Table of ContentsView AllTable of ContentsSymptomsDiagnosisTreatmentPrognosisCopingFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Symptoms
Diagnosis
Treatment
Prognosis
Coping
Frequently Asked Questions
A chest wall recurrence is when breast cancer returns after receivingtreatment. A chest wall recurrence may involve skin, muscle, andfascia(a thin layer of connective tissue) beneath the site of the original breast tumor, as well as thelymph nodes.
If a chest wall recurrence is localized, it is referred to as a nonmetastatic breast cancer recurrence. Risk of recurrence can vary depending on several factors, including the type of breast cancer and types of treatment received.
This article will review symptoms and diagnosis of breast cancer recurrence, as well as potential treatment options and survival outlook with helpful coping tips.
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Symptoms may present differently and can vary greatly depending on where the cancer recurs and what type of treatments you have previously received. Always discuss any new or worrisome symptoms with your healthcare provider.
A few examples of breast cancer chest wall recurrence symptoms are:
If your recurrence is visible, abiopsy(removing a sample of tissue for testing) may be done to determine whether it is a breast recurrence or not. If it is positive, oncologists recommend repeating tests to see if it is estrogen receptor-positive, progesterone receptor-positive, or human epidermal growth factor receptor 2-positive, orHER2-positive.
This may seem like a surprising step to take, since these tests were already done when you were originally diagnosed with breast cancer. But in a recurrence, the receptor status of the cancer cells can change, especially if it has been more than a year or two since yourmastectomy.
In other words, if you originally had a breast cancer tumor that was estrogen receptor-positive, your tumor cells may have changed and become estrogen receptor-negative. Medically, this is referred to as discordance of a tumor.
A biopsy is recommended, even if your physician is certain that you’re dealing with a recurrence of your original cancer. This is done because of discordance, and results can have a great impact on choosing the best treatment options moving forward.
Since a locoregional recurrence can be associated with distantmetastases, a workup for staging is often done again and may include apositron-emission tomography (PET) scanto identify if the cancer has spread to other regions of the body.
Understanding Hormone Status in Breast Cancer
The first step in deciding on treatment is determining if a chest wall recurrence is confined to one area or if additional areas of recurrence, especially distant metastases, are present. Treatment options include the following:
Surgery
Surgery is the mainstay of treatment to remove the area of recurrence. A full thicknessresectionis recommended when possible and, when done on people who are appropriate candidates, can result in a 41% survival rate after 15 years.
Chemotherapy
If the area of recurrence is too extensive to be removed completely with surgery, chemotherapy may be used first to reduce the size of the tumor so that local treatment is possible.Chemotherapyuses strong medications to kill fast-growing cells, such as cancer cells, in your body. It will also be prescribed if the tumor has metastasized to distant areas of the body.
Around 27% of women with a locoregional recurrence, such as a chest wall recurrence, will have a synchronous distant metastasis.
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Radiation Therapy
If radiation therapy (using high-powered radiation to kill and shrink tumors) was not used at the time the original cancer was treated, it is usually used (along with surgery or other methods of removing the tumor) to make sure all cancer cells are treated. Cells may not be seen on imaging, but are assumed to possibly be present.
Types of Radiation Therapy for Breast Cancer
Hormonal Therapy
If the recurrence is estrogen receptor-positive and was previously negative, hormonal therapy will be recommended. This may be the drug tamoxifen, for those who are premenopausal, postmenopausal, or who are premenopausal and have undergone ovarian suppression therapy with anaromataseinhibitorsuch as Aromasin (exemestane), Arimidex (anastrozole), or Femara (letrozole).
If the tumor is estrogen receptor-positive and your previous tumor was as well, your oncologist will carefully consider your options. When a recurrence occurs when you are on hormonal therapy, the tumor may have become resistant, and a different medication may be recommended.
Targeted Therapy
If your tumor is HER2-positive and your original tumor was HER2-negative,HER2-targeted therapies, such as Herceptin (trastuzumab), will likely be recommended. If your tumor is HER2-positive and was so before, a different HER2 inhibitor may be used.
Targeted Therapies for Breast Cancer
Proton Therapy
Proton therapy is a relatively new treatment option, and not much research has been done on it thus far. One study showed that proton therapy for chest wall recurrence, when radiation therapy was done for the initial cancer, had acceptable levels of toxicity.Surgery to the chest wall after proton therapy, however, can result in significant problems in wound healing.
What Is Proton Beam Therapy for Cancer?
The survival rates for breast cancer with a chest wall recurrence can vary greatly depending on several factors. Your oncologist can speak to your individual outlook. There are an increasing number of treatment options available.
If your breast cancer comes back, it can be discouraging and sometimes more frightening than when you were first diagnosed. Less often, some people may experience a time when their cancer is no longer curable. Despite this, it is still very treatable, and several options now exist that may make it possible to live with breast cancer as a chronic illness.
If you experience a recurrence in your chest wall, it’s important to research all your options and consider getting a second opinion so you can be confident you are doing everything possible to beat the cancer.
How Breast Cancer Is Treated
Summary
Breast cancer recurrence to the chest wall is when cancer that has been treated comes back. Recurrence can happen locally, regionally, or as a distant metastasis. Where the cancer recurs can affect what type of symptoms are present. Many potential treatment options are available. Overall survival varies. Keep in mind, everyone’s personal experience and treatment options may be different. Speak with your healthcare team to discuss your best options.
Symptoms may vary depending on the extent and area to which the cancer has spread. It’s best to discuss any new or worsening symptoms with your oncologist as they occur. Don’t delay—prompt treatment is key. Your healthcare provider will order tests to determine if your breast cancer has spread to the chest wall.
Breast cancer can recur in (locally) or near (regionally) the original surgery site. Sometimes this may present as a lump, thickened scar tissue, swollen skin, or a feeling of pulling at the incision site. If you ever have concerns about your surgical site (soon after surgery or years later) always bring it to your oncologist’s attention for further investigation.
7 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Sabel M, et al (UptoDate).Clinical manifestations and evaluation of locoregional recurrences of breast cancer.Susan G. Komen.Survival and risk of recurrence after treatment.Cleveland Clinic.Breast cancer recurrence.Wakeam E, et al.Chest Wall Resection for Recurrent Breast Cancer in the Modern Era A Systematic Review and Meta-analysis. Annals of Surgery. 2018;267(4):646-655. doi:10.1097/SLA.0000000000002310Neuman, H. B., Schumacher, J. R., Francescatti, A. B., Adesoye, T., Edge, et al.Risk of synchronous distant recurrence at time of locoregional recurrence in patients with stage ii and iii breast cancer(AFT-01).Journal of Clinical Oncology, 2018;36(10), 975–980. doi:10.1200/JCO.2017.75.5389McGee LA.Postmastectomy Chest Wall Reirradiation With Proton Therapy for Breast Cancer. International Journal of Radiation Oncology. 2017;99(2):34-35. doi:10.1016/j.ijrobp.2017.06.674Breast Cancer Now.Breast cancer recurrence.Additional ReadingMcGee, L., Iftekaruddin, Z., Chang, J. et al.Postmastectomy Chest Wall Reirradiation with Proton Therapy for Breast Cancer.Radiation Oncology, Biology, and Physics. 2017;99(2):E34-E35. doi:10.1016/j.ijrobp.2017.06.674Neuman, H., Schumacher, J., Francescatti, A. et al.Risk of Synchronous Distant Recurrence at Time of Locoregional Recurrence in Patients With Stage II and Stage III Breast Cancer (AFT-01).Journal of Clinical Oncology. 2018;2017.75.538. doi:10.1200/JCO.2017.75.5389Shen, M. et al.Clinical Course of Breast Cancer Patients With Isolated Sternal and Full-Thickness Chest Wall Recurrences Treated With and Without Radical Surgery.Annals of Surgical Oncology . 2013;20(13):4153-60.doi:10.1245/s10434-013-3202-4Wakeam, E., Acuna, S., and S. Keshavjee.Chest Wall Resection for Recurrent Breast Cancer in the Modern Era: A Systematic Review and Meta-Analysis.Annals of Surgery. 2018;267(4):646-655. doi:10.1097/SLA.0000000000002310
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Sabel M, et al (UptoDate).Clinical manifestations and evaluation of locoregional recurrences of breast cancer.Susan G. Komen.Survival and risk of recurrence after treatment.Cleveland Clinic.Breast cancer recurrence.Wakeam E, et al.Chest Wall Resection for Recurrent Breast Cancer in the Modern Era A Systematic Review and Meta-analysis. Annals of Surgery. 2018;267(4):646-655. doi:10.1097/SLA.0000000000002310Neuman, H. B., Schumacher, J. R., Francescatti, A. B., Adesoye, T., Edge, et al.Risk of synchronous distant recurrence at time of locoregional recurrence in patients with stage ii and iii breast cancer(AFT-01).Journal of Clinical Oncology, 2018;36(10), 975–980. doi:10.1200/JCO.2017.75.5389McGee LA.Postmastectomy Chest Wall Reirradiation With Proton Therapy for Breast Cancer. International Journal of Radiation Oncology. 2017;99(2):34-35. doi:10.1016/j.ijrobp.2017.06.674Breast Cancer Now.Breast cancer recurrence.Additional ReadingMcGee, L., Iftekaruddin, Z., Chang, J. et al.Postmastectomy Chest Wall Reirradiation with Proton Therapy for Breast Cancer.Radiation Oncology, Biology, and Physics. 2017;99(2):E34-E35. doi:10.1016/j.ijrobp.2017.06.674Neuman, H., Schumacher, J., Francescatti, A. et al.Risk of Synchronous Distant Recurrence at Time of Locoregional Recurrence in Patients With Stage II and Stage III Breast Cancer (AFT-01).Journal of Clinical Oncology. 2018;2017.75.538. doi:10.1200/JCO.2017.75.5389Shen, M. et al.Clinical Course of Breast Cancer Patients With Isolated Sternal and Full-Thickness Chest Wall Recurrences Treated With and Without Radical Surgery.Annals of Surgical Oncology . 2013;20(13):4153-60.doi:10.1245/s10434-013-3202-4Wakeam, E., Acuna, S., and S. Keshavjee.Chest Wall Resection for Recurrent Breast Cancer in the Modern Era: A Systematic Review and Meta-Analysis.Annals of Surgery. 2018;267(4):646-655. doi:10.1097/SLA.0000000000002310
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Sabel M, et al (UptoDate).Clinical manifestations and evaluation of locoregional recurrences of breast cancer.Susan G. Komen.Survival and risk of recurrence after treatment.Cleveland Clinic.Breast cancer recurrence.Wakeam E, et al.Chest Wall Resection for Recurrent Breast Cancer in the Modern Era A Systematic Review and Meta-analysis. Annals of Surgery. 2018;267(4):646-655. doi:10.1097/SLA.0000000000002310Neuman, H. B., Schumacher, J. R., Francescatti, A. B., Adesoye, T., Edge, et al.Risk of synchronous distant recurrence at time of locoregional recurrence in patients with stage ii and iii breast cancer(AFT-01).Journal of Clinical Oncology, 2018;36(10), 975–980. doi:10.1200/JCO.2017.75.5389McGee LA.Postmastectomy Chest Wall Reirradiation With Proton Therapy for Breast Cancer. International Journal of Radiation Oncology. 2017;99(2):34-35. doi:10.1016/j.ijrobp.2017.06.674Breast Cancer Now.Breast cancer recurrence.
Sabel M, et al (UptoDate).Clinical manifestations and evaluation of locoregional recurrences of breast cancer.
Susan G. Komen.Survival and risk of recurrence after treatment.
Cleveland Clinic.Breast cancer recurrence.
Wakeam E, et al.Chest Wall Resection for Recurrent Breast Cancer in the Modern Era A Systematic Review and Meta-analysis. Annals of Surgery. 2018;267(4):646-655. doi:10.1097/SLA.0000000000002310
Neuman, H. B., Schumacher, J. R., Francescatti, A. B., Adesoye, T., Edge, et al.Risk of synchronous distant recurrence at time of locoregional recurrence in patients with stage ii and iii breast cancer(AFT-01).Journal of Clinical Oncology, 2018;36(10), 975–980. doi:10.1200/JCO.2017.75.5389
McGee LA.Postmastectomy Chest Wall Reirradiation With Proton Therapy for Breast Cancer. International Journal of Radiation Oncology. 2017;99(2):34-35. doi:10.1016/j.ijrobp.2017.06.674
Breast Cancer Now.Breast cancer recurrence.
McGee, L., Iftekaruddin, Z., Chang, J. et al.Postmastectomy Chest Wall Reirradiation with Proton Therapy for Breast Cancer.Radiation Oncology, Biology, and Physics. 2017;99(2):E34-E35. doi:10.1016/j.ijrobp.2017.06.674Neuman, H., Schumacher, J., Francescatti, A. et al.Risk of Synchronous Distant Recurrence at Time of Locoregional Recurrence in Patients With Stage II and Stage III Breast Cancer (AFT-01).Journal of Clinical Oncology. 2018;2017.75.538. doi:10.1200/JCO.2017.75.5389Shen, M. et al.Clinical Course of Breast Cancer Patients With Isolated Sternal and Full-Thickness Chest Wall Recurrences Treated With and Without Radical Surgery.Annals of Surgical Oncology . 2013;20(13):4153-60.doi:10.1245/s10434-013-3202-4Wakeam, E., Acuna, S., and S. Keshavjee.Chest Wall Resection for Recurrent Breast Cancer in the Modern Era: A Systematic Review and Meta-Analysis.Annals of Surgery. 2018;267(4):646-655. doi:10.1097/SLA.0000000000002310
McGee, L., Iftekaruddin, Z., Chang, J. et al.Postmastectomy Chest Wall Reirradiation with Proton Therapy for Breast Cancer.Radiation Oncology, Biology, and Physics. 2017;99(2):E34-E35. doi:10.1016/j.ijrobp.2017.06.674
Neuman, H., Schumacher, J., Francescatti, A. et al.Risk of Synchronous Distant Recurrence at Time of Locoregional Recurrence in Patients With Stage II and Stage III Breast Cancer (AFT-01).Journal of Clinical Oncology. 2018;2017.75.538. doi:10.1200/JCO.2017.75.5389
Shen, M. et al.Clinical Course of Breast Cancer Patients With Isolated Sternal and Full-Thickness Chest Wall Recurrences Treated With and Without Radical Surgery.Annals of Surgical Oncology . 2013;20(13):4153-60.doi:10.1245/s10434-013-3202-4
Wakeam, E., Acuna, S., and S. Keshavjee.Chest Wall Resection for Recurrent Breast Cancer in the Modern Era: A Systematic Review and Meta-Analysis.Annals of Surgery. 2018;267(4):646-655. doi:10.1097/SLA.0000000000002310
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