Confused about recurrent IDC. Advice/input please.

popples1108

Hello!  My mom was diagnosed with IDC in 2015.  She had a lumpectomy and had radiation.  She was considered cancer free and has been on Arimidex the last 2 years.  A few weeks ago she went in for her 6 month mammogram and had a tumor.  The biopsy proved it was cancer.  IDC in the same breast.  The only thing we know so far is it's a grade 3 and more aggressive this time around.  She will be having a mastectomy (possibly chemo before, although I'm not sure I understand why).  We were also told reconstruction wasn't a good option. 

I guess I'm confused about what it means since it's recurrent.  Was the cancer never gone before or did it just come back?  What are the chances that it's somewhere else in the body?  I also read somewhere on this site that recurrent BC (along with metastatic) is considered late stage cancer?  It seems that since this is recurrent, that it's worse than having it the first time?

Emily2008

Those are all really great questions. I'm sorry for your mom's recurrence. I recurred 8 1/2 years after having a double mastectomy, chemo, and being on Tamoxifen for 6 1/2 years. It's quite a shock to the system.

In all my research and in answer to my questions from my local docs and the oncologist I met with at Sloan Kettering, it's a grey area to try to label a recurrence versus a new primary cancer. In general, the median time of recurrence is 4.7 years, so anything above that time period is considered by some docs to be a new primary, and is treated as such. In your mom's case, it's likely a recurrence of her original cancer, even if hormone receptors are different. Even with surgery and rads, some stray cancer cells can be left behind and grow.

It's worse in the sense that there's a greater likelihood that the cancer has spread in the interim. So, in your mom's case, they will likely recommend staging scans (bone scan, CT, MRI) to see if the cancer is anywhere else. In my case, those scans were negative for metastatic disease, but I will have to repeat the scans regularly for the next few years.

The docs are probably recommending against reconstruction because she had radiation already, which makes recon more difficult. There are docs who can do it, but it's more complicated. Depending on your mom's age and health otherwise, she may want to consider consulting other plastic surgeons for their opinion.

They may be recommending chemo due to the grade 3 status. That's aggressive, and more likely to spread, so chemo would be a way to prevent that.

popples1108

Thank you, I'm sorry to hear about your recurrence as well.  I'm going with her to her oncologist appointment tomorrow where we'll be able to ask more questions and hopefully get some more information about the cancer.  I'll also be asking about the staging scans you mentioned.  I know her appointment is tomorrow but I'm so anxious.  Asking other people questions and researching helps pass the time I guess.

Legomaster225

The preadjuvent chemo may be in an attemt to shrink the tumor as well. This is important even if a mastectomy is planned in an effort to get clean margins if the tumor is close to the chest wall or skin. It can also kill the cancer that may have spread to a lymph node as was my case. My biopsy was positive pre chemo and no cancer in that node after chemo. My tumor shrunk significantly as well. In my mind that bodes well for killing off stray cells that may have traveled from the tumor as well. So it does have its advantages.

My surgeon told me that preadjuvent chemo is becoming more prevalent in the US and here are many studies that support it. For some (not me and probably not your mom) it may allow for a lumpectomy instead of a mastectomy. He also said it is used to a much greater extent in Europe with good results.

Anyway, I had good results with chemo prior to my BMX and I'm glad my BS and breast care team recommended this order of treatment.

ElaineTherese

Hi popples!

If your Mom's cancer is a local recurrence, no, she would not be considered Stage IV. I'm with Emily; your Mom should have a PET scan to make sure it is a local recurrence.

Doing chemo first is common with triple negative cancer (ER-/PR-/HER2-) and HER2+ cancer. With triple negative cancer, doing chemo first can demonstrate that chemo is working for her particular cancer. Since she wouldn't have other options for systemic treatment (e.g., hormonal therapy or targeted therapy), her doctors would want to make sure that chemo is doing its job.

I had chemo first with HER2+ cancer because we wanted to shrink the tumor and to have access to Perjeta, the latest targeted therapy for HER2+ tumors. (National guidelines recommend Perjeta for neoadjuvant chemo if the tumor is bigger than 2 cm.)

I'm not sure why your Mom's doctors don't think she's a good candidate for reconstruction. I agree with Emily that it might have to do with the state of her radiated skin. I also agree that if your Mom wants reconstruction, she should talk to a few plastic surgeons about her case before she gives up on it.

Hope you and your Mom have a productive meeting with her doctor tomorrow!

Sunrisefish

Hi Popples, I was also diagnosed with a recurrence in March. My original diagnosis was 2.5 years ago. My recurrence was in the same breast and identified as the same cancer. It is considered a local reccirence, not stage4 or metastasize. I also had various scannings to check for metastasis. All were negative. I had previous radiation and just had a BMX with reconstruction. I have anatomical implants with Alloderm, and will have fat grafting. Your mom will have to find a center that had experience with reconstruction in radiated tissue. It can be done and is being done. She has options. I have healed with no complications and feel great. Her treatment will depend on the grade and type of cancer. My oncotype was a 3, so chemo is not recommended even with local reccurence. She'll get through it! Many of us have! Hugs!

popples1108

Thanks everyone!  The plastic surgeon did say the fact that she's had radiation would make it difficult and that they'd like have to take some skin/tissue from her back.  The other issue (and I think the main reason they suggested against reconstruction) is that she had a PE almost exactly a year ago and she was worried about the length of the surgery and another PE occurring.

Hopeful82014

Hi, Popples - So sorry about your mom's recurrence and the natural anxiety this creates for all of you. It's great, though, that she's got you doing research and attending appts. with her. If you haven't thought of this already, you might consider recording her visits w/her MDs on a smart phone or pocket recorder. We did this for all of my consults and found it extremely helpful to be able to go back and listen to a conversation again. It saved being distracted by taking notes and frequently led me to realize what issues hadn't been fully addressed. Sometimes it was very reassuring, tool! Most MDs are fine with it; just tell them you want to do so very matter-of-factly. Be sure she also gets copies of all her pathology reports, etc. for her own records.

There's a fair amount of material on this site (on the main portion of the site, not just the forums) covering different types of reconstruction, including delayed reconstruction, using materials from different regions of the body, etc. Both of you may find that helpful. I've not had such surgery but my impression is that using implants allows for a shorter surgery, which might be helpful with her PE situation. Maybe someone else can give you more insight on that issue? But if she's really better off without reconstruction no one should push her to do otherwise.

The neoadjuvant chemo has become very widely used and can be reassuring in demonstrating how well the cancer responds to a particular chemo cocktail and making a change, if needed. It can, as others have pointed out, help shrink the tumor to improve the outcome overall.

I know this is a very tough time. Take care of yourself as well as your mom and keep in mind that while this is not what anyone would want to see happen, it can be dealt with. Don't be afraid to get 2nd and 3rd opinions (which most insurers will cover) so that you can be confident in her treatment plan. Good luck.

TwoHobbies

Poppies, everyone has given you good answers already. I had a local recurrence. With my surgery I had another sentinel node biopsy. If it has spread to the lymph nodes it would be "regional". They will mostly likely do scans and if found in another part of the body, that would be a distant recurrence. Hopefully it will not have spread yet. Cancer cells could have spread before and just been dormant and have now grown. I did have chemo the second time, although it was not clear whether that was needed, and they switched my hormone therapy. That was four years ago, so I'm hopeful I kicked it this time.