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Posted by on Mar 11, 2013 in Breast cancer | 0 comments

This paper evaluates the process health care professionals follow to diagnose a cancer that reoccurs in the same location as a previous cancer (locally recurrent), or a cancer that has spread (metastasized).

Despite earlier detection and improved treatment options for breast cancer, it is still the leading cause of cancer related deaths in women.

When a doctor suspects that a cancer has recurred or has spread, they should perform a full physical exam, x-rays and scans to locate any possible tumors.  When a tumor is identified it should be removed if possible; sometimes a biopsy may be taken before surgery depending on tumor location. Tumor characteristics should be re-evaluated, without assuming that it is identical to the previous one. This includes identifying if it has estrogen or progesterone receptors, and if it HER-2 positive.

The prior surgery a patient has had must also be considered. If a local recurrence is diagnosed and the patient has had breast conserving therapy (or “lumpectomy”; removal of the lump), then a mastectomy should be advised (removal of the entire breast). If a patient previously had a mastectomy but did not receive radiotherapy, then this along with surgical removal of a lump may be advised. If all of the above treatments have already been received then the patient should have additional radiotherapy but only on limited areas.

Additionally, depending on the presence of hormone receptors, a patient may receive hormonal therapy. This may include medications such as Tamoxifen (Nolvadex) or an aromatase inhibitor such as Anastrozole (Arimidex). Chemotherapy may also be given, particularly if the tumor does not express hormone receptors. The regimes and drugs used for chemotherapy vary but may include a combination such as Doxorubicin (Adriamycin) plus Cyclophosphamide (Cytoxan) or a single drug-based therapy such as Paclitaxel (Taxol).

To date there is no evidence supporting the routine screening of patients who have previously been diagnosed with asymptomatic early breast cancer to look for metastatic disease.  However, with new scanning techniques now available such as MRI, new studies need to be carried out to consider this as a new routine diagnostic technique.

This paper contains comprehensive lists of factors a doctor has to consider during the diagnosis of a recurrent cancer or one that has metastasized. It also contains a thorough list of chemotherapy regimens and hormone receptor medications.

In conclusion, this paper provides a clear pathway that a patient can follow to allow them to see the process that they go through if their cancer recurs or spreads, and the treatment options that are available for them. 

Published By :

Annals of oncology

Date :

May 01, 2009

Original Title :

Locally recurrent or metastatic breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

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