What Is My Prognosis
This is a very common question that isnt always easy to answer. There are many factors involved in working out prognosis. Remember that a prognosis is just a figure at the point at which you receive it. For most people, the prognosis gets better with time.
Sometimes we use a five-year figure because we know that if cancer comes back, most of the time it comes back within five years. If the cancer has not come back within five years, then the chance of it coming back within ten years is quite low, and if it does not come back within ten years, then you have an almost normal life expectancy.
Its a bit like buying a second hand car. You dont really know how long its going to last, but if it lasts year after year without breaking down, then the car starts to look more and more reliable to make that long trip.
Working out prognosis can be difficult.
Four Steps To Avoid A Recurrence
Theres nothing you can do to guarantee that your cancer wont come back, but you can make some changes to help you feel your best after cancer treatment and keep your body stay strong.
Eat a balanced diet. Reach for a colorful mix of fruits and vegetables, good sources of fiber like beans and peas, and whole grains like whole wheat bread and brown rice every day. Avoid or limit drinks that are high in sugar and red or processed meat like beef, pork, hot dogs and sausages. You probably dont need to take vitamin or mineral supplements, unless your care team suggests them. In fact, taking more of certain vitamins or minerals than you need can have a negative effect on your cancer recovery, so be sure to discuss any supplements youre considering with your care team before taking them.
Exercise on most days of the week. Being active can improve your mood, boost self-esteem and reduce fatigue. Its even been shown to lower anxiety and depression and relieve nausea, pain and diarrhea.
Lean on a strong support system. Cancer might be all about the cellular changes in your body, but you know it certainly doesnt stop there. Taking care of your emotional health, whether it be cultivating a strong circle of friends and family as support or getting mental health services, can help you manage the stressors that cancer treatment and recovery can bring.
How Is A Local Recurrence After Lumpectomy Diagnosed
After a diagnosis of early stage breast cancer, any remaining breast tissue should be evaluated annually with scans .
Most local recurrences within the breast after lumpectomy are detected on routine annual breast imaging, which usually takes the form of mammography and ultrasound, and on occasions MRI.
If you have a local recurrence or new primary breast cancer, you may find symptoms similar to an initial breast cancer. This includes:
- A new lump in the breast, armpit area or around the collarbone
- A change in breast size or shape
- Changes to the nipple, such as sores or crusting, an ulcer or inverted nipple
- Clear or bloody nipple discharge
- Changes to the skin including redness, puckering or dimpling
- Breast tenderness or pain
Once a local recurrence has been diagnosed, we do tests to see whether there are signs of cancer elsewhere in the body. These may include a chest X-ray, CT scan, bone scan or PET scan, and blood tests , then we have to figure out how best to treat the tumour in the breast. Usually in these cases we do a mastectomy, as the prior less drastic surgery and radiation didnt take care of it.
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What Questions Should I Ask My Healthcare Provider
You may want to ask your provider:
- What type of breast cancer recurrence do I have?
- Has the cancer spread outside the breast?
- What stage is the breast cancer?
- What is the best treatment for this type of breast cancer?
- What are the treatment risks and side effects?
- Should I look out for signs of complications?
A note from Cleveland Clinic
Most breast cancer recurrences respond well to treatments. You may be able to try new drugs or combination therapies in development in clinical trials. Your healthcare provider can discuss the best treatment option based on your unique situation.
Last reviewed by a Cleveland Clinic medical professional on 03/24/2021.
References
The Positive Aspects Of Stress Management In Breast Cancer Patients
Earlier research explored the positive aspects of stress management in breast cancer patients shedding another view on how stress management may prevent recurrence of breast cancer.
The researchers noted that after treatment completion, breast cancer survivors frequently experience residual symptoms of pain, fatigue, high levels of psychological stress, anxiety, depression, fear of recurrence, and metastasis.
Post-treatment stress, in particular, can adversely affect health-related quality of life, which, in turn, induces onset or recurrence of chronic diseases. Effective interventions that target these psychological symptoms and their physiological consequences are needed
One of the worst periods of stress, the researchers wrote, was when women completed main treatments and they progress to and have to face the stage of watchful waiting, a stressful period when the physician seems to be doing nothing.
Therefore, survivors continue to report remaining physical symptoms of pain, fatigue, and sleep dysfunction, high levels of psychological stress, anxiety, depression, fear of recurrence and metastasis, and impaired quality of life. This the researchers report may even contribute to the recurrence or progression of the disease.
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What Causes Fatigue In People With Cancer
Causes of cancer-related fatigue are complex, wide-ranging and not yet fully understood. Lifestyle, including poor nutrition, lack of exercise and alcohol consumption can be factors. CRF is also affected by sleep disturbances, certain medicines and your mental health prior to a cancer diagnosis. Many causes of CRF are linked to the cancer itself or the treatment youre receiving for your cancer.
Causes of CRF linked to cancer include the following:
- Anemia
Why Does Breast Cancer Come Back After Treatment
Even with the best treatment, cancer can come back. If just a few cancer cells remain in your body after your initial treatment, those cells can spread through the blood or lymph system and grow. This may happen from a few months to many years after the first diagnosis.
If your breast cancer has come back, you may second-guess your previous treatment choices. But the fact is, there is no guarantee with any treatment. Now it is time to make new decisions and explore other treatment options.
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Underlying Mechanisms Of Fatigue
The etiology of fatigue, whether experienced during initial treatment or during survivorship, is far from being definitively characterized. The underlying mechanisms likely vary from patient to patient and the candidate causes surely co-vary considerably. This variability adds to the complexity of understanding this rather vague, but common and potentially disabling complaint. In addition to the usual suspects, such as dysphoric mood, disrupted sleep, anemia, recent studies have suggested some possible novel mechanisms . Thus, fatigue is multiply determined, with a likely mixture of both biological and psychological underpinnings. For example, evidence implicates anemia, ATP, links between the HPA axis, cytokines and circadian rhythms, and vagal afferents.,,,-
Because most previous studies of cancer fatigue involved cross-sectional research designs, the direction of causality between these candidate risk factors and the experience of cancer-related fatigue cannot be determined with certainty. Nonetheless, the literature suggests important possible links between fatigue and a wide range of potential underlying mechanisms.
Treatment Options For Metastatic Breast Cancer In The Lungs
Doctors consider metastatic breast cancer to be a stage 4 cancer. It is not curable, and treatments focus on weakening the cancer to stop it from growing while working to improve the quality of life for the individual.
Treatments for metastatic breast cancer in the lungs usually involve systemic, or body-wide, medications that treat cancer throughout the body, such as the following:
Chemotherapy.Chemotherapy is a drug therapy that destroys all fast-growing cells in the body, both cancerous and healthy.
Hormonal therapy. Hormonal therapy is a cancer treatment that controls cancer cell growth by lowering the levels of certain hormones the cancer needs to grow. Hormone receptor-positive breast cancers respond well to this treatment.
Targeted therapy. This form of cancer treatment attempts to treat cancer with more precision than chemotherapy. These treatments target specific receptors, proteins, or molecules on cancer cells that either make it easier for the bodys immune system to identify and destroy cancerous cells or reduce their growth.
Radiation. In the case of metastatic breast cancer, doctors often use radiation therapy to reduce symptoms and control the cancers growth. Radiation therapy can help reduce pain and lower the risk of broken bones weakened due to cancer.
Metastatic breast cancer in the lungs can cause other health complications that impact a persons overall health and wellbeing.
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Fatigue Prior To Treatment
Several studies have now shown that women with breast cancer complain of fatigue even before the start of treatment., Ancoli-Israel et al. found that women diagnosed with breast cancer had increased fatigue, disturbed sleep, and increased daily dysfunction before the start of chemotherapy, and that those patients with fatigue, poor sleep, and depression pre-chemotherapy experienced more fatigue and poor quality of life during chemotherapy than women with fewer pre-treatment symptoms. These data suggest that fatigue is not just a result of radiation or chemotherapy, but rather is multifactorial.
Risk Factors For Distant Recurrence
There are several risk factors that raise the risk of recurrence overall . These include:
- Tumour size: Larger tumours are more likely to recur than smaller ones both early and late.
- Positive lymph nodes: Tumours that have spread to lymph nodes are more likely to recur at any time than those that have not.
- Age at diagnosis: Breast cancer recurrence is more common in younger women.
- Treatments received and response to treatments: Both chemotherapy and hormonal therapy reduce the risk of recurrence
- Tumour Characteristics: More aggressive cancers are more likely to recur than less aggressive tumours , especially in the first five years. We also take into account the receptor status and an estimate of proliferation .
There are also factors that do not appear to affect the risk of recurrence. Recurrence rates are the same for women who have a mastectomy or lumpectomy with radiation and are also the same for women who have a single vs. double mastectomy.
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How You Feel Emotionally
Being diagnosed with cancer can be hard to accept. Youre likely to go through a range of emotions before, during and after your treatment. This is very normal.
You might have a lot of worries, some of these might include:
- will my treatment work?
- will I be able to deal with side effects?
- how will my family and friends cope?
- will I have enough support?
- will I be able to keep working?
- how will I get to the hospital for my treatment?
- will the treatment be painful?
- what if I lose my hair?
All these worries can make you feel anxious or down. Anxiety and depression are common in people with cancer. Theyre often very draining emotions.
Fatigue can be worse if you are taking a combination of these drugs.
What To Look For
- You feel tired and it doesnt get better with rest or sleep, it keeps coming back, or it becomes severe.
- Youre more tired than usual during or after an activity.
- Youre feeling tired and its not related to an activity.
- Youre too tired to do the things you normally do.
- Your arms and legs feel heavy and hard to move.
- You have no energy.
- You spend more time in bed and/or sleep more. Or, you may have trouble sleeping.
- You stay in bed for more than 24 hours.
- You become confused or cant concentrate or focus your thoughts.
- Your tiredness disrupts your work, social life, or daily routine.
It may be hard for you to talk about it, but tell your cancer care team about your fatigue. Tell them how its affecting your life. Someone on your team should be able to help you if they know youre having this problem. Managing fatigue is part of good cancer care. Work with your cancer care team to find and treat the causes of your fatigue.
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What Are The Symptoms
The symptoms depend on where the cancer is and how large it is. The most common places for breast cancer to spread are within the breast or to the nearby chest wall or to the liver, lungs, or bones. Common symptoms include a lump in your breast or on your chest wall, bone pain, and shortness of breath.
Or you may not have any symptoms. Sometimes recurrent or metastatic breast cancer is found with an X-ray or a lab test.
Box 1 Suggestions For Screening Of Chronic Fatigue In Adult Cancer Survivors The Overview Is Based On International Guidelines And The Norwegian Directorate Of Health’s Recommendations
Assessment of fatigue level
General history of fatigue: onset, pattern, duration, change over time, factors that exacerbate/improve the symptoms, pattern of activity throughout the day and week
Other factors:
-
psychological factors, particularly high anxiety level and catastrophising sleep, pain, medication, abuse of alcohol or narcotics
-
somatic comorbidity
-
cancer treatment can predispose for comorbidity, for example cardiomyopathy after cardiotoxic chemotherapy or hypothyreosis following radiotherapy targeting the lower neck
A general physical examination should be undertaken to detect somatic conditions as an underlying cause. Recurrence of the cancer should be considered if a patient who has been in good shape develops fatigue
Additional examinations must be considered individually:
-
Relevant blood tests are: haematological profile, hormone tests , electrolytes, liver/gallbladder function
-
Radiological examinations should be performed if clinical signs of somatic disease
-
Referral to other medical specialists must be based on findings and clinical evaluation. Referral to the following may be needed:
-
Cardiologist after completion of cardiotoxic treatment
-
Neuropsychologist in cases of memory and/or concentration difficulties, particularly in younger patients
-
Psychologist/psychiatrist if signs of mental disorders
-
Pain management team
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Coping With Worries About Recurrence
Nearly everyone who has been treated for cancer worries about it coming back.
At first, every ache or pain can frighten you. But, as time passes, you may come to accept minor symptoms for what they are in most cases warning signs of a cold or flu or the result of over-exerting yourself.
Some events may be particularly stressful the days or weeks leading up to your check-ups, the discovery that a friend or relative has been diagnosed with cancer or the news that someone you met while having treatment is ill again or has died.
We all cope with such anxieties in our own way and there are no easy answers. But keeping quiet about them and not wanting to bother anyone is probably not the best approach.
Just as talking about your diagnosis and treatment may have helped you through the early days, talking about your fears relating to recurrence may help you later on.
Breast Cancer Nows Forum lets you share your worries with other people in a similar situation to you.
You can also read our tips on coping with anxiety and find suggestions in BECCA, our free app that helps you move forward after breast cancer.
How Does Breast Cancer Spread
Breast cancer can spread through the lymphatic system, the bloodstream, or uncommonly, by local invasionwhich is when cancer cells actually invade nearby tissues, such as the chest wall or ribs.
When breast cancers spread and enter the lymphatic system, they usually first arrive at nearby lymph nodes and may still be early-stage. The spread of breast cancer to lymph nodes does not necessarily mean that its metastatic, even though pathology reports often somewhat confusingly state breast cancer metastatic to lymph nodes.
A growing cancer may shed a cell or a clump of cells, and It can use your blood or lymph system as a network of highways for traveling. So, if a loose cancer cell makes it via the lymphatic system to your lymph nodes, its also possible that it may spread via the bloodstream to other parts of your body.
When cancer recurs in a lymph node near the breast, it is considered a regional recurrence and not a distant recurrence.
When breast cancer spreads to lymph nodes it has essentially declared its intent to metastasize. Breast cancer reaching the lymph nodes is in effect a declaration that its working to spread further.
In women with negative nodes, its trickier. What we want is a way to identify the 20 to 30 percent who have microscopic cells elsewhere and not over-treat the other 70 percent. At present we dont have a perfect way to do this.
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Chronic Fatigue In Adult Cancer Survivors
National Advisory Unit on Late Effects after Cancer Treatment
Oslo University Hospital
Kristin Valborg Reinertsen , specialist in oncology and senior consultant. She completed her PhD in 2011 on long-term effects after treatment for breast cancer.
The author has completed the ICMJE form and reports no conflicts of interest.
Regional Advisory Unit for Palliative Care
Oslo University Hospital
Jon Håvard Loge , specialist in psychiatry and in child and adolescent psychiatry. He heads the Regional Advisory Unit for Palliative Care, South-Eastern Norway Regional Health Authority. He is professor II at the Department of Behavioural Sciences in Medicine. He was head of the National Advisory Unit on Late Effects after Cancer Treatment from 2011 to 2014. He has worked with late effects after cancer treatment since the mid 1990s with particular focus on chronic fatigue in cancer survivors.
The author has completed the ICMJE form and reports no conflicts of interest.
Department of General Practice/Family Medicine
Institute of Health and Society
University of Oslo
Mette Brekke , specialist in general practice and professor. She also works as a GP at the Kurbadet group practice, Oslo.
The author has completed the ICMJE form and reports no conflicts of interest.
National Advisory Unit on Late Effects after Cancer Treatment
Oslo University Hospital
Cecilie E. Kiserud , PhD and senior consultant in oncology. She heads the National Advisory Unit on Late Effects after Cancer Treatment.
