Signs of breast cancer recurrence

Recurrent breast cancer can occur months or years after the first treatment, with the tumor remaining in the original location or spreading to other areas.

Although initial treatment aims to eliminate all cancer cells, a small number of cells may evade treatment and survive, multiplying and becoming recurrent breast cancer.

According to Dr. Nguyen Do Thuy Giang (Head of Breast Surgery Department, Tam Anh General Hospital, Ho Chi Minh City), cancer can recur in the same location as the original cancer (local recurrence) or spread to other areas (distant metastasis). Treatment can eliminate recurrent breast cancer at the local level, in the lymph nodes, or that has metastasized to distant sites. Even if a cure is not possible, treatment can control the disease for a long time.

The signs and symptoms of recurrent breast cancer vary depending on the location and extent of the recurrent lesion.

Local recurrence: Local recurrence is when cancer reappears in the same area as the original cancer. If you have had a wide excision of the tumor, the cancer may recur in the remaining breast tissue. If you have had a mastectomy, the cancer may recur in the tissue on the chest wall or on the skin.

Signs and symptoms of recurrence after wide mastectomy include: the appearance of a new lump in the breast or an irregular firming area, changes in breast skin, dermatitis or redness of the skin, and nipple discharge. According to Dr. Giang, signs and symptoms of chest wall recurrence after mastectomy include: one or more painless nodules on or under the skin of the chest wall and a new thickened area along or near the mastectomy scar.

Breast cancer can recur in the same location as the original tumor or spread to other areas. (Image: Freepik)

Regional recurrence: Regional recurrence is when cancer recurs in the lymph nodes on the same side as the original breast cancer, including the axillary or supraclavicular lymph nodes, or the internal mammary lymph nodes (in the chest). Signs and symptoms of recurrence include lumps or swelling in these lymph nodes: under the arm, in the armpit, near the clavicle, in the supraclavicular fossa, and in the neck.

Distant recurrences - distant metastases: The most common distant recurrences and metastases are to the bones, liver, and lungs, and contralateral lymph nodes (such as axillary, supraclavicular, or subclavian lymph nodes, mediastinal, or intrathoracic lymph nodes). Signs and symptoms include: persistent and worsening pain such as chest, back, or hip pain; persistent cough; shortness of breath; loss of appetite; rapid weight loss; severe headache; seizures; contralateral lymph node locations such as axillary, supraclavicular, or subclavian lymph nodes.

Recurrent breast cancer occurs when cells that were part of your original breast cancer break away from the original tumor and hide nearby in the breast or in another part of the body. These cells then begin to grow back.

Chemotherapy, biological therapy, radiation therapy, hormone therapy, or other treatments you received after your initial breast cancer diagnosis aim to kill any cancer cells that may have remained after surgery. But sometimes these treatments cannot kill all the cancer cells.

Dr. Thuy Giang further explained that cancer cells can remain inactive for many years without causing harm. Then, something happens that triggers these cells, causing them to grow and spread to other parts of the body. Currently, research is not yet clear on why this happens.

Risk factors for breast cancer recurrence include: age (younger age under 35 at the time of initial breast cancer diagnosis); obesity (higher body mass index) increases the risk of recurrence; cancer stage; triple-negative breast cancer (lacking receptors for estrogen or progesterone and Her2); and inflammatory breast cancer.

Other risk factors include: detection of metastatic cancer in lymph nodes at the time of initial diagnosis; large tumor size; positive margins (a wide surgical margin of malignant cells or very little healthy tissue, making it unsafe); lack of radiotherapy after wide surgical resection; and lack of endocrine therapy for hormone receptor-positive breast cancer.

After completing breast cancer treatment, patients undergo regular follow-up examinations and monitoring based on the stage of the disease and hormone therapy. The doctor will check for any symptoms or signs of recurrence, diagnose and manage side effects of hormone therapy, and screen for remaining breast cancer.

You can share any new signs or symptoms with your doctor before your regular check-up. If you notice any persistent signs and symptoms that worry you, you should see a doctor.

Duc Nguyen

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