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Treatment for Breast Cancer Recurrence

There are several treatment options available for breast cancer recurrence. Depending on the location, size, invasiveness and extent of spread, treatment for the recurrence can vary from only a surgical procedure to any combination of chemotherapy, radiation therapy and hormone therapy.

Your options for treatment of recurrence may depend on the type of treatment you had for the initial cancer. For example, if you chose to have breast conserving therapy, which is a partial mastectomy followed by radiation to the cancer site and axilla, you cannot have breast conserving therapy again. This is because the maximum dose of radiation allowed is given with treatment of the initial cancer and the site cannot tolerate any more radiation without complications. Thus, a mastectomy must be done to treat the recurrence.

Another option is neoadjuvant chemotherapy, or chemotherapy given prior to surgery with or without radiation therapy to follow. This type of treatment is very aggressive and may also be used in advanced stage primary breast cancer.1

It is important to note that breast cancer recurrences have a greater chance of being resistant to chemotherapy. As a result, if neoadjuvant therapy is being given, it is essential that your doctor monitors whether or not the chemotherapy is working prior to finishing the scheduled treatment period. Continuing with treatment that is ineffective could be a waste of valuable time, energy and resources, not to mention the potential of further spread during this time.

You may choose to have an elective mastectomy of the opposite breast, called a risk-reduction or prophylactic mastectomy, if you experience a recurrence in the same breast as before. Although this may seem drastic and aggressive, some women choose to have this done for treatment of the initial cancer as well, due to an elevated lifetime risk of breast cancer and recurrence based on several factors. Some of these factors are genetic risk, stage of the primary cancer at diagnosis and even desire for reconstruction. This type of surgery is not recommended without a clear understanding of the potential emotional and psychological consequences that will follow a bilateral mastectomy. 2

Treatment Options for Recurrence

One very promising option for primary or recurrent breast cancer is Lapatinib. This medication is taken by mouth once a day and has limited cardiovascular side effects. It does, however, have serious side effects associated with the liver and must be monitored very closely. It may also help to prevent brain metastases when treating an aggressive primary cancer. It is indicated for patients with HER2 positive breast cancers and works by inducing apoptosis, or programmed cell death of cancer cells that express HER2. 3

When diagnosed with a breast cancer recurrence, it is important to maintain a strong support system. Sometimes patients feel that treating a recurrence is only prolonging the inevitable or that it will not work. This negative attitude about the potential outcome may delay a patient from seeking out treatment. Reach out to the people who helped you fight your cancer the first time. More than likely, they will be willing to help again.

As with the initial breast cancer treatment options, all treatment options for recurrence must be considered in order to make the best choice for you. The potential risks, benefits, estimated success rates, and the quality of life for the patient should be determined. In advanced cases where the cancer has metastasized to a place that cannot be treated, aggressive management may not be an option. In these situations, it may just be best to consider pain management and management of symptoms instead of treating the cancer.

References

1 Byrski, T., Gronwald, J., Huzarski, T., et al. (n.d.). Response to neo-adjuvant chemotherapy in women with BRCA1-positive breast cancers. Epidemiology , 289-296.

2 American Cancer Society. (2004). A Breast Cancer Journey: Your Personal Guidebook. Atlanta: American Cancer Society

3 Costa, S.-D., Jackisch, C., & Thomssen, C. (2010). Future Roles of Lapatinib in ErbB2-Positive Breast Cancer: Adjuvant and Neoadjuvant Trials. Breast Care , 22-24.

4 Sirohi, B., Arenedos, M., Popat, S., et al. (2008). Platinum-based chemotherapy in triple-negative breast cancer. Annals of Oncology , 1847-1852.

This article was originally published on July 27,2012 and last revision and update of it was 9/2/2015.