Recurrent breast cancer

Diagnosis

If your doctor suspects you may have recurrent breast cancer based on results of a mammogram or physical exam, or because of signs and symptoms, he or she may recommend additional tests to confirm the diagnosis.

Tests and procedures may include:

• Imaging tests. What imaging tests you'll undergo will depend on your specific situation. Imaging tests may include magnetic resonance imaging (MRI), computerized tomography (CT), X-ray, bone scan or positron emission tomography (PET).

  Not every person needs every test. Your doctor will determine which tests are most helpful in your particular situation.

• Removing a sample of tissue for lab testing (biopsy). Your doctor may recommend a biopsy procedure to collect suspicious cells for testing, as this is the only way to confirm whether your cancer has returned. Working in a laboratory, a pathologist examines the cells and determines the types of cells involved.

  A pathologist can determine if the cancer is a recurrence of cancer or a new type of cancer. Tests also show whether the cancer is sensitive to hormone treatment or targeted therapy, since these may have changed since your original cancer diagnosis.

Treatment

Your treatment options will depend on several factors, including the extent of the disease, its hormone receptor status, the type of treatment you received for your first breast cancer and your overall health. Your doctor also considers your goals and your preferences for treatment.

Treating a local recurrence

Treatment for a local recurrence typically starts with an operation and may include radiation if you haven't had it before. Chemotherapy and hormone therapy also may be recommended.

• Surgery. For recurrent breast cancer that's confined to the breast, treatment usually involves removing any remaining breast tissue.

  If your first cancer was treated with a lumpectomy, your doctor may recommend a mastectomy to remove all of your breast tissue — lobules, ducts, fatty tissue, skin and nipple.

  If your first breast cancer was treated with a mastectomy and the cancer comes back in the chest wall, you may have surgery to remove the new cancer along with a margin of normal tissue.

  A local recurrence may be accompanied by hidden cancer in nearby lymph nodes. For this reason, the surgeon may remove some or all of the nearby lymph nodes if they weren't removed during your initial treatment.

• Radiation therapy. Radiation therapy uses high-energy beams, such as X-rays or protons, to kill cancer cells. If you didn't have radiation therapy for your first breast cancer, your doctor may recommend it now. But if you had radiation after a lumpectomy, radiation to treat the recurrence isn't usually recommended because of the risk of side effects.
• Chemotherapy. Chemotherapy uses drugs to kill cancer cells. Your doctor may recommend chemotherapy after surgery to reduce your risk of another cancer recurrence.
• Hormone therapy. Medications that block the growth-promoting effects of the hormones estrogen and progesterone may be recommended if your cancer is hormone receptor positive.
• Targeted therapy. If testing shows your cancer cells produce excess HER2 protein, medications that target that protein will likely be recommended.

Treating a regional recurrence

Treatments for a regional breast cancer recurrence include:

• Surgery. If it's possible, surgery to remove the cancer is the recommended treatment for a regional recurrence. Your surgeon may also remove the lymph nodes under your arm if they're still present.
• Radiation therapy. Sometimes radiation therapy may be used after surgery. If surgery isn't possible, radiation therapy may be used as the main treatment for a regional breast cancer recurrence.
• Drug treatments. Chemotherapy, targeted therapy or hormone therapy also may be recommended as the main treatment or may follow surgery or radiation.

Treating a metastatic recurrence

Many treatments exist for metastatic breast cancer. Your options will depend on where your cancer has spread. If one treatment doesn't work or stops working, you may be able to try other treatments.

In general, the goal of treatment for metastatic breast cancer isn't to cure the disease. Treatment may allow you to live longer and can help relieve symptoms the cancer is causing. Your doctor works to achieve a balance between controlling your symptoms while minimizing toxic effects from treatment. The aim is to help you live as well as possible for as long as possible.

Treatments may include:

• Hormone therapy. If your cancer is hormone receptor positive, you may benefit from hormone therapy. In general, hormone therapy has fewer side effects than chemotherapy, so in many cases it's the first treatment used for metastatic breast cancer.
• Chemotherapy. Your doctor may recommend chemotherapy if your cancer is hormone receptor negative or if hormone therapy is no longer working.
• Targeted therapy. If your cancer cells have certain characteristics that make them vulnerable to targeted therapy, your doctor may recommend these medications.

• Immunotherapy. Immunotherapy uses your immune system to fight cancer. Your body's disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that help them hide from the immune system cells. Immunotherapy works by interfering with that process.

  Immunotherapy might be an option if you have triple-negative breast cancer, which means that the cancer cells don't have receptors for estrogen, progesterone or HER2. For triple-negative breast cancer, immunotherapy is combined with chemotherapy to treat advanced cancer that's spread to other parts of the body.

• Bone-building drugs. If cancer has spread to your bones, your doctor may recommend a bone-building drug to reduce your risk of broken bones or reduce bone pain you may experience.
• Other treatments. Radiation therapy and surgery may be used in certain situations to control signs and symptoms of advanced breast cancer.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Alternative medicine

No alternative medicine treatments have been found to cure breast cancer. But complementary and alternative medicine therapies may help you cope with side effects of treatment when combined with your doctor's care.

For instance, many people diagnosed with cancer experience distress. If you're distressed, you may feel sad or worried. You may find it difficult to sleep, eat or concentrate on your usual activities.

Complementary and alternative treatments that can help you cope with distress include:

• Art therapy
• Dance or movement therapy
• Exercise
• Meditation
• Music therapy
• Relaxation exercises
• Yoga

Your doctor can refer you to professionals who can help you learn about and try these alternative treatments. Tell your doctor if you're experiencing distress.

Coping and support

Finding out your breast cancer has returned can be equally or more upsetting than your initial diagnosis. As you sort through your emotions and make decisions about treatment, the following suggestions might help you cope:

• Learn enough about recurrent breast cancer to make decisions about your care. Ask your doctor about your recurrent breast cancer, including your treatment options and, if you like, your prognosis. As you learn more about recurrent breast cancer, you may become more confident in making treatment decisions.
• Keep friends and family close. Keeping your close relationships strong will help you deal with your recurrent breast cancer. Friends and family can provide the practical support you'll need, such as helping take care of your house if you're in the hospital. And they can serve as emotional support when you feel overwhelmed by cancer.

• Find someone to talk with. Find a good listener who is willing to listen to you talk about your hopes and fears. This may be a friend or family member. The concern and understanding of a counselor, medical social worker, clergy member or cancer support group also may be helpful.

  Ask your doctor about support groups in your area. Or check your phone book, library or a cancer organization, such as the National Cancer Institute or the American Cancer Society.

• Look for a connection to something beyond yourself. Having a strong faith or a sense of something greater than themselves helps many people cope with cancer.

Preparing for your appointment

If you have any signs or symptoms that worry you, make an appointment with your primary care doctor or family doctor.

Your doctor can recommend the necessary tests and procedures to confirm a diagnosis of recurrent cancer. Then you'll likely be referred to a doctor who specializes in diagnosing and treating cancer (oncologist).

What you can do

• Be prepared to discuss your new symptoms and any other health problems you've had since your first cancer diagnosis.
• If you're seeing a new doctor, request your medical records from your former doctor. If you already have these, be sure to bring your medical records and any imaging tests you have with you. Otherwise, you'll need to sign an information release form so that your new provider's office can acquire the records.
• Make a list of all medications, vitamins or supplements that you're taking. Let your doctor know if you have tried any alternative treatments for your cancer.
• Consider asking a family member or friend to come with you. It may be hard to remember all of the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

If you might have recurrent breast cancer, some basic questions to ask your doctor include:

• Has my cancer returned?
• Are there other possible causes for my symptoms?
• What kinds of tests do I need? Do these tests require any special preparation?
• What are the hormone receptor status and the HER2 status of the cancer recurrence?
• What treatments are available to me at this stage, and which do you recommend?
• What types of side effects can I expect from treatment?
• Are there any alternatives to the approach that you're suggesting?
• Are there any clinical trials open to me?
• What's my prognosis?

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to spend more time on. Your doctor may ask:

• When did you first begin experiencing symptoms again?
• Has there been a change in the symptoms over time?
• Do these symptoms feel different from when you were first diagnosed with cancer?
• How do you feel overall?
• Have you had any unexpected weight loss? Have you lost your appetite?
• Are you experiencing any pain?