Recurrence in the chest wall

Recurrence in the chest wall

Cancer that returns after a mastectomy in the place where the breast used to be is called a chest wall recurrence. You might have surgery first to remove the tumor. But surgery is rarely recommended if you have:

• several tumors that are widely scattered
• a red rash indicating that cancer is spreading through the skin

If you have recurrence within a reconstructed breast, occasionally your doctor may recommend that the flap or implant be removed.

After you recover from surgery, radiation therapy is usually the next treatment given if you haven't had it before. If you have had radiation in the past, limited additional radiation therapy may still be an option. But in that case you will be more likely to develop significant side effects from the extra radiation, including:

• a skin rash that doesn't heal
• an increased risk of rib fractures
• scarring and tightness of the muscles

To reduce side effects that can occur after repeat radiation, your doctor might make changes in your treatment. He or she might alter:

• the amount of radiation in each dose
• the frequency of each treatment
• the size of the area treated

For example, your doctor might recommend smaller doses of radiation given twice a day.

If you haven't had radiation therapy before, your side effects will be less severe. You will probably just get a sunburn-like reaction that's red, sore, tight, and itchy and might peel and ooze. Your doctor may recommend one or a combination of things to help avoid, reduce, or relieve these problems, including:

• Biafene
• Jeans cream
• Lindi Skin cream
• aloe vera
• Aquaphor
• A & D ointment
• Silvadene ointment
• 1% hydrocortisone
• a prescription steroid cream such as betamethasone

During your treatment, if the side effects on your skin and soft tissue get worse, your nurse or doctor might recommend a stronger combination of medicines.

You may also get twinges of pain or stiffness of the chest wall that can be relieved by Tylenol (acetaminophen) or anti-inflammatory medicines. In some women who have breast implants, radiation therapy may cause a hard capsule of scar tissue to form around the implant. This capsule can be painful and distort the shape of the breast.

Systemic (whole-body) therapy, such as chemotherapy, hormonal therapy, or targeted therapies, may be recommended after chest wall recurrence. About half the women who develop a chest wall recurrence have cancer cells that eventually spread beyond the chest area. Medicines that work on the entire body can help get rid of those cells.

But you may not need chemotherapy if ALL of these categories apply to you:

• You are post-menopausal.
• You have only one small, removable chest wall tumor.
• Your recurrence developed 10 years or more after your first treatment for breast cancer.

The type of treatment that's recommended depends partly on what treatments you've had before. Sometimes, cancer comes back in the chest wall while you're on hormonal therapy. In this situation, your doctor will probably recommend that you switch to another type of hormonal therapy. The hormonal therapy itself did not trigger the occurrence. It's just that you have been on one medicine long enough so that it's stopped fighting the cancer adequately, and another hormonal therapy might be able to do that.

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