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
