Surveillance for breast cancer recurrence
Once treatment is over, many breast cancer survivors feel that although they are happy it’s over, they also wonder about what comes next. Many say that they had lots of information and support during their illness, but now there are new questions and concerns to address. You can also expect things to keep changing as you begin your recovery. This section will help you to know what to expect after your breast cancer treatment ends.
The new normal
When treatment is over, you may expect life to return to the way it was before you were diagnosed with cancer. It’s not so much “getting back to normal” as it is finding out what’s normal for you now. It can take time to recover. People often say that life has new meaning or that they look at things differently now. Your new “normal” may include making changes in the way you eat, the things you do, and your sources of support. You may find that others think of you differently now—or you may view yourself in a different way.
Follow-Up Medical Care
After cancer treatment is completed, your doctor will continue to monitor your recovery, manage any long-term side effects, and watch for specific signs or symptoms of recurrence. Your follow-up care plan may include, regular diagnostic imaging or/and physical examinations during the coming months and years. For most patients, an annual mammogram will be arranged.
You will likely continue to be followed by your primary care physician, surgeons and/or oncologist after treatment has ended. To prepare yourself, have a discussion with your health care providers about how your care will be coordinated and who will lead and plan your ongoing medical care. This decision depends on several factors, including the type and stage of cancer, treatment side effects, community resources, and your personal preferences.
If you have any concerns about following the recommended follow-up care plan, talk with your health care team. Also talk with your health care provider about any concerns you have about health. They can give you information and tools to help you after cancer treatment has ended and for the long term. Participating in follow-up care and keeping a medical support system in place is essential for maintaining both your physical and emotional health.
Questions you may ask your healthcare team during follow up visits:
How often should I see my doctor?
What symptoms may be signs of a potential recurrence? Which should I report to my doctor right away? Which should I report at my regular follow-up visits?
What can be done to relieve pain, fatigue, or other problems after treatment?
What can I do to lower my risk of cancer coming back after treatment?
Are there any support groups I can go to?
Watching for recurrence
One goal of follow-up care is to check for a recurrence of cancer. A recurrence is when the cancer comes back after treatment. Cancer may recur because some cancer cells remain in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. Depending on the type of cancer, this can happen weeks, months, or even many years after the original cancer was treated.
A recurrence may be local, which means cancer has come back in the same breast or chest area as the original cancer. It may also be regional, which means it has returned in an area near the original location, in lymph nodes in the armpit (axillary lymph nodes) or collarbone area. It may also be distant where the breast cancer spreads away from the original tumour to the lungs, bones, brain or other parts of the body. This is metastatic cancer often referred to as stage 4 breast cancer.
Symptoms of a local recurrence you should watch for include, a new lump in the breast or the chest wall an area of the breast that feels unnaturally firm; swelling of all or part of the breast; skin irritation or redness in the breast area; flattening or other nipple changes; skin pulling or swelling near the original breast cancer surgery site; and, thickening of surgery scars. The symptoms of a regional recurrence are a lump or swelling in the lymph nodes under the arm, above the collarbone or near the breastbone; pain, swelling, or numbness in one arm or shoulder; and, constant chest pain.
It’s important to mention that, after breast cancer surgery and radiation therapy, the breast area may be swollen and red for a few months after those treatments are completed. Also, you may feel lumps caused by a build-up of scar tissue. These lumps usually aren’t cancer, but tell your doctor about any lumps you feel in your breast so they can be monitored.
Breast cancer can spread to other parts of the body including bones, lungs, liver, brain, and chest. Symptoms you should watch for and report to your doctor include, back, bone, or joint pain that does not go away; constant dry cough or shortness of breath; chest pain; loss of appetite; abdominal bloating; pain or tenderness; constant nausea, vomiting, or weight loss; jaundice; severe headaches; vision problems; seizures loss of balance; and confusion.
To help find signs of a potential recurrence, your doctor will ask specific questions about your health and usually do a physical examination during your follow-up visits. If a recurrence is suspected, your doctor may order additional diagnostic imaging tests and/or biopsies.