Local/regional recurrent disease

After any local/regional therapy for early-stage breast cancer, there is a risk of cancer returning to the same breast. This can occur in a breast that underwent partial surgery (lumpectomy) or total breast removal (mastectomy). It can also occur on the same side in the lymph nodes. Treatment for a recurrence of cancer in the breast or lymph nodes depends on the type of surgery that was initially performed (lumpectomy or mastectomy) and how extensive the recurrence is.

Treatment may require a combination of surgery, systemic therapy (chemotherapy or estrogen blockers), and radiation therapy. As with an initial diagnosis of breast cancer, the goal of this treatment is cure.

Metastatic Breast Cancer

Metastatic breast cancer is breast cancer that has spread to other parts of your body. Cancer cells break off the original tumor in your breast and spread to other parts of the body by traveling through your bloodstream or lymphatic system. The new tumor is made up of cells from the breast cancer. So, even if the breast cancer spreads to a bone, it's made up of the breast cancer cells, not bone cells.

While most patients with newly diagnosed breast cancer present with a disease that is localized to the breast and lymph nodes (stage 0-3), about 4-6% of patients will present with a disease that has already spread to other areas of the body. This is called de novo, stage 4, metastatic breast cancer. Patients who are treated for early-stage breast cancer are also at risk for distant recurrence of the disease. This is considered recurrent, stage 4, metastatic breast cancer.

For patients with de novo stage 4 as well as recurrent metastatic breast cancer, treatment is aimed towards alleviating symptoms and prolonging life with the best quality of life possible. Some patients with stage 4 breast cancer can achieve long-term remission of the disease and even a cure. That's why it is important to understand all treatment options, including potential participation in a clinical trial.

Treatments for metastatic breast cancer are complex. Doctors consider the characteristics of the breast cancer, including the expression of estrogen receptor, progesterone receptor, and HER2/neu, as well as the molecular signature of the cancer, which can be evaluated on tumors using Next Generation Sequencing (NGS) or on circulating tumor cells in the blood (Liquid biopsy – ctDNA).

It is important to know that breast cancer can spread to many other organs, including the liver, bones, lungs, brain, lymph nodes, etc. If patients develop new symptoms that are persistent and can't be explained by other medical problems, these symptoms should be discussed with a medical oncologist.

Treatment of metastatic breast cancer has improved greatly, and mortality rates have decreased by 43% over the last 30 years, thanks to better screening, early detection, and better treatments. Patients should always explore participation in clinical trials since they give patients the opportunity to receive the treatment of tomorrow, today.

Tests

Mammograms
Mammograms are the fastest, most accurate way of detecting an abnormal growth in your breast. With tomosynthesis, or 3-D mammography, radiology technologists can get breast images from multiple angles, enhancing the accuracy of a reading and reducing the potential need for repeat scans.

Breast Ultrasound and Magnetic Resonance Imaging (MRI)
Your doctor may request a noninvasive imaging exam, such as breast ultrasound or breast MRI, if you have dense breasts and you’re at a higher risk of breast cancer — especially for those with a 20 percent or higher lifetime risk for breast cancer.

Ductoscopy
More than 80 percent of breast cancer growths arise in milk ducts. If your symptoms include a watery, blood-tinged discharge from the nipple, your surgeon will use ductoscopy to find the lesion to sample or remove it. It uses a fiber-optic scope less than a millimeter thick inserted into the milk duct at the nipple to send images to a computer monitor.

Biopsies
A biopsy is a small sample of the suspicious breast tissue that’s removed and tested. Biopsies can be performed in several ways, depending on the circumstances: fine needle aspiration (minimally invasive biopsy), image-guided core needle biopsy, cyst aspiration, ductoscopy (milk ducts), and surgical biopsy (excisional or incisional biopsy). Once a small sample of breast tissue is removed, your doctor may do multigene or hormone tests to learn more about your specific cancer.

Estrogen and Progesterone Receptor Test
This test looks for estrogen and progesterone (hormone) receptors in your cancer tissue. If your breast cancer cells have estrogen and progesterone receptors, the cancer may grow more quickly. The test tells your doctor whether treatment to block estrogen and progesterone will be effective.

Human Epidermal Growth Factor Type 2 (HER2/Neu) Receptor Test
This test measures how many HER2/neu breast cancer genes there are and how much HER2/neu protein is made in a sample of breast tissue. If there are more HER2/neu genes or higher levels of HER2/neu protein than normal, the cancer may grow or spread more quickly.

Multigene Tests
Because no tumor has a single mutation, genomic profiling allows the pathologist (cellular expert) to identify groups of mutations in your tumor tissue sample. We then can create a tumor profile for you. That profile helps us determine what type of treatment would be the most effective, and how long you should have treatment.

Treatments

After determining the extent and location of your cancer, your oncology team will discuss options with you for surgery, radiation therapy, chemotherapy and other leading-edge options available in clinical trials. Sylvester Comprehensive Cancer Center has the most breast cancer clinical trials in South Florida.

Why Choose Sylvester Comprehensive Cancer Center?

Sylvester is an NCI-designated cancer center. The National Cancer Institute has recognized Sylvester for its outstanding work conducting research in its laboratories, treating patients in its clinics and hospitals, and reaching out to medically underserved communities with innovative prevention strategies.

Renowned Braman Family Breast Cancer Institute at Sylvester. We offer treatments customized to your individual needs at one of the nation's best breast cancer diagnosis and care programs.

Breast Imaging Center of Excellence designation by the American College of Radiology. Thanks to imaging excellence, you receive a more precise diagnosis, which then guides a more effective treatment plan.