Four weeks ago, I noticed this in the mirror while drying my hair after a shower. There was a small red mark on my chest, just to the left of my mastectomy scar. The day before, I could have asserted that this was not the case.
It wasn’t painful, but when I ran my finger over it, I could feel a small, hard nodule-like lump under my skin. I knew exactly what it was. My breast cancer was recurring for the third time.
A cold, nauseating feeling overwhelmed me. I went to see her husband, Dermot, and he hugged me. But was it a local recurrence, where the cancer recurred in the same area as the original tumor? In 2018, three years after my first breast cancer diagnosis, I had one of them.
Horrifyingly, local recurrences are curable. But what if it had now metastasized to the lungs, liver, and bones?
My family doctor made an urgent appointment at the breast clinic, and while I waited, I was interviewed multiple times to promote my new book, Under The Knife, which had just been published.
I recorded a podcast with Victoria Derbyshire and talked about the local relapse. I have spoken with several breast cancer support groups about how to deal with the side effects of treatment.
During that time, I was terrified that I had an incurable disease.
At the breast clinic, a few patients in the waiting room noticed me. We chatted but it was so hard to stay positive and friendly when I just wanted to hide.
I had an ultrasound of the nodule and the doctor did a punch biopsy. A small portion is excised for inspection.
A few days later, a full-body CT scan was done to see if the cancer had spread elsewhere.
The last week of waiting was the worst. I mentioned it to a few wonderful friends who messaged me daily to cheer me up. But at night I was alone, scared, and lost in thought of what was to come. I struggled to eat and spent hours reading every information I could find.
Last Friday, July 26th, I got the news I was waiting for. It was a local recurrence. Everyone was excited for me, but it felt strangely anti-climactic.
I had surgery on Friday to remove the nodule and some of the tissue around it. Once healed, radiation therapy is started within a few weeks, followed by drug therapy. The aim is to keep the cancer from coming back a fourth time, but I know it can come back.
When I was first diagnosed with melanoma in 2015, a friend had melanoma skin cancer. He had a good prognosis and was told he had a 95% chance of being cured. However, the cancer recurred and spread throughout his body. He said that before he died, he was almost glad when he heard the terrible news that he was terminally ill. That means I could stop waiting for it to happen.
And I understand that. No one wants to have terminal cancer. I know how terrifying it is to see my mother die from this disease this year. But so is the horrendous wait of each scan, not knowing if it’s good news or bad news. After my last treatment, I started getting treatment once a year. The anxiety and fear that rises at that time will never disappear.
Due to amazing advances in medicine, cancer is no longer a guaranteed death sentence. He has 3 million people living with cancer in the UK and is expected to rise to 4 million in the next decade.
But survival isn’t everything. Ringing a bell doesn’t always make you happy. For the majority of cancer survivors, cancer will change their bodies and lives forever.
The left breast had been amputated. I had reconstructive surgery, but had to remove the implant at the first recurrence. It’s flat now.
I had to take hormone-blocking drugs, and the first time the cancer came back, I had to have my ovaries removed to allow the new drugs to work.
Dermot and I had just been married when I was diagnosed with breast cancer. Having a child has always been our plan, but because of the treatment, it has fallen away.
I still grieve for the family I will never have again. A 2018 surgery left me with post-mastectomy pain syndrome (PMPS) in my chest wall. Radiation therapy put pressure on the scars in my armpits and stiffened my shoulders. I was forced to retire as a breast surgeon. Without the ability to move the arm properly, the operation could not be performed safely. Of course I am grateful to be alive, but at what cost?
I will do whatever the doctor recommends to continue. I’m going to keep working and writing — that’s what I’ve been doing since I retired from being a full-time doctor — but it’s going to be difficult. scar. The sadness of what you can’t do anymore, what you can’t have. I did everything “right”. I’m fit, I exercise, I’m a healthy weight, and I drink very little. Of course, it put me physically in a better position for what was to come.
But the facts remain the same. Even after going through and losing everything, my cancer came back. And it may happen again.
Ironically, the day I noticed the nodule, I was writing a manuscript for a social media post about the local recurrence. This is a rare occurrence, but it is often misunderstood.
Treatment of breast cancer usually includes surgery to remove the tumor. This can be either a partial excision, in which only the tumor and some tissue around it is removed, leaving the rest of the breast, or a mastectomy, in which the entire breast is removed. Despite our best efforts, it is not possible to remove all cancer cells and some will be left behind.
This is similar to peeling an orange. It is not possible to remove all the pulp. We administer radiation therapy, chemotherapy, drugs such as tamoxifen to trap these residual fragments, and these treatments have proven to be very effective. However, in a minority of cases, some cells remain and at some point start proliferating.
If you have had a lumpectomy, the cancer may come back in the remaining breast tissue, nipple, or skin. It can also occur if you had a mastectomy like I did. If you have undergone nipple-sparing reconstructive surgery, the tumor may recur in the nipple or skin.
Both cases are called local recurrences. For this reason, it is important to check yourself after a mastectomy. I recorded a video showing exactly how to do it and posted it on my YouTube channel. See left panel for details.
The risk of local recurrence of breast cancer depends on the type of cancer. For ER+ve Her2-ve cancer (the cancer I had), one of the most common forms, the risk is 2-3% 10 years after surgery. For triple-negative breast cancer (a much less common and difficult-to-treat type), the risk within 10 years is 10-12%.
These risks are the same even if a woman has a lumpectomy or mastectomy. In some cases, the characteristics of a local recurrence may differ from the original breast cancer.
For example, the initial recurrence may be hormone receptor negative and cannot be treated with hormone therapy, whereas a local recurrence may be hormone receptor positive and can be treated with hormone therapy.
Local recurrence is different from so-called secondary, advanced, or stage 4 metastatic breast cancer. All of these terms have the same meaning. This means that cancer that has recurred can be treated, but not cured.
It occurs in one-third of women with breast cancer and often does not last more than 10 years after initial diagnosis.
Advanced cancer means that the tumor has spread throughout the body. Doctors believe that cancer cells enter the bloodstream and circulate.
Chemotherapy and other drugs (such as tamoxifen for breast cancer) are given to kill these rogue cells. However, some may remain for reasons that are not fully understood. At some point, it begins to regrow in other locations as small tumors known as metastases.
Drug therapy can shrink and even eliminate these metastases, but they continue to recur.
Most local recurrences are treated initially with surgery. A mastectomy is usually done if the woman has had a lumpectomy before.
If you had a mastectomy initially, your surgeon will remove a piece of skin from the recurrence area. Some people need plastic surgery, such as a skin graft, to close the wound. Radiation therapy may be given after a local recurrence, even if radiation therapy was not given the first time.
Depending on the type of cancer, women may be given chemotherapy and other drugs.
You’ll probably need to take a CDK inhibitor (the kind of drug given to women with hormonal breast cancer like me), which can have side effects like nausea, fatigue, upset stomach, infection and risk of anemia. deaf.
The big question, of course, is what the future holds. In fact, we need to do more research to know for sure. Some breast cancer experts believe that a local recurrence does not always mean that the cancer is likely to spread in the future. However, some believe that local recurrence increases the risk.
I’m trying to focus on the now. Cancel plans to get treatment. Dermot was incredible. It will be hard for him to see his wife go through cancer treatments for the third time.
And I am overwhelmed with the love and support given by my followers in the online community. It is very helpful to put it in the pocket of the buttocks.
But the person I really need is my mom, even though I can never be with her.
She died six months ago from metastatic bone cancer. It would be hard if she didn’t hug me. But I would like to follow her example and overcome her positive and cheerful treatment just like her.
- Under the Knife: Life Lessons from the Operating Room (Unbound) by Dr. Liz O’Riordan is available now with a suggested retail price of £12.99.
