Recurrent Breast Cancer

Tuesday, October 6, 2015

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Breast cancer is the most common malignancy diagnosed in women. Survival rates have increased. The number of deaths is declining due to earlier detection and prompt treatment.
Five to ten percent of breast cancers are due to genetic mutations passed through family generations. Inherited mutated genes increase cancer likelihood. The most common are cancer gene 1 (BRCA1) and 2 (BRCA2). Both of these increase risk for breast and ovarian cancer.
Presence of genetic risk doesn't mean that cancer will occur. However, risk is higher with increasing age. Cancer in one breast increases risk for cancer in the opposite breast. A family member with breast cancer at a young age increases risk. The majority of those have known family history. Risk factors include obesity, onset of early menstruation, and menopause at older age. Women who gave birth to their first child after age thirty and those who haven’t been pregnant but took hormone (estrogen) have elevated risk. However, risk decreases when the medicines are stopped.
Presence of a lump requires a mammogram. If there is a lump, a diagnostic mammogram is more specific. Ultrasound is reasonable to distinguish a solid mass or cyst.
Biopsy should be ordered to determine if tissue and cells are cancerous. An MRI with contrast is reasonable. Biopsy or surgery could determine the stage or type of cancer.
Further workup includes a blood count, bone scan, CT (computerized tomography), breast MRI, and PET (positron emission tomography) scan.
Stage four cancer indicates that the cancer that has spread. Simple mastectomy or modified radical mastectomy is considered. Chemotherapy, hormone therapy, or radiation treatment is initiated
If surgery is considered, a second opinion from a breast specialist is appropriate. Surgery includes lumpectomy, breast sparing surgery, and removing the tumor with a small margin of surrounding healthy tissue. Simple mastectomy involves removing all breast tissue, including the lobules, ducts, fatty tissue and skin, including the nipple and areola.
Removing a limited number of lymph nodes (sentinel node biopsy) could determine whether cancer has spread to the lymph nodes. If the nodes are cancer free, probability of finding cancer in remaining nodes is minimal. Should there be cancer in the sentinel node, additional nodes are removed. Those with cancer in one breast could decide to have their other (healthy) breast removed if there is a strong family history. However, most women with cancer in one breast won’t develop cancer in the other.
 Plastic surgery reconstruction involves a breast implant (silicone or water-filled) or reconstruction using one’s own breast. Radiation therapy is considered to obliterate remaining cancer cells.
External beam radiation, or brachytherapy, involves placing radioactive material inside the tumor area. It’s performed after lumpectomy for early-stage breast cancer. Radiation to the chest wall after mastectomy could be considered if cancer has spread to the lymph nodes.
Radiation side effects include fatigue and red, sunburn-like rash where radiation is applied. The tissue could appear swollen or firm. Rarely, damage to the heart or lungs could occur in the treated area.
If cancer has spread outside the breast, chemotherapy is given to mitigate the cancer and decrease symptoms. Effects include hair loss, nausea, vomiting, fatigue, and infection. Rare effects include premature menopause, infertility (if premenopausal), injury to the heart and kidneys, nerve damage, and blood cell cancer.
Hormone-blocking therapy treats breast cancers sensitive to hormones. It might be considered after surgery to decrease recurrence. (SERM) selective estrogen receptors, block estrogen from attaching to the estrogen receptors, slowing tumor growth, and obliterating cancer cells.
There are no alternative medicine treatments that have been found to cure breast cancer. However, complementary and alternative medicine (CAM) may help. Survivors have fatigue during and after treatment that could continue for years. When combined with a doctor's care, CAM could relieve fatigue and improve sleep. Exercising three to four times a week, journaling, walking, yoga, Tai Chi, and swimming decrease depression and improve mood.
A breast cancer diagnosis is overwhelming. Local groups, such as the American Cancer Society, give support. .
 Women who eat a Mediterranean Diet supplemented with extra-virgin olive oil and mixed nuts reduced cancer risk. The diet focuses on plant-based foods, such as fruits and vegetables, whole grains, legumes and nuts. Those who follow this diet choose healthy fats, like olive oil, over butter and fish, instead of red meat. Estrogen-blocking medications reduce cancer risk. These include Tamoxifen and Raloxifene (Evista). Removal of the ovaries further reduces risk.

 Signs and symptoms include a breast lump or thickening different from the surrounding tissue, bloody discharge from the nipple, and change in breast size, shape, and appearance. Nipple scaling with redness or pitting are suspicious findings.

Make an appointment with your treating doctor to review your current medical history and medications. An annual checkup is crucial.