Living with recurrence
Breast cancer may return in the area around the breast or in other organs of the body.
If the breast cancer comes back in the breast or the skin of the chest it is called a local recurrence. If it spreads nearby, for example, to lymph nodes draining the breast area such as the axilla (armpit), it is called a regional recurrence.
Metastases are cancer cells that have spread from the original, or primary, cancer. If the breast cancer has spread to another part of the body this is called distant metastasis or secondary breast cancer.
Tests can show that metastases are from the spread of breast cancer rather than being a new, different cancer. When breast cancer has spread from the breast to another part of the body, the cells in the new area are breast cancer cells. For example, under a microscope, cells from a breast cancer that have spread to the lungs will look like breast cancer cells and they will behave like breast cancer, whereas the cells making up a primary lung cancer will look like and behave like lung cancer cells.
Does it make any difference to the treatment if I have a recurrence of the original breast cancer or a new primary cancer?
Yes, the treatment may be quite different for a primary cancer than for a secondary breast cancer. That is one of the reasons why it is very important to have tests done to find out which it is before embarking on a long course of treatment.
If my breast cancer does come back, can it be treated successfully?
If the breast cancer comes back in the breast or chest wall area it can still be cured. But once breast cancer has spread away from these areas to other parts of the body it can no longer be cured, although it can still be treated with the view to halting its growth for as long as possible – and this could be years.
Are the same options available for treating secondary breast cancer as there are for treating primary cancer?
The treatments may be similar. For example, secondary breast cancer may be treated with chemotherapy, hormone therapy or radiotherapy and occasionally surgery. This will depend on several factors including:
• The type of primary breast cancer;
• How the primary breast cancer was treated (particularly what radiotherapy, chemotherapy and hormone therapy drugs you have had before);
• How long ago you had your initial treatment;
• Where the secondary breast cancer is in your body (it may be in more than one area).
Is there a limit to how much treatment I can have?
There are limits to how often some forms of treatment can be used. For example, if you have had a high dose of radiotherapy to your breast/chest, there will be a point at which you could not have any more radiotherapy in that area without causing permanent damage to the tissues.
However, you could have radiotherapy to another part of your body. With chemotherapy you can usually have more, but you will not have too much of one drug very soon after you had it previously, and you may need to have different drugs than before because of the side effects.
My wife has secondary breast cancer and the doctor recently talked to us about palliative treatment. What does he mean by this?
Palliative treatment or palliative care is a term that describes the use of treatment to control or alleviate symptoms, such as pain, rather than aiming to reduce or get rid of the cancer completely.
Some people live for a number of years having regular palliative treatment to keep cancer symptoms at bay. Not being able to be cured does not mean that you (or the health professionals) give up.
There are many things that can be done to help your wife to continue to live normally.
What will happen to me if there are no more treatment options?
Breast cancer is one of the most well-researched and documented types of cancer. This means that whatever kind of breast cancer you have, there is likely to be information available to doctors to help look for treatment options.
There are many different clinical trials taking place at any time and a significant number of these will be related to breast cancer. If there are no more regular treatment options available, there might still be a trial taking place for which you are eligible.
If you are not eligible for any trials then palliative care may still be effective at controlling symptoms for some time. I can’t believe that my breast cancer can’t be cured.
Isn’t there something I can try that might still cure it?
It is very difficult to be told you have secondary breast cancer which cannot be cured. It is quite normal to feel that there must be something new you could try which gives you renewed hope.
Remember some people live with secondary breast cancer for many years and new treatments are developed all the time. If you do decide you want to try something else, here are a few things you could do.
• Get a second opinion from another specialist to see if they have any suggestions.
• Find out if there is a clinical trial of a treatment for the type of breast cancer you have.
• Certain complementary therapies might help you to feel as though you are continuing to do something active in terms of helping yourself.
However, beware of ‘miracle cures’ as there is no evidence that they will be able to cure, or control, breast cancer.
