When breast cancer returns

SINGAPORE — After successfully completing her treatment for early-stage breast cancer 11 years ago, Madam Nicole Ang thought she had everything under control. Eight years later, the cancer returned in the same spot in her left breast.

The relapse was a huge blow to the 47-year-old sales coordinator and mother of two teenage children. “Despite my efforts to lead a healthy lifestyle, the cancer still came back. I was so disappointed and felt like there was no hope left,” said Mdm Ang.

For cancer patients like Mdm Ang, the word “relapse” is a devastating one. Most people will assume it is a death sentence.

NEW TREATMENT OPTIONS

The good news is, “patients are living longer even with advanced disease and certain groups have very good survival rates, even when the disease has spread”, said Dr Chan Ching Wan, senior consultant at the Division of Surgical Oncology (Breast Surgery) at the National University Cancer Institute, Singapore (NCIS).

With the advancements in treatment options in the past two decades, more patients with recurrent and advanced breast cancer are living beyond 18 to 24 months, said Dr Khoo Kei Siong, deputy medical director and senior consultant of Parkway Cancer Centre.

For instance, Herceptin, a targeted therapy drug for HER2-positive breast cancer, has helped more patients live longer, improving the five-year survival rate from 13 to 23 per cent in one study, said Dr Khoo.

Diagnosed in one in five patients, HER2-positive breast cancer is typically more aggressive than other forms of breast cancer.

RISKS AND SURVIVAL CHANCES

Dr Khoo said up to one in four patients with early breast cancer may suffer a relapse.

The risk level depends on how advanced it was and when it was first discovered, said Dr Chan.

He explained: “With late-stage cancer, it means the cancer has been around in the body for a fair amount of time and has a greater chance to spread.

“We suspect that in such patients, the disease exists in different parts of the body on a microscopic level but is too small to be detected by the scans we have at the moment.”

How the initial cancer is treated is also critical. Under-treating the cancer the first time is a sure way of allowing it to return, said Dr Chan.

The location of the cancer’s recurrence will also determine the patient’s survival chances.

The relapse can occur in the same location as the initial cancer (known as local recurrence) or in other parts of the body, such as the bone, liver, lung or brain, said Dr Lim Yi Wan, who treated Mdm Ang and is consultant at the Department of Haematology-Oncology at NCIS.

“If the recurrent cancer is localised, there can still be a good outcome with treatment,” said Dr Lim.

Dr Chan explained that cancer that returns in areas outside the breast and lymph nodes is considered Stage 4 cancer.

In this situation, the patient’s survival chances are lower — between six and 12 months — than someone with a local recurrence.

FIGHTING CANCER WITH SUPPORT

There are now treatments to bring recurrent breast cancer under control and improve patients’ quality of life, said Dr Khoo. Besides talking to their oncologists about their treatment options, patients should also harness the support of family, friends and volunteers.

“Don’t fight this alone,” said Dr Khoo. “Although recurrent breast cancer is a serious condition, it is not necessarily hopeless.”

With her family’s support and encouragement, Mdm Ang underwent more intensive cancer treatments, which involved a major operation to remove her entire left breast and the lymph nodes under the arm, as well as chemotherapy.

“I was in such denial that I did not want to do any treatment at all. I thought about it for a long time and eventually decided to remove my left breast. It was a hard decision,” said Mdm Ang.

Currently on daily oral medication, Mdm Ang shows no clinical signs of the disease.

For Mdm Ang, her two-time brush with death has made her rethink her priorities.

“If you have been diagnosed with a cancer relapse, my advice is not to give up on yourself,” she said.