Breast Cancer

Lesson 8: Life Goes On

Recurrence

For any woman who has had breast cancer, the lingering possibility of a recurrence is always hidden somewhere in the back of your mind. I've been a survivor for 4 years now and most days I don't even think about recurrence. When I'm due for my mammogram or blood work, the nasty thoughts of "What if?" manage to work their way to the forefront of my brain.

Recurrence happens on three levels - local, regional and metastatic. Local means that they find cancer cells in the area of the original cancer. This is usually easy to eradicate. It is simply cells that were not destroyed with your first round of treatment. To be on the safe side, you will have to endure the battery of tests to determine if the cancer is really local. Tests such as a bone scan, liver blood tests, chest Xray and so on. You've probably been through this regiment before, but now you probably don't trust your body anymore. You feel betrayed. The good news is most local spread does not leave you in any greater risk group than if they had gotten all the cancer the first time around. Don't be quick to blame this recurrence on your medical team - sometimes the cells are too minute to detect; others lay dormant and something triggers them awake. If you have to have a recurrence, this is the easiest kind to deal with.

A regional recurrence shows up in the lymph nodes of the armpit or collarbone. With the advent of Sentinel Node Biopsy, it is possible that a few stray cells could be left behind. Additional surgery and/or radiation or even chemotherapy will usually control this spread of the disease. If the affected lymph nodes are located elsewhere, than a more aggressive treatment approach is usually indicated.

A distance spread of cancer, or metastatic disease, is the most serious type of recurrence. While this spread can not be cured, it can be treated. While the thought of cancer spreading is mind-boggling to me, I find hope and power in the knowledge that I have many survivor friends who have survived many rounds of metastases and are still as proud, beautiful and vital as ever. My pal, Rosalie, started her cancer journey in 1989, has endured endless treatments, mets to several locations and she is still one of the most outspoken, powerful advocates I know. She is also a gentle and wonderful woman. So take heart! A recurrence is devastating, but you can not only survive, but thrive.

The statistics give most women with metastatic disease a life expectancy of 2-3 years, but 25-35% of these patients live 5 years and about 10% are alive after 10 years. Think positive - someone has to be in that 10% group. New methods of treating breast cancer are being developed almost daily. Some of the new scientific research reminds me of Star Wars - transporting molecule directly into the cancer cells is just one example. The researchers are young, innovative and committed. We have to make sure there is enough funding for the necessary studies and trials.

Breast cancer mets generally show up in the bones, lung, liver or brain. Bone metsastasis usually is discovered if the patient has bone pain. Now most of us, as we age, get some aches and pains, such as arthritis. How do you distinguish? My oncologist told me that bone met pain does not change. If I am achy when I wake up, and then feel better later in the day, chances are it is just arthritis or some other bone-related pain. Cancer pain would remain constant, regardless of time of day, position of body, etc. Bone pain is checked through a bone scan. Another location for mets is the lung. This only happen sin about 20% of the cases. Symptoms include shortness of breath and a chronic cough. Chest Xrays and a needle biopsy can confirm this diagnosis. The liver is another site for cancer spread. Loss of weight, loss of appetite, gastrointestinal problems and pain under the ribcage are possible signs of this. Liver metastasis is detected through a CAT scan, ultrasound and blood tests.

Regardless of where the cancer has spread, you want to know how to treat it. You will be offered a variety of chemotherapy agents, radiation, hormonal therapies and possibly surgery. The goal is to reduce the size of the tumor(s), slow down the spread or possibly eliminate the tumor. The main goal is to keep you, the patient, comfortable.

You, the patient, make the biggest impact on how you will live out your life. Are you worried about pain? There are many pain medications that work wonders today. Is death the issue? No one can predict your death for you; the doctors can quote stats, but they are just that - numbers. Everyone is unique. It is up to you to determine how much/how little treatment you want. Do you want to participate in a clinical trial? Do you want to opt for some alternative/complementary treatments? Do you feel the need to put your life in order? Some people choose hospice care at the end of their days. This sounds terribly depressing, I know, but the emotional issues surrounding a recurrence can be more painful than the disease itself. How you deal with a recurrence is up to you. Once again, it is your body, your decisions. Me? If I ever have to face a recurrence I will fight with every ounce of strength I have and use the entire arsenal available to me through the medical community. And I will live, hopefully, as I do now -enjoying every minute of every day and trying to help others.

Tough topic, but here are some websites for further information on metastatic breast cancer - http://www.bcmets.org http://www.nabco.org/index.php/25

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