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Topic: How do you know if it's a recurrence or a new primary?

Forum: Second or Third Breast Cancer — For those confronting a new primary diagnosis or undergoing treatment.

Posted on: Nov 2, 2016 12:31PM

Emily2008 wrote:

Hi everyone -

I was recently diagnosed with another breast cancer. I asked my BS if it would be considered a recurrence or a new primary (she referred to it as a recurrence). She told me it doesn't really matter what it's called because that doesn't influence treatment. I asked her if the properties of the new cancer are different from the original one, would it then be considered a new primary. She said even recurrences can have different properties (hormone receptors, etc.), so that alone doesn't mean it's a new primary.

So I'm wondering if it would only be called a new primary if it showed up in the other breast, for example. If it's in the same breast, as mine is, is it automatically considered a recurrence? I know it doesn't matter really, but I would like to know how to think about it.

Thanks,

Emily

Dx 5/08, IDC, Left, Stage 1, Grade 1, BRCA 2 pos. Mast. w/TRAM and implant, A/C x 4, Tamox. for 6.5 yrs, ooph and hyst in 2010. Dx. 10/16, local recurrence, Left, Grade 2, breast segmentation, 30 rads from Jan-March 2017, then AIs. Dx 5/14/2008, IDC, Stage I, Grade 1, 0/5 nodes, ER+/PR+, HER2- Dx 10/31/2016, IDC, Left, 1cm, Grade 2, ER+/PR+, HER2-
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Nov 3, 2016 10:40AM KBeee wrote:

I think what your oncologist said is correct. Sometimes thoughthey can't even know for sure. Mine was in the same spot, so even though the pathology changed, it's considered a recurrence.

Karen. Dx 8/5/2013, IDC, Right, 1cm, Grade 2, 0/1 nodes, ER+/PR+, HER2- (IHC) Surgery 8/26/2013 Mastectomy: Left, Right Chemotherapy 9/20/2013 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Hormonal Therapy 12/12/2013 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 1/23/2014 Reconstruction (left); Reconstruction (right) Surgery 1/29/2015 Lumpectomy: Right Dx 2/2/2015, IDC, Right, 1cm, Grade 2, 0/0 nodes, ER+/PR-, HER2- (FISH) Dx 2/25/2015, IDC, Right, 1cm, Grade 3, 0/13 nodes, ER+/PR-, HER2- (IHC) Surgery 2/25/2015 Lumpectomy: Right; Lymph node removal: Right, Sentinel, Underarm/Axillary; Prophylactic ovary removal Chemotherapy 3/31/2015 AC + T (Taxol) Radiation Therapy 8/25/2015 Whole-breast: Breast, Lymph nodes, Chest wall Hormonal Therapy Femara (letrozole)
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Dec 8, 2016 11:45PM NotAgain2015 wrote:

Hi Emily,

My oncologist referred to my 2nd BC as a new primary. Still stage 1. Last year had it again on my original DCIS side. Had bi-lat mastectomy with immediate diep reconstruction. No lymph nodes and less than 1cm. So what am i? What stage am i? The answer wasnt completely clear but he said women with BC are living longer now and that staging is more geared toward first diagnoses. Im a recurrent stage 1 is what he told me. My oncotype score us low. I take arimidex.

I feel for you. The 2nd diagnosis is a blow, but hang in there. Im one year out and feeling oretty great. Hope .you are doing ok. What is your plan

Dx 4/23/2010, DCIS, Left, <1cm, Stage 0, Grade 2, ER+, HER2- Dx 2/17/2011, IDC, Right, <1cm, Stage IA, Grade 2, 0/2 nodes, ER+/PR+, HER2- Dx 10/30/2015, IDC, Left, 1cm, Stage IA, Grade 2, ER+/PR+, HER2- Surgery 12/15/2015 Mastectomy: Left, Right; Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap
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Dec 24, 2016 07:03AM Emily2008 wrote:

Well, a bit of a twist. I consulted at Sloan Kettering, and the doctor there as well as my local doc think this is a new primary, not a recurrence. Two main reasons: the average length of time for a recurrence is 4.7 years, and this was 8.5 years. Also, there was DCIS present as well as the IDC. Apparently, these two factors combined lead the doctors to call this a new primary, not a recurrence.

Good news is that I had surgery on Dec.5, had wide margins, negative SNB, and since this is being classified as a new primary, the tumor was sent for Oncotype testing. The doc at Sloan Kettering has predicted an intermediate score based on my Ki67 score from the pathology report. We shall see.

Assuming I don't need chemo, I will start rads in January and be on an AI for 5 years. If we go with chemo, that will be first, followed by rads.

My doc here seems to be leaning toward chemo, or at least he's preparing me to be ready. I think if the Oncotype score is intermediate to high he will recommend chemo. I'm BRCA 2 pos, which responds well to chemo, and i'm 44 with a second breast cancer. These issues factor into the decision.


Dx 5/08, IDC, Left, Stage 1, Grade 1, BRCA 2 pos. Mast. w/TRAM and implant, A/C x 4, Tamox. for 6.5 yrs, ooph and hyst in 2010. Dx. 10/16, local recurrence, Left, Grade 2, breast segmentation, 30 rads from Jan-March 2017, then AIs. Dx 5/14/2008, IDC, Stage I, Grade 1, 0/5 nodes, ER+/PR+, HER2- Dx 10/31/2016, IDC, Left, 1cm, Grade 2, ER+/PR+, HER2-
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Oct 14, 2017 07:34PM - edited Oct 14, 2017 07:35PM by hopeful_36

A radiation oncologist with who I had a consult after the surgery (lumpectomy after double mastectomy) for recurrence said there is no way to tell if its a new primary cancer or a recurrence, or a left over DCIS that went invasive. What puzzled me though is her saying that "if its a recurrence, then it is considered an aggressive kind. But if its a new primary, then its a grey area, hard to tell, but still considered very early stage". I didn't really understand the logic, but got reassurance that cancer (its typology, origins and etc) is a great mystery, and there is so much the conventional medicines doesn't know. I don't think the allopathic doctors will ever solve the mystery of cancer, unless they look at a much larger picture, including psychospiritual, epigenetic, metaphysical and other aspects of human life.

Dx 3/27/2013, DCIS, Left, Stage 0, Grade 3, 0/3 nodes, ER+/PR+, HER2- Surgery 4/19/2013 Mastectomy: Left; Prophylactic mastectomy: Right Dx 8/27/2017, IDC, Left, 1cm, Stage IA, Grade 3, ER+/PR+, HER2+ Surgery Lumpectomy: Left Surgery Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Oct 14, 2017 09:02PM NTK2 wrote:

Hello Hopeful_36. Sorry to hear about your reoccurence. I too had a double mastectomy little over a year ago with no radiation or chemo. It was DCIS, stage 0. I too am concerned still on how do you tell if there is reoccurrence. Without a mastectomy, patients at least have the radiation or chemo and can still get their mamograms. With me, I don't know how to tell. How were you able to tell you either had a reoccurrence or had cancer again? And how long ago was your masceptomy if you don't mind sharing. Thanks for assistance.

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Oct 15, 2017 07:00PM hopeful_36 wrote:

NTK2, of course, I don't mind sharing:

I had dmx 4 years ago for multifocal DCIS. I've noticed a tiny (size of a rice grain) hard spot this April when I was rubbing around implants for a "scar tissue" massage. I thought it was a scar, and kept rubbing it pretty hard for 5-7 days wanting it to flatten out. I wish I've never done it. It started growing fast. I guess I've triggered it inflaming the tissue around it. I had it checked 3 months later, and biopsied 2 months later. Turned out being invasive stage 1, plus DCIS on margins extracted with lumpectomy.

Again, docs don't know if its a left over DCIS that's turned invasive in 4 years, or a brand new spot of its own IDC. If former, they consider it a "very aggressive" kind, if latter - not too too scary stage 1. Go figure.

But the worrisome part is they say it was already affecting the muscle, i.e. going deep. I wonder how come a thing that I haven't had a few months ago could have gone so aggressively growing so fast. One factor to mention - the last few years in my life were were stressful, e.g. hostility of a divorce, financial challenges, loss of a parent, other. I believe those had to do a lot with the recurrence. I highly recommend the book "Genie in your genes" to everyone concerned about their health, cellular expression and degenerative diseases like cancer.

Dx 3/27/2013, DCIS, Left, Stage 0, Grade 3, 0/3 nodes, ER+/PR+, HER2- Surgery 4/19/2013 Mastectomy: Left; Prophylactic mastectomy: Right Dx 8/27/2017, IDC, Left, 1cm, Stage IA, Grade 3, ER+/PR+, HER2+ Surgery Lumpectomy: Left Surgery Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Dec 20, 2017 10:53PM Totallytubular wrote:

hello,

I had a pet scan on my whole body to confirm that the second cancer on the opposite breast was a new primary. I would say thank god for that.

Dx 11/15/2014, IDC: Tubular, Right, <1cm, Stage IA, Grade 1, ER+/PR+, HER2- Surgery 12/10/2014 Lumpectomy: Right; Lymph node removal: Sentinel Radiation Therapy 1/31/2015 Whole-breast: Breast Dx 10/30/2015, IDC, Left, <1cm, Stage IA, Grade 1, ER+/PR-, HER2- Surgery 11/18/2015 Lumpectomy: Left Radiation Therapy 1/13/2016 Whole-breast: Breast Chemotherapy 4/3/2016 CMF Hormonal Therapy Arimidex (anastrozole) Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Jun 14, 2018 01:42PM robinblessed54 wrote:

Hello friends, I have found a small pea size lump almost the same location as first time. It will be 4 years in September. I had the sneaky ILC that I found but mammogram didn’t. I know my body so well. I had BMX with immediate TEs and then gummy anatomical implants. No chemo or rads. I am on Femara. I have notified my MO and waiting for her reply. Do you go to your BS, MO, PS? Who is in charge?? LOL! My CA15-3 went up the last visit. It is beliw 30 at 26.1

Any wisdom is appreciated.

Robin


Dx 9/2/2014, ILC, Left, 1cm, Stage IB, Grade 1, 0/5 nodes, ER+/PR+, HER2- Surgery 9/25/2014 Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Hormonal Therapy 10/15/2014 Arimidex (anastrozole) Hormonal Therapy 12/30/2014 Aromasin (exemestane) Surgery 3/5/2015 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 3/14/2015 Femara (letrozole) Surgery 12/21/2016 Reconstruction (left): Nipple tattoo; Reconstruction (right): Nipple tattoo
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Jun 17, 2018 11:41AM nonomimi5 wrote:

Hi Robin. I am sorry you found a lump Did your MO reply? I would think she is the first to consult. Good luck.

Dx 3/23/2018, DCIS/IDC/IDC: Tubular, Right, 2cm, Stage IIA, Grade 2, 0/3 nodes, ER+/PR+, HER2- (IHC) Surgery 4/30/2018 Lumpectomy; Lymph node removal Radiation Therapy 5/29/2018 Breast Hormonal Therapy 7/2/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Jun 21, 2018 11:51PM KBeee wrote:

I call them all and go to whoever can fit me in first. Any of them can order imaging. Hoping it is benign

Karen. Dx 8/5/2013, IDC, Right, 1cm, Grade 2, 0/1 nodes, ER+/PR+, HER2- (IHC) Surgery 8/26/2013 Mastectomy: Left, Right Chemotherapy 9/20/2013 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Hormonal Therapy 12/12/2013 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 1/23/2014 Reconstruction (left); Reconstruction (right) Surgery 1/29/2015 Lumpectomy: Right Dx 2/2/2015, IDC, Right, 1cm, Grade 2, 0/0 nodes, ER+/PR-, HER2- (FISH) Dx 2/25/2015, IDC, Right, 1cm, Grade 3, 0/13 nodes, ER+/PR-, HER2- (IHC) Surgery 2/25/2015 Lumpectomy: Right; Lymph node removal: Right, Sentinel, Underarm/Axillary; Prophylactic ovary removal Chemotherapy 3/31/2015 AC + T (Taxol) Radiation Therapy 8/25/2015 Whole-breast: Breast, Lymph nodes, Chest wall Hormonal Therapy Femara (letrozole)
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Dec 20, 2018 07:37PM - edited Dec 20, 2018 07:39PM by arby

When tests came back on my 2rd recurrence, this new cancer was hormone positive, Her 2 neg. , It was obviously a new cancer. Previously I was hormone neg and Her 2 positive. Instead of radiation or chemo, I was put on Arimidex for 5 years. Hang in there as a new diagnosis might be treated today less invasively than 10 years ago. That's been a bonus for me this round.


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