Follow-up care may not seem that important to you, especially if your treatment is long or complicated. However, it is crucial to your recovery. You may find the idea of follow-up care stressful because it reminds you of your cancer experience or because you are worried about what a test might reveal. Talk to your healthcare team about how you feel and why follow-up matters. Your healthcare team is there to help and keep you informed.
There are Four Breast Cancer Ribbons
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- Breast cancer: Pink
- Metastatic breast cancer: Pink, teal, and green
- Inflammatory breast cancer: Hot pink
- Male breast cancer: Pink and blue
There are 43 different cancer ribbon colors, each representing a different type of cancer. These ribbons serve as a symbol of our collective awareness and support for those affected by cancer. They also honor the resilience and endurance of cancer survivors, who continue to thrive despite the challenges they face. Their strength and determination are truly inspiring, and we need to understand and empathize with their journey.
Risk of Secondary Cancers
Women who’ve had breast cancer can still get other cancers. Although most breast cancer survivors don’t get cancer again, they are at higher risk of getting some types of cancer. Your healthcare team is there to guide you and provide the necessary support in managing these risks.
The most common second cancer in breast cancer survivors is another breast cancer. (This is different from the first cancer coming back.) The new cancer can develop in the opposite breast or the same breast for women who were treated with breast-conserving surgery (such as a lumpectomy). Advanced cancer treatments have significantly improved survival rates and reduce the risk of recurrence.
Breast cancer can spread to various parts of the body. This is called metastasis. Depending on which types of cancer treatment they received (and other factors), some breast cancer survivors might also be at higher-than-average risk for:
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- Bone
- Brain
- Liver
- Lungs
- Salivary gland cancer
- Esophagus cancer
- Stomach cancer
- Colon cancer
- Uterine cancer
- Ovarian cancer
- Thyroid cancer
- Soft tissue cancer (sarcoma)
- Melanoma of the skin
- Acute myeloid leukemia (AML)
This does not mean that secondary breast cancer will spread to all these areas.
Metastasis Breast (Secondary Cancer) Symptoms
For many people, primary breast cancer, the initial cancerous growth in the breast, never comes back after treatment. However, in some cases, cancer cells from the primary tumor can spread to other body parts through the blood or the lymphatic system. When this happens, these cells can form another cancer in a different part of the body. This is what we refer to as secondary breast cancer or metastatic breast cancer.
The symptoms of secondary breast cancer depend on where in the body the cancer has spread, such as the bones, lungs, liver, skin, and brain. If you have secondary breast cancer symptoms, you may be offered tests, including CT, MRI, and biopsies.
General symptoms
Many symptoms of secondary breast cancer are very similar to those of other conditions. Any new symptom will understandably cause worry. It is always essential to get any concerns checked out.
Some general symptoms that breast cancer may have spread include:
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- Feeling constantly tired
- Constant nausea (feeling sick)
- Unexplained weight loss and loss of appetite
How often you have checkups depends on some factors. These include:
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- How you are feeling
- The type of treatment you have had
- Whether you are still having treatment such as hormone therapy
The American Cancer Society recommends screening mammography yearly for women ages 50-54 and every 1-2 years for those ages 55 and older.
After a mastectomy, you’ll have a mammogram of the opposite breast. For instance, if you’ve had a mastectomy of the right breast, you’ll only have a mammogram of the left breast. This process ensures comprehensive screening.
If you’ve undergone a double or bilateral mastectomy, where both breasts have been removed, mammograms may no longer be necessary. This is because there’s usually insufficient breast tissue left for a mammogram. Any potential recurrence is often detected through physical exams or self-exams.
Some women may have a bone density scan to check their bone strength. This is particularly important if you are taking a type of hormone therapy called an aromatase inhibitor, as it can affect your bone health.
Other symptoms of breast cancer metastasis:
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- Bone pain
- Weakness or numbness in one side of the body
- Dizziness or loss of balance and coordination
- Fits or seizures
- Increased risk of bone breaks or fractures
The signs and symptoms of cancer in the abdomen (belly) may include:
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- pain: Pain in the abdomen, especially on the right side where the liver is located
- swelling: A swollen abdomen
- nausea and vomiting: Feeling sick and vomiting
- loss of appetite: Not wanting to eat
- early satiety: Feeling full quickly when eating
- fluid build-up: A buildup of fluid in the belly
- constipation: Difficulty passing stool
- bloating: Feeling bloated
- jaundice: Yellowing of the skin and whites of the eyes
- itchy skin: Itchy or rash skin
Symptoms of breast cancer that have spread to the abdomen can be similar to those of primary gastric cancer. This can make it difficult to distinguish between the two conditions.
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- Other symptoms of metastatic breast cancer include Weakness, Stool color turning light gray, and abnormally high enzymes in the liver.
Gastrointestinal (GI) metastasis is relatively rare and often occurs within several years after a breast cancer diagnosis.
The signs and symptoms of cancer in the bones may include:
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- When it does occur, signs and symptoms of bone metastasis include:
- Bone pain
- Broken bones
- Urinary incontinence
- Bowel incontinence
- Weakness in the legs or arms
- High levels of calcium in the blood (hypercalcemia), which can cause nausea, vomiting, constipation and confusion
Sometimes, bone metastasis causes no signs and symptoms.
The signs and symptoms of cancer in the brain may include:
If breast cancer metastasizes the brain, it can cause a variety of symptoms to develop, including:
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- headaches
- memory loss
- changes in mood, personality, or behavior
- impaired judgment
- dizziness
- balance problems
- weakness or paralysis in one side of the body (hemiparesis)
- numbness or tingling within the extremities
- changes in vision, such as blurred vision, double vision, loss of vision or seeing flashes of light
- slurred speech
- nausea
- vomiting
- strokes
- seizures
The signs and symptoms of cancer in the liver may include:
Metastasis refers to the growth of additional cancerous cells beyond the location of the original cancerous tumor.
Breast cancer can be metastasized anywhere in the body, affecting the:
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- lymph nodes
- bones
- lungs
- Liver
- brain
Some research suggests there may be something about a person’s liver environment that predisposes their cancer to metastasize to that organ.
The signs and symptoms of cancer in the lungs may include:
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- persistent cough
- chest pain
- shortness of breath
- repeated chest infections
- loss of appetite
- unexplained weight loss
- Coughing up blood
- chest ache
- heaviness in the chest
- pleural effusion (fluid between the chest wall and lung)
You may not have noticeable symptoms at first. Even if you do, you may dismiss them as cold or flu symptoms.
Signs breast cancer has spread to the lymph nodes
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- lump or swelling in your neck, under your arm, or in your groin
- swelling in your stomach (if the cancer spreads to your liver)
- shortness of breath (if the cancer spreads to the lungs)
- pain
- Headaches
- seizures or dizziness
- swelling under the armpit
- swelling in your arm or hand (lymphedema)
- swelling in your collarbone area
- lumps or swellings in the armpits or around the collarbone.
Signs breast cancer has spread to the skin:
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- Texture changes to the skin, such as a rash, redness, or dimpling.
- Swelling in the armpit or near the collarbone.
- Thickening skin, redness, and bruising.
- Orange peel appearance.
- Wounds without injury on the breast.
Schedule follow-up visits
Don’t wait until your next appointment to report any new symptoms and symptoms that don’t go away. Tell your healthcare team if you have:
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- a new lump in the breast or under your arm
- changes in the size, shape, or texture of your breast
- new or worse pain, especially in your legs, hip, or back
- a cough that won’t go away
- unexplained weight loss
- fatigue that gets worse over time
- swelling (called lymphedema) in your hand or arm on the same side of the body as the tumor
- headaches that won’t go away
- numbness or tingling in your hands or feet
- Vaginal bleeding or spotting
- shortness of breath
The chance that breast cancer will come back is most significant within 5 years so that you will need close follow-up during this time. People who are diagnosed with breast cancer also have a higher risk of developing cancer in the opposite breast, as well as colon cancer, ovarian cancer, and uterine cancer.
Follow-up visits for breast cancer are usually scheduled:
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- every 3 to 6 months for the first 5 years
- once a year after 5 years
During follow-up visits
During a follow-up visit, your healthcare team will usually ask questions about the side effects of treatment and how you’re coping.
Your doctor may do a physical exam, including:
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- a clinical breast exam
- checking the surgical area to see how well it healed
- checking the scar to look for signs that the cancer has come back
- feeling the lymph nodes under the arm, in the neck, and around the collarbone
- looking for any swelling in the hand and arm on the same side of your body as the surgery
- checking your lungs
- feeling your abdomen for any swelling or fluid
The only test that is done as a regular part of follow-up care is: Mammography
It is done on both breasts (if you had breast-conserving surgery or BCS) or on your remaining breast (if you had a mastectomy). Mammography is scheduled 6 months after treatment for breast cancer is finished, then once a year after that.
Tests to check how well your heart is working may also be done because some drugs used to treat breast cancer can cause heart problems.
There is a chance that your bones will become fragile and thin (called osteoporosis) if you take an aromatase inhibitor. You may have a bone density scan when you start an aromatase inhibitor regularly while you take this drug.
If you are taking tamoxifen, there is a minimal chance that you could develop cancer in the lining of your uterus. Your doctor will do a pelvic exam every year to check for any changes to your uterus.
No other tests are done if you do not have any signs or symptoms that breast cancer has come back. If there are symptoms of a breast cancer recurrence, your doctor may order one or more of the following tests:
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- blood chemistry tests to see if cancer has spread to the liver or lungs
- a bone scan to see if the cancer has spread to the bones
- a chest x-ray
- an ultrasound of your abdomen
- a CT scan
SUMMARY
It’s crucial to ask your doctor or cancer team about the frequency of your follow-up appointments. Remember, you may need regular checkups for at least five years to ensure your health and well-being. If the cancer has come back, you and your healthcare team will discuss your treatment and care.
How breast cancer spreads depends on several factors and situations that are unique to your body and your cancer. Once the cancer spreads to other organs, there’s no cure.
Regardless, treatment at stage 4 can help improve your quality of life and even lengthen your life. Your doctor and cancer team are the best resources for understanding your cancer stage and suggesting the best treatment options.
If you notice a lump or other changes in your breasts, contact your doctor to make an appointment. If you have already been diagnosed with breast cancer, tell your doctor if you experience pain, swelling, or other worrisome symptoms.
References
America Cancer Society
Cancer Research UK
Canadian Cancer Society
Cleveland Clinic
MacMillian Cancer Support
Mayo Clinic
Medical News Today
