Patients presenting with early breast cancer normally never relapse; a woman presenting with a small primary breast cancer which is node negative at surgery has a five to ten year chance of remaining free of disease of 75%. Conversely, if the patient presents with involvement of the auxiliary nodes, they may have a 75% chance of relapse by five years. A common scenario is that the cancer may have developed in another organ, this is called metastatic relapse. In 10% of patients the relapse is local and if a mastectomy is possible then further treatment may be curative. For patients presenting with metastatic disease further treatment intent would be to stabilise the tumour or palliate. In the majority of cases a cure is not possible.
The oncologist would advise on the most appropriate treatments depending on the original characteristics or the tumour and the findings at relapse. For patients who had hormone responsive tumours, an option of further hormone therapy may be possible. If bone metastases are also present then the addition of bisphosphonate therapy to stabilise bone symptoms and prevent further progression should be considered.
Chemotherapy may provide further symptom benefit for those patients who are no longer responsive to hormone treatments.
There are various schedules of treatments, some of which are well tolerated but many have toxicity and others that may impact on the patient’s normal quality of life. Treatment with Herceptin therapy for patients with positive for Herceptin expression has also been demonstrated to be effective in addition to chemotherapy in preventing tumour progression. Radiotherapy provides further benefit in combination with hormone or chemotherapy where there may be persistent symptoms such as painful bone metastases, persisting lymph node disease or brain metastases.