When breast cancer recurs, it is often more frightening than the initial diagnosis. But even if the disease has returned, breast cancer can be treated. It is often possible to remove the new tumor and prevent further spread of the cancer. To maintain a good quality of life, help and support in everyday life can be important.
In breast cancer, new, uncontrolled tissue forms starting from the mammary gland. When breast cancer returns after an initial, overcome disease, it is called a recurrence . It usually means that cancer cells have remained in the body despite treatment and have started to grow again . This can also happen years and even decades after the initial illness. Sometimes a breast cancer also forms metastases in other parts of the body.
In the case of a local (local) recurrence, a new tumor develops in the breast that was previously affected by cancer. If the breast has been removed, the new tumor may appear on the chest wall or in the overlying skin. "Locoregional" means that cancer cells have also spread to the tissue surrounding the breast, for example, to the skin, armpit, or collarbone region. The tumor may also have grown in nearby lymph nodes or blood vessels. If a tumor develops in the previously healthy, other breast, this is called a new disease.
How often does breast cancer recur? Information about $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$
The risk that a breast cancer will recur after successful initial treatment depends on factors such as,
- how many lymph nodes had tumor tissue growing in them when the cancer was first diagnosed,
- How large the tumor was,
- How fast the cancer cells have grown,
- whether the growth of cancer cells has been influenced by hormones,
- the age at the time of the initial disease, and
- whether the cancer cells had spread through the lymphatic channels of the skin (inflammatory breast cancer).
In about 5 to 10 out of 100 breast cancer patients, local or locoregional recurrence occurs within ten years after breast-conserving surgery and radiotherapy . If the breast was removed during initial treatment, about 5 out of 100 women will have a localized tumor reappear in the armpit or chest wall within ten years.
Some women wonder if their lifestyle may have contributed to the tumor coming back. However, such concerns are unfounded: Whether breast cancer recurs does not depend on lifestyle, character traits or psychological stresses.
How is a recurrence determined? Information about $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$
After surviving breast cancer, many women are very vigilant and pay attention to even the smallest changes. However, many physical changes or health problems have nothing to do with the previous cancer disease. Signs of recurrent breast cancer may include a lump in the breast, scar tissue or breast area, and inflammatory changes in the skin. Some women notice such changes themselves; in others, they are detected during a medical examination, such as follow-up examinations.
The doctor is the first point of contact when it is suspected that the breast cancer has returned. She or he may issue a referral to a hospital, tumor center, or certified breast center for further testing. Anyone who is now away from the practice or center where the initial disease was treated should bring all information about the previous treatment with him or her, if possible. It is also possible to consent to doctors passing on the relevant information to each other.
A detailed discussion of the patient’s medical history is followed by a physical examination, especially of the breast or the chest wall scar. If breast cancer recurs, the doctor will also check whether the tumor has spread to the other breast or elsewhere in the body. If these examinations reveal abnormalities, the respective body region is examined in more detail. When the examinations are completed, the breast cancer is classified according to a certain scheme, just as it was when it was first diagnosed .
What are the prospects of treatment? Information about $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$
If the tumor can be completely removed and there are no distant metastases, a cure is possible even with a diagnosis of recurrent breast cancer.
How good the chances are of controlling recurrent breast cancer depends on very many factors. For example, they are influenced by,
- How big the tumor is,
- Whether it has occurred only in the breast tissue and where in the breast it is located,
- whether the growth of the tumor is influenced by hormones,
- whether growth factor receptors (HER2 receptors) are found on the cancer cells,
- how much the cancer cells have changed,
- how many "trouble spots" there are,
- whether the cancer cells have spread through the lymphatic channels of the skin (inflammatory breast cancer),
- whether the entire tumor tissue can be removed,
- whether there are already distant metastases and
- how long ago the initial disease occurred.
What treatment options are available? Information about $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$
The standard therapy for a localized recurrence is to remove the tumor as completely as possible by surgery. Sometimes neighboring lymph nodes are also removed.
surgery after previous breast-conserving treatment
If breast-conserving surgery was performed for the initial disease and a tumor now reappears in the same breast, it is usually recommended to remove the breast completely (mastectomy). In this case, the entire mammary gland tissue with surrounding skin is removed, the breast muscle remains intact. The nipple can also be preserved if no cancer cells are found here and simultaneous reconstruction is planned. In most cases, conspicuous or affected lymph nodes are also removed.
In the case of small, limited tumors, it may be possible to operate again in a breast-conserving manner. Whether this is an option also depends on the location of the tumor and how much time has passed since the initial illness. In the case of breast-conserving surgery, a new postoperative radiation treatment may be necessary.
Often there is an opportunity to rebuild the breast after a mastectomy. This can be started during the operation (immediate reconstruction), but also at a later time. The latter offers the chance to consider the advantages and disadvantages of the possible options in peace and quiet. Later reconstruction of the breast requires a new operation and a new hospital stay.
Operation after previous breast removal
A recurrence after breast removal (mastectomy) means that the tumor has grown again: in the scar tissue, on the chest wall or in neighboring tissue. Even then, an attempt is made to remove it as completely as possible.
If a tumor cannot be removed surgically because of its size, chemotherapy can be used first to make it smaller. Such a treatment is also called neoadjuvant therapy.
In principle, a drug therapy can also be useful after the operation – similar to the initial treatment. Normally drugs are used here that have not been used yet. For women with a hormone-sensitive tumor, a so-called anti-hormone therapy is possible. To slow down the growth of the tumor tissue.
If radiation therapy was not used during the initial treatment, the surrounding tissue can now be irradiated to destroy any tumor cells that may still be present. Even if the tumor cannot be operated on, radiation therapy is likely to be offered. Tissue that has already been irradiated can be irradiated again if the first irradiation took place a long time ago – possibly with a lower intensity. If the first treatment was performed not long ago, the tissue is usually too sensitive to be irradiated again.
weigh up treatment options Information about $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$
Before deciding for or against a treatment, there is usually time to find out from the doctor about the chances and the side effects to be expected and to talk to relatives and close people. You always have the right to ask for a second opinion and to refuse treatment.
For the preparation of the therapy plan and the treatment of breast cancer, certified breast centers or tumor centers as well as oncological specialized practices are the most suitable options. Specialized professionals from different professions work together to deal with the different effects of the disease and treatment on the body and psyche. However, treatment is also possible in a non-certified hospital or gynecological practice. Perhaps the gynecologist or family doctor can also take over certain treatment and aftercare steps.
What are the consequences of treatment? Information about $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$
If lymph nodes are removed from the affected breast and armpit area, lymphedema may develop. This is when the arm or chest area of the affected side swells because lymph fluid (lymph) is backed up in it. Timely treatment of lymphedema is important because the symptoms can increase over time and then become more difficult to treat.
Depending on the extent of the operation, there may be pain and delayed healing of the wound, and there is almost always a visible surgical scar. It is possible that the sensitivity of the skin and the mobility of the shoulder may be limited after the operation. A common side effect of concomitant cancer therapies is fatigue, a debilitating physical and mental exhaustion.
Losing one or both breasts is a serious event for many women. Breast is a symbol of femininity, sexual attractiveness and maternity. Its loss may cause fears of no longer being attractive, not being able to enjoy sexuality, or even losing a partner. It may therefore be wise to seek a second opinion and further information before deciding whether or not to have surgery. In the case of breast removal, breast reconstruction may also be an option. As a rule, it is not necessary to rush into the decision.
What can I do for my general well-being? Information about $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$
For women with breast cancer it is important to take care of their own well-being. Some ways to actively accompany the treatment and do something good for yourself include
- to exercise regularly, if possible,
- Eating what you tolerate well and what you have an appetite for,
- to find the right balance of activity and relaxation,
- To ensure the most restful sleep possible; and
- Generally do things that bring pleasure.
An adapted exercise program is also a possibility to alleviate fatigue and to sleep better, to lighten the mood and to perceive one’s own body more positively again. As part of cancer aftercare, there are opportunities to participate in special sports programs. It is important to enjoy exercise, to feel good about it and not to overexert oneself.
Many people believe that certain diets or nutrition could prevent cancer or help cure it. However, reliable studies on the influence of diet on breast cancer have so far failed to find any direct impact on disease risk or progression.
How do I deal with negative feelings?? Information on $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$
New anxiety and disappointment about the health setback, as well as anger about the unfairness of the situation or envy of people who are healthy: All of these feelings are normal and no reason to feel guilty about them. In the long run, however, it is probably better for your own well-being to learn to deal with negative feelings and thoughts in such a way that there is room for other things.
Many women report that they find it relieving to admit their fears, worries and despair and to talk about them with people close to them. In addition to talking with your partner, family members, and friends, counseling from psychologically trained professionals can be helpful. Pastoral or spiritual support is available in the community or even in the hospital. It is also possible to exchange ideas in a self-help group.
Sometimes it is also good to simply push away fears and worries for a while. Distracting yourself with enjoyable things or activities can help reduce anxiety and tension to a tolerable level.
How to talk to your loved ones? Information on $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$
Women with breast cancer often worry about how the disease will affect their relationship and, if they are mothers, their children. The stresses and strains of treatment usually push sexuality into the background for a while. They can change everyday life and require a lot of arrangements. All this can lead to conflicts. It is important to stay in conversation with your partner. Those who reach their own limits can get psychological counseling and support, either individually or as a couple.
Whether the children are still young or already grown up – for many mothers it is difficult to talk to their children or grandchildren about the recurrence of their disease. Memories of the time of the first illness and the associated fears are awakened, new worries are added. But even if you would prefer to protect your children from it, children can sense when something is wrong. That’s why it makes sense to talk honestly with them about the fact that the disease has returned, that further treatments may be imminent and that rest is needed more often again.
Younger children often fear that they may be to blame for the disease. Then it is important to explain to them again and again that this is not the case. In such a situation, children need a daily routine that is as regular as possible and a lot of loving attention. Sometimes friends and relatives can step in here, but mental health professionals can also be a valuable source of support. For mothers with breast cancer, there is also the possibility of rehabilitation together with their child or children.
Where do I get support? Information about $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$
Coming to terms with the diagnosis of "localized recurrence" and the associated existential fears and uncertainties is anything but easy. The recurrence of cancer treatment can also be physically and emotionally stressful. That’s why today a good therapy also includes psycho-oncological treatment. Psycho-oncologists are specially trained psychological, medical and / or socio-pedagogical specialists who support patients and their relatives in coping with the disease, if they so wish.
In the hospital, it is mainly doctors and nurses who provide psycho-oncological support. This can be done in cooperation with psycho-oncological services. Psycho-oncological services are also available in the context of rehabilitation. Those who are (again) at home can take advantage of outpatient psycho-oncological services.
In cases of prolonged anxiety or other negative feelings, supportive services also include various forms of psychotherapy. Therapy or counseling is possible individually, together with the partner, or in a group with other affected persons.
One method of reducing stress and coping better with anxiety and the effects of treatment is to learn relaxation techniques such as progressive muscle relaxation, autogenic training or exercises to guide perception. Relaxation courses are often offered in rehabilitation clinics, but also in medical or psychotherapeutic practices. If prescribed by a doctor, health insurance will cover the costs.
In self-help groups, patients find contact with other women who know the feelings and practical problems associated with the disease from their own experience. Women with recurrent breast cancer may already know this experience from their first illness: in a support group, it is possible to address issues that are often difficult to discuss with people who do not have cancer. This can be a great relief. Many women report that the solidarity and helpfulness in a group gives them strength. Self-help groups often offer additional services, such as sports groups or help with socio-legal issues.
A wide range of assistance and financial benefits are available for everyday life – these include, for example, sick pay and help with care, but also with household chores and childcare. There are numerous contact points that can advise on this and help with an application. Specialists can help with personal decisions as well as with financial and socio-legal issues. Individual counseling – by telephone or in person – is available, for example, at
- the cancer information service ,
- the cancer counseling centers of various institutions,
- of the health and pension insurance as well as
- Local (psycho)social counseling centers; the social welfare office and the health department can provide contact information.
The clinic social services can also help to apply for further social or financial assistance. Rehab service centers provide information on medical and vocational rehabilitation and help with applications. Addresses can be obtained from the health insurance or pension insurance company.
How can I shape my life? Information on $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$
Often, the fear of further progression of the disease is even greater in the case of a local or locoregional recurrence than in the case of an initial disease. But just as the disease and its treatment always bring new challenges, dealing with breast cancer can also change again and again. There is no patent remedy for how this can succeed: Each person deals differently with such a disease and must find his or her own personal path.
Many women report that after an initial phase of deep dejection, they gradually reorient themselves, evaluate many things differently, and often experience themselves as more mature and aware than before. They try to live in the present as much as possible, to make the most of every day and to enjoy it. Some women change their daily routine and pursue new interests. Others find support by continuing to live as normally as possible and trying to make the best of each day.
Working Group on Gynecological Oncology (AGO). Diagnosis and therapy of primary and metastatic breast carcinomas: loco-regional recurrence . Recommendations of the AGO Mamma Commission. 01.2017.
German Society for Gynecology and Obstetrics (DGGG), German Cancer Society (DKG). Interdisciplinary S3 guideline for the diagnosis, therapy and follow-up of breast carcinoma . AWMF register no.: 032-045OL. 08.2019.
Know Sarenmalm E, Thoren-Jonsson AL, Gaston-Johansson F, Ohlen J. Making sense of living under the shadow of death: adjusting to a recurrent breast cancer illness . Qual Health Res 2009; 19(8): 1116-1130.
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