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Why does breast cancer come back? How to prevent recurrence?

The cancer returns because some cancer cells may be still present but dormant and may not be seen on microscopy or on imaging like PET scan or mammography but become apparent with time, says Dr Nikhilesh Borkar, Consultant Surgical Oncologist, Sir H N Reliance Foundation Hospital, Mumbai

Even after initial treatment is completed and tests like PET scan show no evidence of disease, there is a chance that breast cancer may return.(Representational)
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Written by Nikhilesh Borkar

As a breast cancer survivor, you need to be wary about tracking any change that may happen in your body. For even after initial treatment is completed and tests like PET scan show no evidence of disease, there is a chance that breast cancer may return. Even women with early breast cancer often develop local recurrence within the first five years of treatment. On an average, around seven to 11 per cent of women with early breast cancer experience local recurrence during this time. For patients with a family history of breast cancer or BRCA1 or BRCA2 mutation, the rate is even higher.

Types of recurrence

The recurrence is usually of three types: Local, when it comes back to the same breast, regional, when it comes back in the nearby areas in the chest wall and distant recurrence, which is also called as metastatic cancer, when cancer cells from the original tumour in the breast travel to other parts of the body via lymphatics or bloodstream. These may reach bones, liver, lungs and brain.

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Why does breast cancer return?

The cancer returns because some cancer cells may be still present but dormant and may not be seen on microscopy or on imaging like PET scan or mammography but become apparent with time. Some cancer cells could have already spread from the original tumor site and reached other parts of the body but lie in a state of dormancy, meaning they are able to grow and divide with certain triggers. Sometimes, many years after the initial cancer treatment, dormant cells can reawaken and give rise to new tumors in different parts of the body. These tumors may also be of a different kind compared to the original one — for example, they may have different receptors that make them more aggressive.

Usually, this happens within the first three or four years but sometimes in hormone receptor positive cancers, it can come back even after 10 to 12 years. Rarely will it be a new cancer developing in the breast rather than recurrence of the original cancer.

What are the signs and symptoms of recurrence?

It all depends upon where the cancer recurs. You might not see or feel any sign of local recurrence and if you do, it will probably be a slight change in and around your breast or underarm area. More often than not, it may be a finding by the physician during a physical exam or a mammogram.

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A distant recurrence will typically produce some symptoms but because many of those breast cancer symptoms are related to other health problems, it can be hard to tell if they are due to recurrence or something else, so one must discuss the symptoms with your cancer specialist, especially if they last for more than two or three weeks. Beware of these following symptoms:
1) Weight loss without trying
2) Headaches
3) Bone pains or any new or different pain that you can’t explain
4) Shortness of breath or wheezing
5) Seizures
6) Fever, chills or a cough that won’t get better 7) Jaundice
8) Easy bruising or bleeding
9) Digestive issues like nausea, vomitting, diarrhoea, loss of appetite or trouble swallowing
10) Blood in urine or stones
11) Any lumps or areas of swelling

How can you prevent cancer from coming back?

1) First of all, follow the treatment which your physician recommends to a T.
2) Eat a balanced diet, full of fruits, vegetables and fibre.
3) Avoid too much oily and sugary food to avoid obesity.
4) Exercise on most days of the week.
5) Have a strong support system with a circle of friends and family.
6) Don’t skip follow-up care.The follow-up may not prevent cancer from coming back but can help detect it at an earlier stage than when you become symptomatic, which might be too late.

Treatment protocols

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If it’s a local recurrence after a lumpectomy, most probably you would need a mastectomy. If it’s a regional recurrence, it will need the excision of the nodes or chest wall nodule. If it’s a distant recurrence, the patient will need only systemic therapy and local treatment like surgical excision will be for symptomatic care only.

Theories about the factors that may reawaken them range from exposure to stress at the cellular level, the erosion of a kind of collagen “blanket” that surrounds dormant cells, and the protective effect of the micro-environment.

First published on: 08-12-2022 at 19:07 IST
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