Histologic grade — This refers to how much the tumor cells resemble
normal cells when viewed under the microscope. The grading scale is 1 to 4.
Grade 4 tumors contain very abnormal and rapidly growing cancer cells. There
is a greater chance of recurrence the higher the histologic grade.
Nuclear grade — This is the rate at which cancer cells in the tumor
divide to form more cells. Cancer cells with a high nuclear grade (also called
proliferative capacity) are usually more aggressive (faster growing).
Oncogene expression — An oncogene is a gene that causes or promotes
cancerous changes within the cell. Tumors that contain certain oncogenes may
increase a patient’s chance of recurrence.
Treatment team
Following local breast cancer treatment, the treatment team will determine
the likelihood that the cancer will recur outside the breast. This team usually
includes a medical oncologist, a specialist trained in using medicines to treat
breast cancer. The medical oncologist, who works with the surgeon, may advise
the use of tamoxifen (tamoxifen citrate, Nolvadex) or possibly chemotherapy.
These treatments are used in addition to, but not in place of, local breast
cancer treatment with surgery and/or radiation therapy.
Treatment of breast cancer recurrence
The type of treatment for local breast cancer recurrences depends on the
woman’s initial treatment. If she had a lumpectomy, local recurrence is
usually treated with mastectomy, since radiation therapy cannot be delivered
twice to the same area. If the initial treatment was mastectomy, recurrence near
the mastectomy site is treated by removing the tumor whenever possible, usually
followed by radiation therapy. In either case, hormone therapy and/or
chemotherapy may be used after surgery and/or radiation therapy. If breast
cancer is found in the other breast, it may be a new tumor unrelated to the
first breast cancer. Treatment would include a lumpectomy or mastectomy and,
sometimes, systemic therapy.
Women with distant recurrence involving organs such as the bones, lungs,
brain, or other organs, are treated with systemic therapy using chemotherapy,
hormonal therapy, or both. Radiation therapy or surgery also may be recommended
to relieve certain symptoms.
Immunotherapy with trastuzumab (Herceptin) alone or with chemotherapy may be
recommended for women whose cancer cells have high levels of the HER2/neu
protein. Immunotherapy is generally started after hormonal or chemotherapy is no
longer effective.