Cancer recurrence – a speedbump on a highway towards cancer-free life

Neelam, a mother of two fought breast cancer for almost three years and survived. After her victory over the disease, she started living her life as a blessing, making each and every moment count. However, when she went to the doctor to check the inflamed skin on her breast, she was shattered after the results came out. She started crying her heart out, because her cancer had come back. Cancer recurrence is indeed a traumatic experience. More than the physical tensions, it attacks patient’s will to live.

Cancer recurrence

Cancer recurrence means that cancer has come back after the treatment and between the times during which the cancer could not be detected. The first cancer has higher chances of coming back. Recurrence starts with cancer cells that were not fully destroyed or removed during the first treatment. However, this does not mean that the treatment was wrong. Neither it means that patient did something which made cancer reoccur. It just means that some cells survived during the treatment at first time. Even though it seems that treatment has got rid of all those cancer cells.

The problem is mainly because the cancer cells those are inactive for many years after the first treatment. But in some cases, suddenly the changes in immune system activate the cells. It can grow and divide to create other cells. Once those cells go on growing and dividing, it becomes big enough for a test to detect it as a recurred cancer. Cancer recurrence is found in one of the five patients. Sometimes, the mutated genes can cause a second type of cancer.

Cancers are more likely to come back if –

  • They are aggressive i.e. fast growing.
  • Advanced cancers i.e. detected in later stages.
  • Cancer is widespread in the body.

Types of cancer recurrence

When the cancer is detected again, it is not necessary that it will be found at a same spot. It can be found anywhere else. Here are the types of cancer recurrence.

  • Local recurrence.

When the cancer appears in the same spot where it was first found, it is called local recurrence. This means that the cancer has not spread to the lymph nodes or other parts of the body.

  • Regional recurrence.

When can cancer reappears in the tissues located close in the surroundings of the earlier cancer, it is called as regional recurrence.

  • Distant recurrence.

Sometimes when the cancer reappears, it is nowhere close to the original cancer spot from where it was removed earlier. It is called as distant recurrence.

When the recurrence occurs, the doctor informs the patient about the type of recurrence and the best possible treatments for the same.

Image credits- Corbis
Image credits- Corbis

When does the cancer recur?  

Cancer can reappear any time after the treatment but breast cancer mostly recurs in the first three to five years after initial treatment.  Breast cancer can come back as a local recurrence i.e. in the treated breast or near the mastectomy scar or as a distant recurrence. The most common sites of recurrence are the lymph nodes, the bones, liver, or lungs.

Genetics and cancer recurrence.

Now medical advancements have made it a little easier to gauge the recurrence of cancer. One of such tests is Liquid Biopsy. It is a very sensitive screening which tests for cancer-free DNAs in body and can thus, accurately monitor cancer recurrence.

Though positive or negative attitude does not control the cancer or its recurrence, it definitely helps the patients to gain more strength to fight the battle against cancer.

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Role Of Genetics In Breast Cancer and BRCA-1 & 2 Mutations

“I know my children would never have to say- mom died of cancer!” said Angelina Jolie- famous Hollywood actress after her decision of preventive surgery for ovarian cancer where she had her ovaries and fallopian tubes removed. BRCA mutation was found in her tests and three women in her family; including her mother had died of cancer. Thus, she had to take a preventive measure.

Genes and genetic variations in our body contribute to the bodily functions and overall health. This also includes the possibility of having various diseases which are hereditary or developed in our body due to changes in the genetic codes.

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Each cell in our body consists of genes that have genetic code for our body. These codes contain the information regarding various functions of our body for example – when the cells grow, divide, and die. Changes in these genetic codes are called mutations. Many of these are harmless; while some increase the risk of diseases like breast cancer. BRCA are inherited mutations; thus you need to undergo this test only once. I.e. they do not develop during our lifetime.

According to the American Journal of Human Genetics and Journal of Clinical Oncology, around 55-65% of women with confirmed BRCA mutation will develop breast cancer by the age of 70 and their immediate family members have 50% chances of possessing the same risk.
It’s not only women who are at risk; while women have 85% risk of breast cancer and 40% risk of ovarian cancer; men too have about 20% risk of prostate cancer and/ or male breast cancer.

Thus, to examine the risk of it, Datar Genetics Limited has introduced a test using NGS platform that has 99.9% analytical sensitivity and 100% specificity and accuracy. NGS means Next Generation Sequencing. It enables us to examine the genetic mutations in members of families with high incidence of cancer.

BRCA -1 & BRCA – 2 are two genes which are linked to HBOC (Hereditary Breast & Ovarian Cancer) these genes produce tumor suppressor proteins which help to repair damaged DNA. When either of these genes have mutations, it increases the risk of cancer.

BRCA 1 & BRCA 2 testing should be considered if:-

  1. You had breast cancer at early age
  2. Your mother, sister, or daughter had breast cancer at early age or ovarian cancer.
  3. You are a woman with 1st degree relative who’s diagnosed with bilateral breast cancer before age of 50
  4. The men in your family have strong history of breast/ ovarian cancer.

Genetic testing

A doctor/ genetic counselor helps you decide whether genetic testing is appropriate for you. In most cases, test is primarily done on the person in the family who has breast cancer. If mutation is not found, other family members need not be tested.

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image description

The test includes counseling and a blood test and you can get the results in around two weeks.

It is very important for you to know if you are at a risk of mutation and you should ask your doctor what tests and precautions should be taken to lower the risk.

Women who have BRCA 1 gene mutation are at higher risk of triple negative breast cancer while BRCA 2 carriers have breast cancers that are Estrogen Receptor positive. BRCA 1/2 mutations increase the risk of ovarian cancer. Men with BRCA 2 mutation have increased risk of prostate and breast cancer.

Risk reduction options:-

Following are the recommended cancer screening tests:-
  1. Breast Self Examination/ Clinical Breast Exam (CBE)
  2. Mammography
  3. Breast Magnetic Resonance Imaging

There are also some risk lowering options for BRCA1/2 carriers, like- FDA approved drugs and treatments like prophylactic mastectomy and prophylactic oophorectomy.

Timely examinations and preventive treatments are best way to lower the risk of breast cancer.


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