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What is a recurrence?
A recurrence is when breast cancer returns after you have completed treatment for your initial diagnosis of breast cancer. This can happen within a relatively short period of time after treatment or many years later. There are three types of breast cancer recurrence:
- Local recurrence: This is when the breast cancer tumor cells grow back in the original site (or breast). If a mastectomy has been performed, this may mean that the cells grow back in the chest wall skin or nearby tissue.
- Regional recurrence: This is when the breast cancer has spread outside the breast and axillary (underarm) lymph nodes, such as in the pectoral (chest) muscles, internal mammary lymph nodes under the breast bone and between the ribs, in the supraclavicular nodes (above the collarbone) or in the nodes surrounding the neck.
- Distant recurrence: (or metastasis) This is when the breast cancer has spread through the lymph system or bloodstream to other sites in the body such as; the bone, lungs, liver, brain or other organs.
What is metastatic breast cancer?
Metastatic breast cancer, also referred to as advanced breast cancer, is when breast cancer spreads beyond its original site to a different organ in the body. Metastatic breast cancer, or metastasis, most often occurs in the bones, lungs, liver, and brain, but can show up in other areas of the body. A breast cancer metastasis is still a breast cancer, regardless of what organ it may spread to. For example, a breast cancer metastasis that spreads to the liver is not liver cancer.
What symptoms should I watch for?
Anything unusual that lasts more than two weeks or is severe should be checked out. Keep in mind that cancer patients still get arthritis and the flu, so don't panic. Most women whose breast cancer has metastasized do not show symptoms until the disease is extensive. Symptoms of metastatic breast cancer may include:
- Bone pain
- A persistent dry cough that continues for an extended period
- Shortness of breath
- Lack of appetite
- Weight loss
- Neurological pain or weakness, headaches
While these symptoms may be possible signs of metastasis to the bone, lung, liver or other parts of the body, this does not mean that every woman who experiences them has metastatic breast cancer. There can be a variety of other reasons why you might experience the above symptoms, and they may have nothing to do with cancer of any kind. The important thing is that you listen and pay attention to what your body is trying to tell you and that you seek medical help to determine what may be causing your particular symptom or condition.
Where can breast cancer spread?
Breast cancer has the potential to spread to almost any region of the body. The most common region breast cancer spreads to is the bone, followed by lung and liver.
How do doctors test for metastatic disease?
There are several tests used to detect metastatic disease:
· Bone scans
· Chest X-ray
· CAT scan
· MRI scan
· PET scan
· Blood Tests/Tumor marker tests (Measure markers found in the blood that can be followed over time). Two such markers for breast cancer are CEA and CA 15-3. These markers tend to be elevated in women with metastatic breast cancer. However, because the tests are not very sensitive, they are not usually very useful for patients with early-stage breast cancers.
What are the survival statistics of metastatic breast cancer?
In general, women have more treatment options if their breast cancer is detected early, and their chances of survival are greater. However, this does not mean that women with advanced breast cancer do not survive. Many breast cancer mental health professionals recommend that women avoid survival statistics. This is because treatment options are constantly being expanded and statistics are old by the time they are reported. However the American Cancer Society website provides some basic statistics.
What are my treatment options?
Since every woman is an individual and each situation is unique to her, the treatment options available may vary. However, treatment of advanced breast cancer generally involves systemic (whole body) treatment such as chemotherapy and/or hormonal therapy. An overview of the various treatments:
- Chemotherapy: Common chemotherapy drugs include Taxol, Taxotere, Adriamycin, Navelbine, and Xeloda
- Hormonal Therapy: Common hormonal treatments include tamoxifen, Raloxifene, Aromasin, Arimidex, and Femara (of those, only tamoxifen is recommended for pre-menopausal women).
- Herceptin: Available only for patients with HER2-overexpressing tumors. Recent data showed that Tykerb is an option for HER2 overexpressing tumors if Herceptin no longer prevents disease progression or is not an option.
- Radiation: Can be used if the metastasis is localized. For example, if cancer has spread to only one or a few closely grouped spots on the bone, radiation may be an option. For metastasis to the brain, whole or partial brain radiation may be considered.
- Surgery: A recent study in the Journal of Clinical Oncology showed that removing the tumor even when breast cancer has metastasized improves survival.
- Ovarian Suppression or Ablation: shutting down or removing ovaries is an option for estrogen receptor positive breast cancers with antiestrogens or aromatase inhibitors.
Where can I communicate with someone who has advanced breast cancer or who is knowledgeable about metastatic disease?
The YSC ResourceLink Point of Contact program will match young women with others who have been through a similar situation. Contact ResourceLink at 877.YSC.1011 or ResourceLink@youngsurvival.org for a referral to a POC volunteer.
You can meet and talk with other young women about metastatic disease on the YSC bulletin board, or read Survivor Stories on our website from women living with metastatic disease.
The Y-ME National Breast Cancer Organization has a 24-hour hotline you can call for services and support: 1.800.211.2141
www.advancedbc.org is a website dedicated to information and support for women facing advanced breast cancer.
www.bcmets.org has an advanced breast cancer list server for women of all ages, though many young women are represented on the list.
