Download 2 years later, she noticed multiple 1.5

2 years later, she noticed multiple 1.5 2 cm. nodular masses at the MRM site.
Breast Cancer Recurrence
• anytime, mostly occur in the first 3 – 5 years
after initial treatment
• can come back as a local recurrence (in the
treated breast or near the mastectomy scar)
or as a distant recurrence somewhere else in
the body
• most common sites of recurrence include the
lymph nodes, the bones, liver, or lungs
Factors for recurrence
• Lymph node involvement
• Tumor size
– the larger the tumor, the greater the chance of recurrence.
• Hormone receptors
– two-thirds of all breast cancers contain significant levels of estrogen receptors,
which means the tumors are estrogen receptor positive (ER+)
– ER-positive tumors tend to grow less aggressively and may respond favorably to
treatment with hormones.
• Histologic grade
– Grade 4 tumors contain very abnormal and rapidly growing cancer cells
– The higher the histologic grade, the greater chance of recurrence.
• Nuclear grade
– Refers to the rate at which cancer cells in the tumor divide to form more cells
– Cancer cells with a high nuclear grade (also called proliferative capacity) are usually
more aggressive (faster growing).
• Oncogene expression
– tumors that contain certain oncogenes may increase a patient's chance of
recurrence.
Breast Changes
• An area that is distinctly different from any other area
on either breast
• A lump or thickening, in or near the breast or in the
underarm, that persists through the menstrual cycle
• A change in the size, shape, or contour of the breast
• A mass or lump, which may feel as small as a pea
• A marble-like area under the skin
• A change in the feel or appearance of the skin on the
breast or nipple [dimpled, puckered, scaly, or inflamed
(red, warm, or swollen)]
• Bloody or clear fluid discharge from the nipples
• Redness of the skin on the breast or nipple
Impression?
Locoregional recurrence of the breast
cancer on the mastectomy site
Treatment
• With previous mastectomy:
– Surgical resection of the locoregional recurrence
– Appropriate reconstruction
– Chemotherapy
– Anti-estrogen therapy
Biopsy?
• Yes!
– to determine the characteristics of the
lesion/tumor
– to determine the staging of the recurrence
– to permit doctors discuss the appropriate
management
• A current study shows that 10 out of 29 recurrent
tumors changed ~ 35%
Biopsy Of Recurrent Breast Cancer
Can Alter Treatment
• Article Date: 20 Mar 2009
• A group of doctors from Toronto has recently
completed the world's first study that compared
original breast cancer tumors with a biopsy of
suspected tumors that recurred elsewhere in the
body.
• found that the biopsy resulted in 20% of the
women having a significant change in their
treatment
– change in drug treatment
– change in diagnosis to a benign condition.
Biopsy Of Recurrent Breast Cancer
Can Alter Treatment
• "The results show that cancers may change over time
and not respond to treatment that was appropriate for
the original cancer,“
•
principal investigator, Dr. Mark Clemons, a medical oncologist specializing
in breast cancer in the Princess Margaret Hospital Cancer Program,
University Health Network (UHN).
• leading us in a new direction to understand more
about why some women don't respond to treatment
• this will help us to always deliver the right treatment,
to the right patient, at the right time
Biopsy Of Recurrent Breast Cancer
Can Alter Treatment
• 29 biopsies of accessible, recurrent tumors taken
from women whose breast cancer had spread to
bone, skin, lymph nodes, lung or liver
• compared the results of the original cancer with
the results of the new biopsy by analyzing the
predictive markers that influence breast cancer
tumor growth - estrogen, progesterone and Her2
status
• the presence, absence and/or combinations of these
markers become the map oncologists use to determine the
most effective treatment for each patient.
Biopsy Of Recurrent Breast Cancer
Can Alter Treatment
• Result:
– 15 cases was unchanged
– 10 cases the markers in the cancer changed
– 3 cases, women originally felt to have metastatic
breast cancer had benign disease
– 1 case, the "recurring" cancer was a different type
of cancer, lymphoma which is treated in a very
different way to breast cancer.
References:
• Brunicardi, F. C., et. al., Schwart's Manual of
Surgery, 8th ed., 2006
• www.medicinet.com
• Annals of Oncology, Oxford University Press
(Doi:10.1093/annonc/mdp028)
• www.cancer.org (American Cancer Society)