Editing Recurrent breast cancer


== '''Patterns''' ==

* Local recurrence
** True recurrence - at lumpectomy site
** Marginal miss - recurrence close to but not within the boost volume
** Elsewhere recurrence - different quadrant to original procedure
* Regional recurrence - draining lymph nodes - axillary, infraclavicular, supraclavicular, internal mammary
* Metastatic disease

== '''Predicting recurrence''' ==

* See entry under 'breast cancer'

== '''Scenarios''' ==

* '''Ipsilateral breast tumour recurrence after breast-conserving therapy'''
** Assuming metastasis has been excluded, mastectomy is standard of care. Repeat lumpectomy is associated with higher recurrence rates, especially if it's been <5 years since original cancer. If it's later than 5 years, likely to be a different primary cancer.
** About 10-20% are inoperable for whatever reason
** If regional spread is present, may need neoadjuvant CTX
** Generally standard mastectomy with delayed reconstruction is necessary, due to previous radiation. Autologous tissue flaps (DIEP/TRAM) is often required.
** Ability to perform nodal staging is dependent on original operation
* '''Local recurrence after mastectomy'''
** Uncommon
** Assess feasibility of resection with examination, USS, MRI, CT - may require WLE of ribs or chest wall etc
** Consider neoadjuvant CTX
* '''Lymph node recurrence'''
** Incidence is about 1% in those who had ALND, and less than that if they had a negative SLNB originally
** Workup: 
*** Full systemic staging (CT BCAP + bone scan/PET)
*** Core biopsy of axillary disease to confirm same molecular profile to original tumour
** Treatment:
*** If they were previously SLNB negative or never had an ALND, they should have an ALND
*** If they already had an ALND, they should have a redo/completion ALND to level III, or radiotherapy to axilla
*** Adjuvant systemic therapy if not contraindicated
** Prognosis: 60% overall survival at 5 years, 45% at 10 years

[[Category:Breast]]