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    How to Cope When Breast Cancer Returns

    The lessons to be learned from Elizabeth Edwards -- very public battle with cancer recurrence.

    How Cancer Recurs continued...

    According to Virginia Kaklamani, MD, assistant professor and a medical oncologist at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University in Chicago, when breast cancer recurs, two-thirds of the time it shows up in places other than the breast. The risk of recurrence depends on the length of time from the first diagnosis (the more quickly it recurs, the more aggressive the tumor and the worse the prognosis) and the characteristics of the tumor, such as its size.

    Kaklamani says in Stage 1, when the breast cancer has not spread to lymph nodes and the tumor is under 2 centimeters, it returns in about 10% of patients. At Stage 2 (when the tumor is 2 to 5 centimeters) and Stage 3 (when the tumor is larger than 4 centimeters), 20% to 30% and 40% to 70% of survivors, respectively, will have a recurrence.

    Freedman says the most important factor is whether the recurrence is local or distant. "Local recurrence can still have an excellent prognosis," he says. "Distant recurrence can't be cured, except in rare cases with a single isolated occurrence in the lung or liver." Other factors include where the distant recurrence is (cancer in the bone has a better prognosis than cancer in an organ) and whether it is estrogen receptor-positive, or ER-positive, which means it may respond to hormone therapy.

    Freedman says when the vast majority of tumor cells are confined to the breast area, they can be cured with surgery and radiation; and chemotherapy and hormone therapy can even eradicate small amounts of undetectable, microscopic disease that has spread through the bloodstream to, for example, the liver. "But there are very few cancers that can be cured once they have spread to other organs and are systemic like leukemias, lymphomas, or testicular cancers that are the most sensitive to chemotherapy," Freedman says, adding that doses of chemotherapy simply can't tackle the large number of cells present when the cancer spreads to distant organs. So once breast cancer spreads, it can be controlled but not cured.

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