor significantly increases the likelihood of developing postoperative cancer chest.
• Insufficient removal of nearby healthy tissue during surgical treatment breast oncology.
• Absence radiotherapy after a mastectomy.
• Young women, especially those under the age of 35 at the time of initial diagnosis, are at very high risk of tumor metastasis.

Diagnosis of recurrent breast cancer

If the gynecologist during the follow-up postoperative examination suspects the presence of a repeated malignant lesion of the breast, then he may prescribe additional research methods. Clarification of the diagnosis is carried out using magnetic resonance imaging, computed tomography, bone tissue scanning and positron emission diagnostics.

The final diagnosis of the presence or absence of recurrence after breast cancer surgery is established after a histological analysis of biological material taken directly from the site of pathological tissues. This analysis is carried out during the biopsy.

Treatment of breast cancer after surgery

Treatment of relapses begins with surgery and includes the use of radiation therapy if it has not been previously performed. Also, if breast cancer has resumed after surgery, a cancer patient may be recommended chemotherapy and a course of hormonal drugs.

Methods and treatment that oncologists use today:

• Surgical treatment involves removing any affected breast tissue.
• Radiation therapy involves exposing the chest to high-energy rays to kill cancer cells.
• Chemotherapy uses cytotoxic drugs that have a detrimental effect on malignant tumor tissues.
• Hormone therapy blocks the formation of estrogen. This treatment is recommended for hormonal imbalances caused by cancer.

Breast cancer is one of the most common diseases. Pathology of a malignant nature is mainly observed in women after 45 years. Breast cancer occurs under the influence of various factors. Symptoms and methods of treatment of oncological disease depend on timely diagnosis and the degree of its development.

To indicate the stage of development of breast cancer, the international TNM classification system is used. The form of a malignant tumor is determined during the initial diagnosis of the disease, the nature of the disease is clarified after the tumor is removed.

Deciphering the TNM classification includes the nature and size of the neoplasm in the mammary gland:

• "T" - parameters of the primary tumor (from 0 to 4 sentiments).
• "N" - the degree of spread to the lymph nodes (from 0 to 3 centimeters).
• "M" - the presence of distant metastases (from 0 to 1 centimeter).

The detailed description of each stage in the TNM system is fixed with additional letters and numbers.

Histological types

According to the histological structure of neoplasms in the mammary gland, there are two main forms of a malignant tumor:

1. non-invasive carcinoma. This type Breast cancer refers to the initial stage of the development of the oncological process. A malignant neoplasm is located in a separate lobe or in the lactiferous canal of the mammary gland and has no connection with adjacent tissues.
2. invasive carcinoma. This type of breast tumor has a more complex malignant course, since the pathological process affects the surrounding breast tissues, with the possible spread of metastases to other organs.

Non-invasive breast cancer is divided into several types:

• Ductal carcinoma in situ is the earliest stage in the development of the oncological process.
• Lobular carcinoma in situ - pathology most often develops simultaneously in two mammary glands ax and is characterized by the localization of malignant cells only in the lobules of the paired organ.

Invasive breast cancers include:

• Infiltrating flow carcinoma - a malignant tumor that spreads beyond the borders of the milk ducts.
• Infiltrating lobular or lobular carcinoma is the development of a pathological process outside the lobules of the breast.
• A malignant lesion with an inflammatory character is a rapidly developing and most dangerous form of breast cancer with the presence of characteristic seals in the gland that block the lymphatic ducts.
• Medullary carcinoma is a tumor in the gland with medium degree invasiveness, which has fairly pronounced boundaries between cancer cells and healthy tissue.
• Paget's cancer is a pathological process that affects the nipple and its surrounding tissue.

There are several histological types of breast cancer, which are extremely rare:

• Metaplastic pathology - characterized by a bumpy surface and has an aggressive malignant course.
• Mucinous carcinoma - characterized by a high content of mucus both inside and outside the cancer cells.
• Tubular carcinoma of the breast - refers to small neoplasms of a malignant nature, which rarely form metastases.

The degree of danger of a cancerous tumor in the mammary gland largely depends on the level of differentiation. The lower it is, the higher the rate of development of cancer cells.

Molecular taxonomy

To determine the aggressiveness and degree of danger of the overgrown malignant neoplasm molecular diagnostics is carried out, which is based on the study of various tumor markers, including the HER2 gene. The absence or presence of its amplification indicates the nature of the tumor in the mammary gland, and also allows you to choose a more effective treatment.

Depending on the molecular structure, a breast tumor is divided into four main subspecies:

• Luminal cancer type A is a non-aggressive pathology with a fairly good prognosis.
• Luminal type B is an aggressive neoplasm characterized by a satisfactory prognosis.
• HER2+ is a dangerous breast tumor belonging to an aggressive category of cancer with a negative prognosis;
• The triple negative subspecies is a neoplasm with a high degree of developmental aggressiveness and low rate survival.

All four subspecies are classified as estrogen-dependent.

Main causes and risk factors

The oncological process in the mammary gland in most cases occurs in women. The cause of the formation of cancer cells can be:

• hereditary predisposition
• chronic type diseases
• high levels of estrogen in the body
• low level of immune defense

Often the cause of breast cancer is the presence of pathological processes in the gland. The following factors may influence the development of a malignant tumor:

• long-term use of hormonal drugs
• the presence of gynecological, as well as somatic chronic diseases
• malnutrition, excessive consumption of fatty foods
• metabolic disorder, obesity
• chest injury
• lack of regular sex life
• early start of the menstrual cycle
• late pregnancy - after 35 years
• a large number of abortion
• past oncological diseases female organs, including breast cancer
• having bad habits
• menopause after age 55
• exposure to ionizing rays
• rejection breastfeeding during lactation

According to studies, the formation of malignant cells can also be affected by poor ecology in the region of permanent residence.

Women over the age of 40 are at risk for breast cancer. Breast cancer in men occurs in only 1% of patients.

Symptoms of the disease

The nature of the manifestations of breast cancer depends on the degree of development of the pathology. In the initial stages of the oncological process, there are no pronounced symptoms. First signs malignancy in the gland can be detected by self-examination:

• expansion of the saphenous veins in the chest area
• presence of seals
• breast deformity
• sores, skin redness
• discharge from the nipple
• swollen lymph nodes
• education on skin"lemon peel"
• lump around the nipple

With the development of breast cancer observed:

• tissue edema
• neoplasm pressure on nerve endings
• crowding out healthy cells
• aching chest pain

There are several characteristic symptoms breast cancer, which are used by mammologists when making a diagnosis:

• Payr's sign - as a result of squeezing the chest on both sides, a pronounced fold is formed on the skin.
• Krause's symptom - the presence of a pronounced thickening of the areola and nipple folds.
• A sign of a "platform" - when the skin is compressed at the site of the focus, an irreversible process of its deformation occurs.
• Kernig's symptom - the structure of tissues is noticeably compacted and the level of elasticity of the skin is noticeably reduced.
• Symptom of umbilization - over the affected area, the skin is stretched, while a small depression is observed at the site of the focus.
• Pribram's symptom - when sipping on the nipple, the tumor is displaced.

The initial stage of development of breast cancer is painless. Unpleasant sensations appear in the process of trophic changes in the tissues of the mammary gland. Severe pain in cancer is observed at the stage of tumor metastasis.

A sign of breast cancer can also be nonspecific symptoms:

• increase in body temperature
• sudden weight loss
• aches and pains in the muscles
• nausea, vomiting reflexes
• headache
• yellowing of the skin
• fatigue, weakness and drowsiness

During the formation of metastases, shortness of breath and cough with blood particles in the sputum are sometimes observed.

There are four main stages in the development of the oncological process in the mammary glands:

• The first - the size of the neoplasm does not exceed 2 centimeters. The pathological process occurs only in the cells of the mammary gland, without affecting the skin and subcutaneous fatty tissues.
• The second - the tumor increases in volume up to 5 centimeters, does not penetrate into the adjacent tissues, but spreads to the regional nodes of the lymphatic system.
• Third - the neoplasm in the chest grows significantly, penetrating into the lymph nodes, the skin, touching the walls chest.
• Fourth - there is a divergence of malignant cells in all organs, including lymph nodes above the collarbone, bone metastases, damage to the lungs, liver and brain.

Each stage of breast cancer requires a different treatment approach.

Diagnosis of breast cancer in women

The success of breast cancer treatment depends on the stage of development of the pathological process. Therefore, it is important to detect the tumor in time.

To assess the patient's condition, first of all, the doctor performs palpation, an external analysis of the mammary glands and the collection of the patient's history. After that, laboratory and instrumental screening is prescribed, which consists of a number of studies:

• mammography
• ultrasound procedure
• blood test for tumor markers
• biopsy
• immunohistochemistry (IHC)

A FISH test for breast cancer can also be prescribed, with the help of which the presence of oncology is confirmed, the prognosis of the disease is clarified, and the possibility of using specific chemicals is determined.

To find out where breast cancer has metastasized, a PET CT scan is performed. This method combines radiological and computed tomography and allows you to identify changes in the body at the cellular level. With the help of a three-dimensional PET CT image, differential diagnosis of a malignant tumor is carried out.

The productivity of further therapy depends on the accuracy of determining the size, location, nature of the tumor. Therefore, when establishing a diagnosis, an integrated approach to the diagnosis of breast cancer is required.

Treatment of breast cancer

It is possible to eliminate the malignant process only on early stages oncological disease. Therapeutic actions in breast cancer are aimed at the complete destruction of mutating cells in the body. The type of therapy depends on the nature of the tumor in the breast and the stage of its development.

Surgery is the main treatment for malignant tumors. There are several types of surgeries used for breast cancer:

1. Organ-preserving surgery. This method consists in removing only the neoplasm and adjacent tissues. At the same time, the main part of the mammary gland is preserved. The operation is possible in the early stages of the development of pathology with a tumor size of not more than 5 centimeters with the absence of metastases. An exception is the localization of the focus near the nipple and the presence of a pathological process in several places of the mammary gland.
2. Mastectomy. The operation is performed in case of extensive spread of a malignant tumor. This type of surgery involves the complete removal of the breast.

In more severe cases, not only the breast is removed, but also the lymph nodes, blood vessels, pectoral muscles and ribs.

Radiation therapy

Ionizing radiation of a tumor is carried out in order to stop its malignant development. Radiation therapy for breast cancer is prescribed in the following cases:

• Before surgery to transfer an aggressive tumor to an operable state.
• After surgery to destroy the remaining cancer cells.
• To support the condition of patients whose cancer cannot be removed.

The irradiation procedure is carried out for six weeks. The exact course of radiation therapy is set depending on the stage of growth of a malignant tumor and its localization.

Chemotherapy

This treatment method involves the use anticancer drugs With chemical composition. Used in combination with other therapies. Indications for chemotherapy are:

• tumor larger than 2 cm
• the presence of poorly differentiated cancers
• childbearing age of the patient
• lack of estrogen and progesterone receptors in cancer cells

Chemotherapy consists of the use of cytotoxic drugs that are capable of destroying cancer cells. This group includes drugs:

• "Adriablastin"
• "Doxorubicin"
• "Cyclophosphamide"
• "Fluorouracil"
• "Mitoxantrone"

Medicines are used both for intravenous infusion and for oral administration.

hormone therapy

Hormone therapy is used when estrogen and progesterone receptors are detected during research. This method is used in complex treatment and assumes:

• Usage medicines to block the functions of the endocrine system.
• The use of hormone antagonists that suppress estrogen receptors, thereby destroying cancer cells.

These drugs include Tamoxifen, Bromocreptin, as well as drugs that reduce estrogen levels - Femara and Arimidex.

Hormone therapy for breast cancer is prescribed only by the attending physician. The duration of the course depends individual features the patient and the susceptibility of his organism to the administered drugs.

Targeted Therapy

The basis of such a modern technique for the treatment of cancerous tumors in the mammary gland is a point effect on the affected tissues. In the course of treatment, targeted drugs are used that affect only cancer cells.

The course of such treatment consists of taking:

• aromatase inhibitors
• estrogen receptor blockers
• selective drugs that suppress growth factors
• PARP protein blockers

During treatment, side effects are sometimes observed - fever and chills. Traditional methods are used to relieve symptoms. medicines. Targeted therapy for breast cancer is carried out only under the supervision of a doctor.

Quite a few importance in the process of therapy has a diet with a restriction of fats, spicy and acidic foods, spices, strong coffee, tea, and alcoholic beverages. Proper nutrition with cancer significantly increases the chances of recovery.

Treatment of breast cancer with non-traditional methods involves the use of poisonous herbs and plants that can destroy cancer cells. Recipes traditional medicine very much against malignant tumors. The most common tinctures are:

• fly agaric
• nutty
• potato flowers
• celandine
• hemlock

The use of such herbal mixtures requires precise adherence to the proportions of preparation and daily dose. Wrong treatment folk remedies can lead to poisoning of the body. All healing actions must be agreed with the attending physician.

Prognosis and life expectancy

The success of the treatment of a malignant tumor depends on the degree of its aggressiveness, the presence and number of metastases. Great importance for a positive outcome timely treatment and no recurrence of breast cancer for five years. Having overcome such a period without negative changes in most patients, the chances of life expectancy increase significantly.

According to statistics, the five-year survival rate for each stage of tumor development in the mammary gland has its own percentages:

• first - 95%
• the second - up to 80%
• third - 40%
• fourth - no more than 10%

Scientists have found that a low prognosis and the possibility of recurrence in hormone-independent neoplasms.

Prevention of the appearance of a tumor

It is impossible to completely eliminate the occurrence of breast cancer, but there are methods that can reduce the risk of developing oncology.

Prevention of a malignant tumor in the breast, based on the prevention of the disease, includes the following activities:

• Regular self-examination of the mammary glands.
• Proper nutrition, weight control.
• Planned pregnancy up to 30 years, prolonged breastfeeding after childbirth.
• Annual examination in medical centers.
• Exclusion of bad habits, maintaining a healthy lifestyle.

Cancer prevention should be carried out throughout life. It is recommended to pay special attention to the state of health of people who have a genetic predisposition to oncological diseases. Regular examination of the mammary glands by a mammologist, as well as ultrasound and MRI studies, will help prevent the appearance of pathology.

Breast cancer is a dangerous and widespread disease, the development of which can cost a person life. It is very important to recognize the tumor in the early stages of its formation, therefore, at the first suspicion of a neoplasm in the breast, you should immediately consult a doctor.

As a treatment, they are used quite radical methods- surgery, chemotherapy, radiation and hormonal therapy.

What is the risk of breast cancer recurrence?

If treatment is not started on time, the disease progresses rapidly. In 9% of patients, relapse during the first visit is already accompanied by metastases. Another 9% of patients cannot undergo surgery due to the growth of metastases, somatic diseases and general exhaustion of the body against the background of the resumption of oncology.

Why is the disease returning?

In the treatment of a breast tumor, it is not always possible to identify and remove all cancer cells - this main reason relapse. The likelihood of recurrence of the disease also directly depends on:

• aggressiveness of tumor growth;
• level of differentiation of malignant cells;
• hormonal background;
• the presence of a metastatic process in the lymph nodes closest to the chest.

To reduce the risk of recurrence, combined treatment is usually prescribed: surgery (mastectomy or lumpectomy) and subsequent therapy.

The first signs of breast cancer recurrence

Women who have been treated for oncology in the past and monitor their health are themselves able to notice initial symptoms indicating recurrence of breast cancer.

to the most obvious early signs return of the disease include the following:

1. The usual outlines and shape of the breast have changed.
2. The skin covering of the gland or around it is reddened or otherwise discolored.
3. A colorless, greenish, or bloody liquid comes out of the nipple. The amount of discharge is constantly increasing, regardless of the menstrual cycle.
4. The chest itches, a burning sensation is felt.
5. The nipple ulcerates, cracks form on it.
6. On palpation, a painless induration is felt.
7. The skin may peel off.
8. Over the tumor, the skin sinks, forming a wrinkled surface and forming an "orange peel" effect.
9. With metastases, lymph nodes increase.
10. Headaches and neurological pathologies may begin.
11. If other organs are affected by metastases: their soreness or transformation.
12. A person quickly gets tired, appetite disappears, general weakness is felt.
13. The patient is rapidly losing weight, becomes pale.

Necessary tests and examinations

If the patient has already undergone the removal of a breast tumor, but there are new complaints, the oncologist conducts a thorough examination, based on which a preliminary diagnosis is possible - a recurrence of breast cancer.

To confirm or refute the presence of a relapse, a number of studies are assigned. Mammography reveals the presence of microcalcifications associated with oncology in the gland, shows violations of the vascular pattern and other direct symptoms.

In addition, for clarification, an x-ray with an oblique projection is used, or ultrasound, which helps to identify the fluid characteristic of the cyst. However, ultrasound is not considered highly informative method, it will help clarify the diagnosis in about 75% of cases. The final point in the diagnosis will be made by such a study as a biopsy performed under x-ray or ultrasound control, as well as studies on tumor markers and a blood test to detect anemia.

If metastases have been identified, then individual tests are prescribed. Additionally, MRI and CT scans, X-rays and other studies may be prescribed.

Treatment

Recurrent tumor is extremely aggressive and depending on the circumstances, the treatment regimen is somewhat different.

1. Most often prescribed surgery followed by radiation, chemical or hormonal treatment.
2. If an organ-preserving surgical intervention was performed, but a relapse occurred over time, then radical mastectomy with radiotherapy. Such treatment can be performed both before a mastectomy and after it.
3. Metastases necessarily involve chemotherapy or radiation therapy.
4. Some types of neoplasms require treatment with hormones and immunostimulants. The same treatment regimen is prescribed for the ineffectiveness of previous therapy.

What can be done to prevent recurrence of breast cancer?

To prevent a recurrence of the disease, it is imperative to engage in the prevention of the resumption of the disease. This is done after the end of the first course of treatment, because oncological cells easily penetrate from the gland into the blood, the likelihood of getting sick is high.

After treatment, the oncologist necessarily tries to calculate the risk of recurrence of oncology. If such a probability is high, then the doctor will advise a course of chemotherapy or prescribe special drugs that suppress the production of estrogen in the female body.

Forecast

With local recurrence after a mastectomy without damage to the lymph nodes and distant organs, the survival rate of 75% of patients is 5 years. If there are metastases, then the life span of patients is an average of 3 years. If the cancer was detected at an early stage of development, then the probability of a cure is high.

The patient herself necessarily participates in the prevention of the disease, she not only follows the instructions of the attending physician, but also carefully monitors the condition of the breast. Upon detection the slightest change in the gland, the appearance of seals, growths, peeling, burning or discharge, she should immediately seek help so that a qualified specialist professionally evaluates these phenomena.

Recurrence of breast cancer is not so terrible if it is detected in a timely manner. The problem is often detected 3-5 years after the previous operation, but sometimes it happens much earlier - after six months. Therefore, the state of the glands should be monitored immediately after discharge from the hospital after the first operation.

comments 2

One of the causes of relapse is stress, especially severe or prolonged, so this must be taken into account in the prevention of relapse! After the first operation (stage 2, complete resection), my mother lived for 11 years until the moment when my father was admitted to the hospital with an advanced oncological disease. After the second operation (metastases in the first p / o suture), my mother lived for another 2 years until the second serious illness of my father. Further, the disease developed rapidly: unrelieved nausea, rapidly increasing pain in the legs and spine ... m / st in the liver, spine and bones were discovered by chance, in the process of useless treatment of sciatica, and in 2 months my mother died ...

Hello. Please tell me, I had a relapse of the mammary gland after a complete amputation. I applied on time, but while I was waiting in line for a chemotherapist, my lymph nodes began to increase. What to do?

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The information on this site is provided for informational purposes only! Apply the described methods and recipes of treatment cancer alone and without consulting a doctor is not recommended!

Breast cancer recurrence

Breast cancer recurrence is the recurrence of the disease several months or years after the end of the course of treatment (chemotherapy, radiation therapy, surgical treatment). Cancer in this case develops both at the site of the primary tumor and remotely. This condition will be a new tumor in case of damage to another breast or another area of ​​the breast.

The recurrence of breast cancer, of course, scares a woman. After all, it seemed that she completely got rid of this ailment, as everything returns again. Involuntarily, the patient has questions about the correctness of the diagnosis and the completeness of the treatment. In most cases, the cause is not a violation of the treatment technology, but the inability to identify and destroy absolutely all 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 combined 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 a recurrence if it is detected in the same mammary gland as the initial tumor lesion, as well as if the tumor focus is located in any other area other than the mammary gland. In the case of a distant location, they speak of cancer metastasis from the primary focus, and a relapse of the underlying disease. The presence of recurrence indicates in most cases the fact that individual tumor cells were 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 tissues, as well as nearby and distant lymph nodes. In addition, with a recurrence of breast cancer, the bones of the skeleton, lungs, liver, peritoneum, and brain can be affected.

When can breast cancer recur?

Cancer recurrence can occur at any time, but recurrence is most common 3-5 years after treatment. They are local (the tumor occurs in the cured breast or near the mastectomy scar) or distant (the neoplasm appears in some other place).

Oncologists classify breast cancer recurrence as follows:

• local recurrence - in the area of ​​the operated mammary gland;
• regional metastases - recurrence occurs in regional lymph nodes;
• metastatic breast cancer - cancer is diagnosed outside the mammary glands - in the liver, spongy bones, brain, distant lymph nodes.

Most often, recurrent breast cancer affects the lymph nodes, lungs, liver, and bones.

Local recurrence of breast cancer: about 1/3 of all cases of recurrence are detected during routine self-examination, 1/3 with diagnostic mammography, 1/3 of recurrences - only with 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, as well as a breast biopsy.

Cancer recurrence in regional lymph nodes: accounts for about 40% of all cancer recurrences. It is usually observed in cases where a limited resection of the lymph nodes was performed - partial lymph node dissection. With self-identification of enlarged lymph nodes, their biopsy and histological examination are usually performed.

What factors influence the development of cancer recurrence?

There are a number of prognostic indicators that allow the doctor to predict the recurrence of cancer:

• the later the primary disease is diagnosed, the more likely it is to recur;
• the more aggressive the primary disease, the more often relapse develops;
• the larger the size of the neoplasm, the greater the likelihood of recurrence;
• in cases where the primary diagnosis of cancer reveals damage to regional lymph nodes;
• the higher the cellular atypia (histological indicator - the degree of malignancy of the cells) - the difference between the number of atypical malignant and healthy cells - the higher it is, the higher the risk of relapse;
• 2/3 of all breast cancers are accompanied by a significant level of positive estrogen receptors, which means that malignant growths (ER +) respond better to hormone therapy and spread more slowly;
• neoplasms containing certain oncogenes often lead to recurrent diseases;
• malignant cells that have a high atomic index (the rate at which they divide) grow faster.

After surgery or radiation therapy, the oncologist assesses the situation for the likelihood of a relapse.

How do you know if you have a recurrence of breast cancer?

One of the main ways early detection cancer is self-examination and self-examination (palpation) of the mammary glands.

Breast changes that may indicate the development of a relapse:

• burning, itching, or change in the nipple;
• any change in the structure, size, contour or temperature of the breast; pitted, reddish surface of the skin;
• an area of ​​skin of a marble-like color;
• atypical discharge from the nipple (with many diseases, but cancer is not excluded).

It is very important to undergo follow-up medical examinations, including diagnostic examinations- Ultrasound of the mammary glands, mammography, as well as laboratory examinations by doctor's prescription. Initially, after the completion of primary treatment, examinations are scheduled once a quarter, and then less frequently. It is necessary to strictly follow the recommendations of a specialist and annually do a mammogram.

How is recurrence treated?

The main treatments for breast cancer recurrence include:

• local treatment - surgery and radiation therapy.
• systemic treatment - chemotherapy, hormonal therapy, targeted therapy.

The type of treatment for recurrence is directly related to the type of treatment for the original disease. If at first a lumpectomy was performed, then a mastectomy is used in case of relapse; if at first there was a mastectomy, then radiation therapy is used for relapse. Chemotherapy and/or hormone therapy is used in any case.

The discovery of cancer in the other breast most likely indicates a new tumor that has nothing to do with the first disease. In this case, lumpectomy or mastectomy is used, and in certain cases, systemic treatment (hormone 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 reduce certain symptoms.

Immunotherapy (possibly in combination with hormone therapy) is recommended for patients whose malignant cells have elevated levels of the HER2/neu protein. Also, this method is used with the ineffectiveness of chemotherapy and hormone therapy.

Breast cancer recurrence

Recurrence in the area of ​​the operated breast

A recurrence of a malignant tumor may be in the same area of ​​\u200b\u200bthe breast where the cancer was. The term "relapse" means that it is not a new cancer, that is, it is not a new disease. However, sometimes a cancer recurrence can occur in a different area than the site of the primary tumor. In this case, they speak of cancer metastasis. The occurrence of a new breast tumor is not so common, but it is preferable to a recurrence. If the doctor has discovered that you have a tumor in another mammary gland or in another area of ​​the mammary gland, then this is not a recurrence, but the appearance of a new tumor. This is especially true if a new tumor arose 5 years after the operation.

Cancer recurrence may occur the following areas: in the region of the mammary gland, in the region of the chest wall, in the region of lymph nodes, in the region of bones, in the region of the lungs, in the region of the liver, in the region of the brain.

It is worth saying that malignant tumors from other areas of the body very rarely metastasize to the mammary gland or chest wall. If you have a tumor in the lymph nodes, lungs, bones, liver or brain, then this is most likely a recurrence of breast cancer, and not an independent cancer of one or another organ. In other words, if you have had breast cancer and now have a tumor in your bones, liver or lungs, then it is a transfer (metastasis) of breast cancer to these organs. That is, if you take a biopsy of the metastasis site and examine it under a microscope, then breast cancer will be revealed. This is very important to understand, as breast cancer is much more treatable than tumors that originally originated in the bone tissue, or, for example, in the liver.

Metastatic breast cancer elsewhere in the body is an invasive cancer. However, recurrent breast cancer after surgery and/or radiation therapy can be either invasive or non-invasive. If cancer has arisen in the opposite mammary gland, in most cases this is not a recurrence, but a new tumor.

Breast cancer recurrence, depending on its spread, can be:

• Local recurrence: in the area of ​​the operated mammary gland.
• Regional metastases: recurrence occurs in nearby lymph nodes.
• Metastatic cancer: Breast cancer occurs in other areas and organs, such as the liver, bones, brain, or distant lymph nodes.

Local recurrence of breast cancer

In two-thirds of cases where cancer recurs in the same breast, the cancer is usually found in the same site or immediately adjacent to it. The remaining third of cancer recurrences are new tumors. Also, if the tumor arose in another area of ​​the breast where there was cancer, or in the opposite mammary gland, then in this case we are talking about a new disease, and not a relapse. About a third of local recurrences of breast cancer are detected using mammography alone. Another third of recurrences are detected during a routine physical examination (palpation of the breast by a doctor or during self-examination), and finally, the remaining third of relapses are detected when a mammogram is combined with a physical examination. Nearly 80% of women with local recurrence of breast cancer have no further signs of cancer elsewhere.

Local cancer recurrence after lumpectomy and radiation

If you had a lumpectomy (removal of part of the breast along with the tumor) for breast cancer and subsequently had a course of radiation therapy (or without it), you are at risk of developing a local recurrence. Such a recurrence is manifested by the fact that a new tumor appears in the thickness of the mammary gland, which becomes larger or the area of ​​​​densification of the gland tissues. However, you should not immediately panic if you find a seal in the area of ​​\u200b\u200bthe "former" breast cancer. It is quite possible that this is one of the following conditions: adipose tissue that has been destroyed as a result of the treatment, scar tissue that has enveloped a small suture knot in the thickness of the gland (the so-called ligature granuloma), scar tissue that has developed after removal of breast tissue.

Redness and swelling in the area of ​​the breast can also be symptoms of cancer recurrence, but usually the reason for this is different. The fact is that the entire breast area may look reddened and swollen for several months after surgery and radiation therapy. Over time, the redness disappears and the code returns to its normal color, but this usually takes a certain amount of time.

If after a few months and even years a new area of ​​redness appears in the area of ​​the mammary gland, especially if it is accompanied by irritability and pain, fever, then most likely these are symptoms of inflammation of the gland - mastitis. Antibiotics are used to treat this disease. If antibiotics do not lead to positive result within one to two weeks, and the mammary gland remains the same edematous and reddened, then the doctor will advise a biopsy. Sometimes non-cancerous diseases, such as psoriasis (a skin disease), can lead to such changes in the skin of the breast.

However, redness and swollen breast skin can be signs of cancer recurrence. In this case, the skin thickens and may look like an orange peel. If the doctor suspects a recurrence of the tumor, then a mammogram is usually prescribed. The following signs of local recurrence of cancer may be detected on a mammogram: an increase in size and an increase in heterogeneity at the site where the tumor was removed, a new tumor or tissue heterogeneity, new accumulations of microcalcifications in the breast tissue.

In the event that similar results are obtained during mammography, additional research methods are usually carried out: ultrasound, MRI or PET. If the results of these research methods allow you to suspect a relapse, then the next step is a biopsy.

Local cancer recurrence after mastectomy

In the event that a woman underwent a mastectomy for cancer (removal of the entire mammary gland with adjacent lymph nodes), a local recurrence of cancer can be: in the skin of the breast, in the area of ​​soft tissues remaining on the chest wall, in the area of ​​the reconstructed mammary gland.

In very rare cases, a new tumor may develop after a mastectomy. This cancer arises from the remaining normal breast cells. These cells may remain either under the skin of the breast or in front of the muscles that are behind the breast. An experienced pathologist can usually determine whether a given tumor is recurrent or new cancer by comparing cells obtained from a biopsy with primary cancer samples. New breast cancer is more treatable than recurrence.

If, after a mastectomy, a woman underwent reconstructive surgery to restore the shape of the breast, she can usually find some swelling or swelling - this is the so-called fat necrosis. The reason for this is scar tissue or deposits of dead fat cells. Do not be afraid - these swellings have nothing to do with cancer. Such "tumors" are usually less common if the reconstruction was carried out only with the help of implants. These swellings are usually detected a few months after reconstructive surgery, when the general postoperative swelling of the breast has passed. Over time, these tumors may shrink in size. If there are several such "tumors" together, they can merge into one large one. You should definitely consult a doctor if these swellings begin to increase in size, although most likely this does not indicate anything serious.

If new tumors have appeared in the thickness of the skin or under the skin, you should be suspicious if: the tumor is heterogeneous, dense to the touch, pink or red, painless.

If your own tissues were used during the reconstructive surgery (TRAM, GAP or DIEP patchwork techniques), then mammography is performed to clarify changes in the mammary gland. Unfortunately, if silicone implants were used during the reconstruction, then mammography is useless in this case, since the implant obscures the whole view of the tissues. In this case, a physical examination by a doctor is very important, as well as methods such as ultrasound and MRI. If the doctor doubts the presence of a recurrence, then sometimes even PET can be used.

Various types of rash

Sometimes a rash may develop on the skin that is not associated with cancerous tumors. For example, psoriasis. However, sometimes a red velvety rash may appear on the skin against the background of swelling. It could be a recurrence of inflammatory breast cancer. If non-healing sores join the rash, then most likely this speaks precisely for the recurrence of cancer. After radiation therapy for breast cancer, there is usually redness, swelling, and sores in the breast area. These manifestations progress slowly, their peak at the same time falls on the first or second week after the end of irradiation, after which they gradually disappear over several months. However, if such changes occur within a few weeks after the end of treatment, then this is more a manifestation of inflammation. In this case, antibiotics are prescribed.

Recurrence of breast cancer in the lymph nodes - regional metastases

In 40% of cases, breast cancer recurrence occurs in the lymph nodes. Usually, during surgery for breast cancer, the surgeon can also remove the lymph nodes in the armpit at the same time. However, metastases can also occur in other groups of lymph nodes: in some of the remaining axillary lymph nodes, supraclavicular lymph nodes, subclavian lymph nodes, lymph nodes inside the chest (intrathoracic lymph nodes), very rarely in the axillary lymph nodes of the opposite side.

If you yourself or the doctor found round swelling in the indicated areas, this may be a regional metastasis. Sometimes enlarged lymph nodes are detected during a mammogram. Usually, regional metastases rarely affect only the lymph nodes in the armpit. This occurs in less than 5% of cases. Most often, such metastases appear both in the lymph nodes and in the breast tissue or in the chest wall.

In case of detection of enlarged lymph nodes, their biopsy and histological examination are usually performed.

Treatment of regional metastases

In the case of detection of regional metastases in the nearest lymph nodes, treatment consists of both local therapy and systemic therapy. In this case, a full course of systemic therapy is carried out, which includes: chemotherapy, targeted therapy (Herceptin), hormonal treatment (antiestrogen drugs), anti-angiogenesis therapy.

Treatment options for breast cancer recurrence

Currently, oncology has various modern effective methods treatment of recurrent breast cancer and its metastases. These methods include both local treatment and systemic.

• Local treatment includes surgery and radiation therapy.
• Systemic treatment includes chemotherapy, hormonal therapy, as well as a modern trend in the treatment of oncological diseases - molecular-targeted target therapy (target - target, goal). One of the well-known drugs for such targeted therapy is Herceptin.

Which local and systemic treatment you will receive depends on the same factors that were taken into account at the time of detection of the primary tumor. In the case, however, the cancer was detected for the first time with metastases, then the treatment depends on, in particular, where exactly the metastasis was found.

Careful diagnosis is very important in choosing proper treatment. Even if you underwent various images during the diagnosis, it is quite possible that such studies will still be required - these are mammography, MRI, CT, PET, scintigraphy, ultrasound and others. If the cancer recurred in the place where the lumpectomy was performed, but no other signs of a tumor were noted from other areas, then a good outcome of treatment is quite possible, that is, if the cancer recurred in the form of a small tumor in the mammary gland, then most likely only local treatment (surgery + radiation therapy) is required. Topical treatment is effective in 8 out of 10 women with breast recurrence.

If the primary treatment for breast cancer consisted of a lumpectomy operation and subsequent radiation therapy, then the standard treatment for recurrence in this case is the complete removal of the breast - mastectomy. A second lumpectomy instead of a mastectomy followed by radiation therapy can only be used if you have not received radiation therapy before and if you have a low risk of tumor metastasis. This is possible in the following situations: cancer recurrence is localized only at the site of the previous tumor, the size of the recurrent tumor is not more than 4 cm and it can be easily removed, cancer recurrence is not invasive (DCIS - ductal carcinoma in situ), a long period of time between the end of primary treatment and the development of cancer recurrence, the course of cancer is not aggressive and the nearest lymph nodes are not affected.

As an alternative to a mastectomy, if you have had a lumpectomy and radiation therapy, you can try treatments that are undergoing clinical trials, such as partial breast irradiation (MammoSite).

If, upon detection of a recurrence, the tumor is assessed as more aggressive, then local treatment is supplemented with systemic therapy. Its goal is to destroy all cancer cells that may be outside the breast, but are not detected during the study.

Recurrence of cancer in the chest wall

If the tumor recurred in the place where the mastectomy was performed (that is, the complete removal of the mammary gland with underlying pectoral muscles and axillary lymph nodes), then this is a recurrence in the chest wall. Indeed, in this place after a mastectomy, there is no breast tissue left, but only the chest wall. Usually surgery is performed to remove the tumor first. But in the following cases, the operation is rarely performed: several tumors that are widely scattered throughout the body, the presence of a red rash, which is the transition of cancer to the skin.

If a recurrence occurs at the site where the reconstructive surgery was performed, sometimes the implant or flap is removed.

The next stage of treatment after surgery is a course of radiation therapy, if you have not received it before. However, if you have had such treatment before, then a small course of radiation is also possible in this case.

However, the likelihood of developing side effects from radiation is much higher: difficult to heal skin rashes, an increased risk of rib fracture due to the effects of radiation on bone tissue, the development of a cicatricial process in the muscles, which leads to their compaction.

In order to reduce the impact of side effects after repeated exposure to radiation, the doctor makes some changes in treatment. For this: the amount of radiation in each dose of radiation is reduced, the frequency of exposure is reduced, the area of ​​exposure is reduced. For example, a course of radiation therapy can be given in small doses twice a day. If you have not received radiation therapy in the past, the side effects will be less pronounced. It is possible that they will look like a normal sunburn, which is manifested by redness, irritation, itching and slight peeling of the skin. In order to reduce these effects, the doctor may prescribe various ointments or creams (for example, 1% hydrocortisone ointment, aloe-based cream, etc.).

If you develop chest pain after radiation exposure, painkillers or anti-inflammatory drugs are prescribed. In some cases, when breast implants are present, exposure to radiation can cause rough scar tissue to form around them. This can cause pain as well as changes in the shape of the implant.

In case of recurrence in the area of ​​the chest wall, systemic treatment may be recommended: chemotherapy, hormone therapy and targeted therapy. In about half of women with breast cancer recurrence in the chest wall, the tumor cells gradually move outside the chest. Systemic therapies are aimed at destroying these cells.

Chemotherapy is not given if the patient has ALL of the following conditions: the patient is postmenopausal, the patient has only one tumor in the chest wall that can be removed, the interval between the last treatment of breast cancer and the development of a recurrence is more than 10 years.

The type of treatment given depends in part on the previous treatment. Sometimes recurrence of a tumor in the chest wall can occur during hormonal therapy. In this case, it is usually recommended to change the hormone therapy drug to another one.

Breast cancer treatment in Moscow and abroad

The likelihood of recurrence of a breast tumor: causes and symptoms

The fight against cancer is debilitating and difficult. When a patient is told of a relapse after a long remission, it sounds like a death sentence. Why does malignancy reappear after a mastectomy? And is it possible to avoid a recurrence of a cancerous tumor?

Causes of relapse

All women who have been diagnosed with a recurrence of breast cancer are tormented by the question: was the initial treatment prescribed correctly? Unfortunately, it is impossible to destroy all atypical cells. Modern diagnostics fixes lesions only from 5 mm.

Cells that are carried with the lymph flow or through the system of blood vessels do not disturb the patient for a long time. In addition, not all cancer cells respond to chemotherapy or radiation.

A breast tumor is considered a recurrence, which was diagnosed 3-5 years after the end of the course of treatment. There are three variants of the course of the disease:

• Local - atypical cells are formed in the operated mammary gland, on postoperative scar;
• Regional - a malignant tumor affects nearby lymph nodes (axillary nodes, in the collarbone and neck);
• Metastatic - a cancerous tumor is diagnosed in distant parts of the body: in bone tissue, liver, lungs.

In 40% of cases, the tumor is re-detected in the regional lymph nodes. Most often, cancer is observed in those patients who underwent partial resection of the lymph nodes. The local form of recurrence is most often asymptomatic, only in 1/3 of cases the patient can detect a tumor during self-diagnosis.

The prognosis for a probable relapse is given by certain factors:

• late stage cancer (3-4) increase the risk of recurrence;
• aggressiveness of the primary disease, regardless of stage;
• the size of the malignant neoplasm;
• lack of radiation therapy after mastectomy;
• involvement of most lymph nodes;
• a high rate of cellular atypia (the difference between healthy cells and malignant ones);
• high atomic indicator: the term means the rate of division of cancer cells, the faster they grow, the more likely the risk of re-tumor in the future.

The prognosis of recurrence in postoperative period depends on the hormonal balance at the time of treatment of the original tumor. The majority of breast cancer diagnoses are accompanied by increased level estrogen. Such neoplasms respond well to hormonal therapy after surgery and slowly spread throughout the body.

Young women under 35 years of age are more at risk of re-tumor.

Symptoms and Diagnosis

In order to detect a possible recurrence of breast cancer as early as possible, doctors advise regular breast self-examinations. The responsibilities of the patient include periodic visits to the diagnostic center for mammography. After treatment, a picture of the mammary glands is taken once every six months.

Women who have breast cancer (BC) detected at the first or second stage have a good chance of a stable remission: after treatment, the patients live a long time without fear of relapse. But no matter how much time passes after treatment, women should be extremely attentive to their health. The patient should be alerted by the following symptoms:

• palpation under the skin of the breast seal;
• changes in the structure of breast tissue;
• inflammatory process on the skin, redness, swelling on the postoperative scar;
• burning, itching, peeling on the skin of the chest;
• change in the shade of the skin from reddish to marble;
• yellowish, purulent discharge from the nipples.

The most negative prognosis for recovery is made when metastases are found in distant parts of the body. Symptoms include:

• shortness of breath, shortness of breath (most often at night);
• loss of appetite;
• sudden loss of body weight;
• headaches that do not respond drug treatment, occur by seizures;
• persistent irritable cough, not amenable to traditional therapy;
• pain in the right hypochondrium.

Symptoms of metastatic breast cancer may vary (depending on the organ affected by metastases). Based on the signs of relapse, diagnostic studies are carried out:

1. Scanning of the skeletal system.
2. Chest x-ray.
3. Blood test for tumor markers.
4. Computed or magnetic resonance imaging.
5. Biopsy (histological analysis of the nature of the origin of tissue taken directly from the tumor).

The prognosis for recovery after re-diagnosis of breast cancer is difficult to give. Some patients after surgery live a full life for many years, in others, oncology returns literally in the first year after surgery.

How to avoid recurrence of cancer?

The medicine of our time cannot predict whether a patient will have a recurrence of a malignant tumor, and how long after the treatment of the primary disease this will happen.

To improve the prognosis for survival, doctors recommend following certain rules after the end of the course of therapy:

• perform regular breast self-exams Special attention give the site on the postoperative scar;
• immediately consult a doctor if you suspect the formation of a tumor;
• young women of reproductive age who have undergone organ-preserving surgery are advised to plan pregnancy and breastfeed;
• you need to control your weight;
• under special control are patients with diabetes or other endocrine pathologies;
• oral contraceptives should be used only after consultation with your doctor;
• taboos on cigarettes and alcohol abuse;
• a diet with a predominance of plant foods, dairy and grain products.

For patients in remission, how much time they spend in the sun is extremely important. Doctors recommend avoiding prolonged sun exposure during hot weather. An excess of ultraviolet rays can worsen the prognosis for recovery and provoke a relapse of the disease.

Women who have undergone stage 3 oncology need to be very careful about their health. With this form of breast cancer, a common cold can become fatal.

For all women with malignant tumors in the breast, it is necessary to adhere to the course of treatment prescribed by the doctor. Hormone therapy is sometimes carried out for 3-5 years. This period is accompanied by regular blood tests for tumor markers, ultrasound of the pelvic organs and chest X-ray.

Procedures are prescribed for early detection of relapse, they cannot be ignored. The method of treating relapse can be radically different from the initial therapy.

The prognosis for healing depends on the stage of cancer: in the advanced stages of oncology, doctors give a life expectancy forecast of 2-3 years.

Tumor recurrence is not a death sentence. Even with a very difficult case, a negative forecast can become erroneous. To prevent the recurrence of the tumor, a woman must follow all the doctor's instructions and keep healthy lifestyle life.

A variety of breast cancer recurrence, methods of treatment and prognosis

Breast cancer recurrence is an oncological pathology. It reappears some time after the completion of treatment for the primary cancer. Basically, a recurrent neoplasm appears at 3-5 years.

Causes and types of relapse

In most cases, the secondary development of oncological formation is caused by the lack of the ability to identify and remove all low-quality cells that have entered neighboring tissues through the blood or lymph. There are a number of factors that influence the development of relapse. These include:

• late diagnosis of the primary tumor;
• aggressive manifestation of the original cancer;
• large parameters of oncological education;
• damage to the lymph nodes;
• high level of malignancy of cancer cells;
• the presence of certain oncological genes in primary education;
• hormonal imbalance in the patient;
• high atomic value of malignant cells.

Basically, the recurrence of breast cancer is divided into types depending on the localization of the tumor. It happens:

1. Local - oncology is formed at the site of primary cancer or near the scar from a mastectomy.
2. Distant recurrence occurs in organs and areas that are not related to the mammary glands.
3. Local recurrence (at the site of a previous surgical intervention);
4. Regional metastases (recurrent tumor in regional lymph nodes);
5. Metastatic tumor (diagnosis of recurrent cancer in areas outside the breast).

Local recurrence may develop after lumpectomy and radiation. In this situation, secondary oncology is formed inside the breast. But when identifying seals, it is important not to despair. Perhaps this is not a cancerous neoplasm, but a fat tissue destroyed during treatment, a ligature granuloma, scar tissue.

After treatment with a mastectomy, local recurrence may develop in the skin of the breast, in the area of ​​soft tissues and in the area of ​​the reconstructed breast. The recurrence of malignant tumors occurs in 6-9% of cases and the probability of their occurrence increases two years after surgery. More than 68% of recurrent formations occur near the postoperative scar.

If, along with a mastectomy, a reconstructive operation was performed to restore the shape of the breast, then swelling and swelling (fat necrosis) is formed in this case. These manifestations are not associated with cancer pathology.

Signs of relapse

At the end of the treatment of breast cancer, it is recommended not to miss scheduled diagnostic examinations and to conduct regular independent palpation. Suspicious signs are a reason to contact your doctor as soon as possible. The initial signs of the development of a recurrent breast tumor include:

• change in the shape and shape of the breast;
• redness or discoloration of the skin on the chest;
• discharge from the nipple of a colorless, greenish or bloody liquid;
• itching and burning in the chest;
• the formation of cracks on the nipple;
• determination by the method of palpation of a painless compaction;
• peeling of the skin on the chest;
• sinking of the skin and the formation of a wrinkled surface at the site of the tumor;
• enlarged lymph nodes;
• headache and neurological pathologies;
• soreness or transformation of organs affected by metastases;
• worsening general condition, lack of appetite;
• weight loss and pallor of all skin integuments.

Depending on the localization of the repeated oncological formation, the corresponding signs of recurrent breast cancer are distinguished. The main symptoms of local recurrent breast cancer:

• the appearance of a neoplasm in the chest;
• the appearance of a seal irregular shape in the region of the mammary gland;
• tension of the skin or the formation of retractions at the site of lumpectomy;
• inflammation and redness of the skin;
• compaction, indentation of the nipple and other deviations.

Recurrent signs after mastectomy:

• the formation on the skin and in the subcutaneous layer of nodules that are not accompanied by pain;
• the appearance of thickening along the surgical scar.

In case of regional recurrence, cancerous formation occurs a second time in the lymph nodes in the armpit or collarbone. The main characteristics of regional recurrence:

• compacted and enlarged lymph nodes;
• swelling of the hand;
• the presence of constant pain throughout the arm or in the area of ​​\u200b\u200bthe shoulder;
• decreased sensation in the hand.

With metastatic recurrence, cancer occurs in distant parts of the body. Main characteristic features metastatic recurrence are:

• having pain in the chest or bones;
• constant presence of dry cough;
• deterioration or lack of appetite;
• labored breathing;
• severe pain in the head;
• the presence of nausea and vomiting;
• weight loss;
• increase in body temperature;
• chills.

Knowing the main signs of all types of recurrence will allow you to quickly identify the pathology and begin prompt treatment.

Diagnosis of recurrence and methods of treatment

Conducting timely mammography and self-examination helps to diagnose the development of relapse at an early stage. When the first signs appear, you should immediately contact your doctor.

If recurrent breast cancer is suspected:

• repeat mammography;
• biopsy;
• study to identify cancer markers.

After these analyzes, studies are carried out to detect cancer and the development of metastases. If required, magnetic resonance imaging and CT scan. An x-ray is prescribed if recurrence of breast cancer is detected. thoracic, mammography of the adjacent breast, densitometry. Only after the final diagnosis, the doctor begins treatment.

Before treating a recurrent mass, an oncologist considers certain factors:

• localization of metastases and their distribution;
• characterization of relapse;
• the duration of the interval between the end of the treatment of the primary oncological formation and the detection of a relapsing tumor;
• methods used to fight the primary tumor;
• effectiveness of hormonal therapy and chemotherapy in primary cancer;
• age and general health of the patient.

Recurrent breast cancer responds well to treatment, but a complete cure is difficult to achieve. With the local development of recurrent formation, the correct therapeutic measures will prolong the life of the patient. Hormone therapy and chemotherapy are usually used. The drug used and the treatment regimen depend on the stage of the disease.

Also, the method of treating a recurring tumor depends on the method of treating the original cancer. If lumpectomy was used, then mastectomy is used to combat recurrence. In the primary use of mastectomy, radiation exposure is used to treat recurrent disease. Hormone therapy and chemotherapy are used after radiation exposure or surgery.

For recurrent oncology in organs not associated with the mammary gland (bones, lungs and brain), systemic therapy is used. To reduce some of the symptoms, radiation exposure and surgery are used.

In the final stages of recurrent cancer, systemic therapy provides an opportunity to improve the quality of life, and the patient can live 1-2 years.

Immunotherapy may be given alone or together with chemotherapy. It is used in the treatment of patients whose cancer cells contain a high content of the HER2/neu protein. Immunotherapy is also prescribed in the absence of effectiveness. hormonal treatment and chemotherapy. After surgery or radiation therapy, the oncologist determines the risk of further oncology manifestations. In some cases, the use of Tamoxifen or chemotherapy is recommended.

Forecasting

Predictions after breast cancer recurrence and treatment are based on the Nottingham Prognostic Index, computer program scores, and the Oncotype DX test.

The Nottingham Prognostic Index is a scale used after surgery to predict the future development of cancer. Three indicators are used in forecasting:

• the size of the cancer;
• the number of pathological lymph nodes;
• degree of oncology.

Specialists in some cases use special computer programs online for forecasting. The effective value is expressed as a percentage of survival after diagnosis. Programs are able to evaluate the benefits of therapy and surgery.

Oncotype DX is an analysis of a sample of breast cancer tissue to determine its genetic makeup. The test determines the likelihood of relapse and its signs. The program determines the appropriate treatment for each individual case.

Breast cancer recurrence is prevented by a comprehensive therapeutic effect for primary education. For early detection of secondary pathology preventive examinations held quarterly for 2 years, and then less frequently.

How many people can live after a recurrence of breast cancer is difficult to say. No analysis and test can give an accurate prediction. When individual metastases are detected, the prognosis worsens significantly.

Treatment of breast cancer in modern medicine has good results, and mortality from this disease is decreasing. However, some patients, after performing a mastectomy or other types of surgery, develop a recurrence of breast cancer - the return of signs of the tumor after its treatment.

Types of relapses

There are 3 types of this condition:

• Local

It occurs when tumor cells reappear after some time at the original site of the malignant neoplasm. This condition is not seen as the spread of cancer, but as a sign of failure of primary treatment. Even after a mastectomy, pieces of adipose and skin tissue remain on the breast, which makes recurrence in the postoperative scar possible, although this rarely happens.

Women who have undergone organ-sparing surgery, such as lumpectomy, or radiation alone, have a higher risk of recurrence.

• Regional

This is a more severe condition, indicating the spread of tumor cells through the lymphatic tract through the axillary lymph nodes into the pectoral muscles, tissues under the ribs and sternum, into the intrathoracic, cervical and supraclavicular lymph nodes. The last two of these localizations of the newly emerged pathological process, as a rule, indicate a more aggressive form of the malignant process.

The frequency of relapses, manifested by the regional spread of tumor cells, is quite high and ranges from 2 to 5% of cases of malignant tumors of the breast.

• Remote

This term refers to the appearance of metastases in other organs. In this case, the likelihood of a cure is significantly reduced.

From the tumor focus, cancer cells enter the axillary lymph nodes. In 65-75% of cases of distant recurrence, they spread from the lymph nodes to the bones. In more rare cases, metastases occur in the lungs, liver, brain, or other organs.

In some cases, after a long time after the primary focus has been cured, breast cancer reappears, but in a different gland. However, it has a different histological structure and other characteristics. Such patients are considered as newly ill.

Development frequency

In the first 5 years after not using additional methods treatment, only 60% of women do not develop new signs of the disease. If only surgery is performed, the probability of recurrence of breast cancer is maximum in the first 2 years after it and is almost 10%.

The researchers studied the data of the case histories of almost 37,000 patients and found that relapses most often occur in stage 1 cancer, since in this case radical surgery is often not used, as well as subsequent treatment with hormonal agents.

The overall recurrence rate and mortality continues to be high for 10 years, with a significant percentage of cases occurring in the first 5 years after treatment. If the patient did not have axillary lymph nodes involved (Stage 1), but she did not receive hormone therapy, the probability of a return of the disease within 10 years after surgery is 32%. With the defeat of the lymph nodes (stage 2), this risk increases to 50%, provided only surgical treatment.

Unlike other forms of cancer, a malignant tumor of the mammary glands is not considered cured if no new signs of the pathological process appear within the next 5 years. Recurrence can occur 10 or 20 years after the initial diagnosis, but this probability decreases over time.

Risk factors

A recurrent course in breast neoplasms occurs if the cells of the primary tumor persist in this area or other parts of the body. Later, they begin to divide again and form a malignant focus.

Chemotherapy, radiation, or hormonal drugs used after the initial diagnosis of cancer are used to kill any remaining malignant cells after surgery. However, in some cases, such treatment is ineffective.

Sometimes the remaining cancer cells lie dormant for years. Then they begin to grow and spread again.

The reasons for recurrence of breast cancer are unclear, but the association of such a condition with various characteristics of the tumor has been noticed. A number of common factors have been identified that can help predict the likelihood of disease recurrence.

Risk indicators:

• Lymph node involvement

The spread of the tumor in the axillary and other lymph nodes at the initial diagnosis, a large number of affected lymph nodes. If the lymph nodes were not involved, this means a favorable outcome for the patient.

• Tumor size

The larger the size of the initial neoplasm, the higher the risk of recurrence. Especially often in such cases there is a relapse after partial removal gland and associated lymph nodes.

• Degree of differentiation

This is an assessment of tumor cells under a microscope. There are 3 main characteristics that determine the malignancy of breast cancer: the rate of cell division, their histological type (ductal tumor is more aggressive than tubular tumor), change in the size and shape of the cells. If the formation is classified as class III (poorly differentiated cancer), the recurrence rate is higher than with a differentiated neoplasm.

• HER2/neu status

This gene controls the production of a protein that promotes the growth of cancer cells. If such a protein is detected, more careful monitoring after surgery is necessary for early detection of precancerous changes in the remaining cells and timely treatment.

Patients with high HER2/neu levels require trastuzumab (Herceptin) immunotherapy, often in combination with additional chemotherapy. Herceptin is also prescribed for the ineffectiveness of chemotherapy or hormonal agents.

• Vascular invasion

The presence of tumor cells in tumor vessels increases the risk of recurrence.

• Status of hormone receptors

If the tumor has estrogen (ER+) or progesterone (PgR+) receptors, the risk of recurrence with additional therapy is lower.

• Proliferation index

This is an important prognostic factor. The Ki-67 protein is formed during cell division. Increasing its concentration is associated with a higher recurrence rate and reduced life expectancy.

Low risk group

The experts of the international group for the study of breast cancer have established that with a positive ER- or PgR-status, the patient can be classified as a low-risk group for recurrence if the following conditions are met:

• the cancer has not spread to the lymph nodes;
• the tumor is less than 2 cm in diameter;
• the nuclei of cancer cells are small in size, slightly changed in color and other characteristics compared to normal ones (highly differentiated tumors);
• there is no invasion of the tumor into the blood vessels;
• the Her2/neu gene is missing.

Even for small tumors, categorized as the lowest risk, in the absence of additional therapy, the 10-year risk of recurrence is 12%.

Categories of risk

Experts suggest classifying patients in the following risk categories:

How to avoid recurrence of breast cancer?

Completely protect the patient from this modern medicine unable.

However, many studies have shown that relapse prevention can be achieved with supplemental hormonal therapy. It reduces the likelihood of the disease returning by at least 30% and significantly improves long-term survival rates.

For additional (adjuvant) hormone therapy, antiestrogens (Tamoxifen) and aromatase inhibitors (letrozole, anastrozole and exemestane) are used. Preference is given to the last group of drugs. They are given after surgery.

In order to prevent the re-development of cancer, a modern one should also be carried out after surgery.

Clinical signs

Any patient who has undergone surgery for malignant breast formation should know how a relapse manifests itself, and in this case, contact an oncologist in time. It must be remembered that its symptoms may occur after many years, when a woman has already been removed from the dispensary.

Signs of recurrence depend on the type of breast cancer.

Local recurrence

The tumor appears in the same area as originally. If carried out, malignant cells can spread into the remaining tissue of the gland. After a mastectomy, a neoplasm may appear in the scar area.

Symptoms:

• uneven density of the gland or the formation of "bumps" in it;
• changes in the skin on the chest, its inflammation, redness;
• discharge from the nipple;
• the appearance of one or more painless nodules under the skin in the area of ​​the scar;
• the appearance of an area of ​​thickened skin near the scar after a mastectomy.

Regional relapse

In this case, cancer cells multiply in nearby lymph nodes. It manifests itself as the formation of a seal ("bumps") or swelling in the area under the arm, above the collarbone or on the neck.

Distant metastases

Cancer cells develop in other organs - bones, lungs, liver, brain. The most common signs:

• persistent persistent untreated pain in the bones, back;
• persistent cough;
• shortness of breath, difficulty breathing;
• loss of appetite, weight loss;
• Strong headache;
• seizures and others.

Diagnostics

The doctor may suspect a recurrence based on clinical symptoms, physical examination data or . In addition, the following studies are assigned:

1. Imaging, that is, allowing you to "see" the tumor or metastases: magnetic resonance, computer, positron emission tomography, radiography, radioisotope scanning.
2. Biopsy followed by histological analysis: it is necessary to determine whether a new tumor is a relapse or another case of the disease, as well as to detect sensitivity to hormonal or targeted therapy.

Treatment

Its options depend on many factors, including the size of the tumor, its hormonal status, previous interventions, the general condition of the body, as well as the goals of treatment and patient preferences.

Local recurrence requires surgical treatment. Since it usually occurs after organ-sparing surgery, the patient undergoes removal of the entire gland. After a previously performed mastectomy, the tumor is removed with part of the surrounding healthy tissue. Axillary lymph nodes are also excised.

According to the US Cancer Society, 190,000 new cases of breast cancer were diagnosed last year. This society offers certain diets, various methods that, to some extent, help sick women fight against breast cancer.

However, scientists have recently developed a new genetic test, which consists in identifying one of the most common forms of cancer - breast cancer. This test greatly helps doctors determine the likelihood of cancer cells spreading in the body. As a result, doctors know for sure whether there is an emergency need for the patient to immediately undergo a course of chemotherapy. To date, this genetic test has the working title "Oncotype DX".

The new method can save thousands of women. So, as it is thoroughly known that chemotherapy causes quite serious side effects in some patients. The test can accurately predict the risk of breast cancer recurrence up to 10 years after starting treatment. Which gives grounds to call this genetic test a real breakthrough in oncology, because in case of a recurrence of breast cancer, the patient will be prescribed a more aggressive and effective cancer therapy, which in the future will help to avoid the appearance of a new malignant tumor.

Every year breast cancer is diagnosed in thousands of women, and in 80% of episodes the tumor is positive directly to estrogen receptors. Patients with this type of breast cancer can be treated with hormone therapy. For example, the treatment of the initial stage of breast cancer has just ended. The woman underwent surgery/chemotherapy/radiation exposure. What in this case gives hormonal therapy? Can it reduce the risk of breast cancer recurrence and is it worth the candle in general?

It is worth remembering that in the beginning the risk of recurrence is never 100%! Suppose risk of breast cancer recurrence in the patient was 20%, and the hormone therapy carried out reduced this risk by half. However, among other things, it is imperative to assess the risk of side effects of hormonal treatment, depending on the general state of health. Hormone therapy is a kind of targeted therapy (i.e., treatment aimed at a specific target), in this case, the target is hormone-positive cancer.

Simply put, hormonal treatment affects cancer cells that have hormone receptors on their surface. The vast majority of forms of hormone therapy have equally positive effects. Depending on the general condition, the nature of the course of the disease, its stage, prevalence and menopausal status, the doctor chooses the appropriate hormonal treatment. When prescribing, which must be strictly adhered to directly to the therapy regimen.

During the course of hormonal treatment, the doctor and the patient herself must definitely monitor potential side effects. Therefore, before prescribing this or that form of hormonal treatment, the doctor carefully "weighs" the pros and cons in order to clearly assess the advantages and disadvantages. However, women with other types of breast cancer are at high risk of tumor recurrence within 10 years after the first course of treatment, which means that these women will have to undergo chemotherapy again. Since chemotherapy drugs for breast cancer kill not only cancer cells, but also healthy nearby ones, this leads to the appearance of very serious side effects.

That's why new genetic test"Oncotype DX" is not only a breakthrough in oncology, but also the salvation of thousands of women with a potential recurrence of breast cancer!!!

REMEMBER - a timely visit to a doctor will save your life!

Taganrog, Rostov region, st. Dzerzhinsky 154-6

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Saturday - from 10.00 to 13.00