What happens after treatment for breast cancer?

What happens after treatment for breast
cancer?

For many women with breast cancer, treatment may remove or destroy the cancer.
Completing treatment can be both stressful and exciting. You may be relieved to finish
treatment, but find it hard not to worry about cancer coming back. (When cancer comes
back after treatment, it is called recurrence.) This is a very common concern in people
who have had cancer.
It may take a while before your fears lessen. But it may help to know that many cancer
survivors have learned to live with this uncertainty and are leading full lives. Our
document, Living with Uncertainty: The Fear of Cancer Recurrence, gives more detailed
information on this.
For other people, the cancer may never go away completely. These people may get
regular treatments with chemotherapy, radiation therapy, or other treatments to try to help
keep the cancer in check. Learning to live with cancer that does not go away can be
difficult and very stressful. It has its own type of uncertainty. Our document, When
Cancer Doesn't Go Away, talks more about this.

Follow-up care
When treatment ends, your doctors will still want to watch you closely. It is very
important to go to all of your follow-up appointments. During these visits, your doctors
will ask questions about any problems you may have and may do exams and lab tests or
x-rays and scans to look for signs of cancer or treatment side effects.
Almost any cancer treatment can have side effects. Some may last for a few weeks to
months, but others can last the rest of your life. This is the time for you to talk to your
cancer care team about any changes or problems you notice and any questions or
concerns you have.
At first, your follow-up appointments will probably be scheduled for every 3 to 6 months.
The longer you have been free of cancer, the less often the appointments are needed.
After 5 years, they are typically done about once a year. If you had breast-conserving
surgery, you will get a mammogram about 6 months after surgery and radiation are
complete, and then every year. Women who had a mastectomy should continue to have
yearly mammograms on the remaining breast.
If you are taking tamoxifen or toremifene, you should have pelvic exams every year
because these drugs can increase your risk of uterine cancer. This risk is highest in
women who have gone through menopause. Be sure to tell your doctor right away about
any abnormal vaginal bleeding, such as vaginal bleeding or spotting after menopause,
bleeding or spotting between periods, or a change in your periods. Although this is
usually caused by a non-cancerous condition, it can also be the first sign of uterine
cancer.
If you are taking an aromatase inhibitor or are pre-menopausal taking tamoxifen or
toremifene, your doctor will want to monitor your bone health and may consider testing
your bone density.
Other tests such as blood tumor marker studies, blood tests of liver function, CTs, bone
scans, and chest x-rays are not a standard part of follow-up. Getting these tests won’t help
a woman treated with breast cancer live longer. They will be done (as indicated) if you
have symptoms or physical exam findings that suggest that the cancer has recurred. These
and other tests may be done as part of evaluating new treatments by clinical trials.
If symptoms, exams, or tests suggest a recurrence, imaging tests such as an x-ray, CT
scan, PET scan, MRI scan, bone scan, and/or a biopsy may be done. Your doctor may
also measure levels of blood tumor markers such as CA-15-3, CA 27-29, or CEA. The
blood levels of these substances go up in some women if their cancer has spread to bones
or other organs such as the liver. They are not elevated in all women with recurrence, so
they aren't always helpful. If they are elevated, your doctor might use them to monitor the
results of therapy.
If cancer does recur, your treatment will depend on the location of the cancer and what
treatments you've had before. It may mean surgery, radiation therapy, hormone therapy,
chemotherapy, targeted therapy, or some combination of these. For more information on
how recurrent cancer is treated, see the section, “Treatment of invasive breast cancer by
stage.” For more general information on dealing with a recurrence, you may also want to
see our document, When Your Cancer Comes Back: Cancer Recurrence.
It is also important to keep health insurance. Tests and doctor visits cost a lot, and even
though no one wants to think of their cancer coming back, this could happen.
Lymphedema after breast cancer treatment
Lymphedema, or swelling of the arm from buildup of fluid, may occur any time after
treatment for breast cancer. Any treatment that involves removing or giving radiation to
the axillary lymph nodes carries the risk of lymphedema because normal drainage of
lymph fluid from the arm is changed.
One of the first symptoms of lymphedema may be a feeling of tightness in the arm or
hand on the same side that was treated for breast cancer. Any swelling, tightness, or
injury to the arm or hand should be reported promptly to your doctor or nurse.
There is no good way to predict who will and will not develop lymphedema. It can occur
right after surgery, or months, or even years later. The possibility of developing
lymphedema remains throughout a woman's lifetime.
With care, lymphedema can often be avoided or, if it develops, kept under control. Injury
or infection involving the affected arm or hand can contribute to the development of
lymphedema or make existing lymphedema worse, so preventive measures should focus
on protecting the arm and hand. Most doctors recommend that women avoid having
blood drawn from or blood pressures taken on the arm on the side of the lymph node
surgery or radiation.
To learn more, see our document, Lymphedema: What Every Woman with Breast Cancer
Should Know.