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2 years later, she noticed multiple 1.5 -2 cm. nodular masses at the MRM site.

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

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2 years later, she noticed multiple 1.5 -2 cm. nodular masses at the MRM site.

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  1. 2 years later, she noticed multiple 1.5 -2 cm. nodular masses at the MRM site.

  2. 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

  3. 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.

  4. 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

  5. Impression? Locoregional recurrence of the breast cancer on the mastectomy site

  6. Treatment • With previous mastectomy: • Surgical resection of the locoregional recurrence • Appropriate reconstruction • Chemotherapy • Anti-estrogen therapy

  7. 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%

  8. 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.

  9. 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

  10. 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.

  11. 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.

  12. 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)

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