Topic: Difference between recurrence and new primary cancer

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

Posted on: Apr 12, 2021 04:29PM - edited Apr 12, 2021 04:29PM by RedMoon

Posted on: Apr 12, 2021 04:29PM - edited Apr 12, 2021 04:29PM by RedMoon

RedMoon wrote:

How do they tell the difference between a new primary cancer and a recurrence of the old cancer. I had ILC in 2017, treated with lumpectomy and radiation. I stupidly refused antiestrogens because I thought I would be OK. They have now found another tumour in the other breast, but say it's ductal this time. Has anyone else had this happen to them? Have appointment with surgeon tomorrow, have to admit I'm way more scared this time around.


Surgery 9/6/2017 Lumpectomy; Lymph node removal: Sentinel Dx 4/2021, IDC, Left, <1cm, Grade 2, ER+/PR+, HER2- Surgery 5/20/2021 Lumpectomy: Left; Lymph node removal: Left Radiation Therapy Whole breast: Breast
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Apr 12, 2021 05:59PM beesie.is.out-of-office wrote:

I'm sorry you are back. It's not fun, is it?

It appears that you have a new primary. Breast cancer doesn't jump from one breast to the other. So with your new cancer being in the other breast, it is almost certainly a new primary. Even if it was in the same breast, if one cancer was ILC and the other IDC, that would be another way to distinguish between a recurrence (which would be ILC) versus a new primary.

Once any of us have been diagnosed one time, we are all higher risk than the average woman to be diagnosed a second time, with a new primary. That's a little secret that too many oncologists don't tell their patients. The further out someone is from diagnosis, the greater the risk, simply because we're older - all women become higher risk as they get older (the greatest risk years for breast cancer are our 60s and 70s) and it's the same for us. A new primary might be in the same breast or the opposite/contralateral breast and it might be a cancer that is similar to the first cancer or it might be completely different.

This board is full of people who've returned with a second primary. For many of us, it's 10 years or more; sometimes even 20 years. My second primary hit when I was 61 - I was just into those highest risk years. Like your situation, mine was also in the contralateral breast. While both my diagnoses were IDC, the presentation was very different, with just a microinvasion and DCIS scattered throughout my breast the first time, and a small solid mass with no DCIS the second time.

Good luck tomorrow! I hope it goes well.


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Apr 12, 2021 08:05PM NoBananas wrote:

I have just been diagnosed for the second time in my life too! 18 yrs on. My second cancer came back on my original mastectomy. I spotted a small spot on my chest sticking out, in the mirror. I just had a prophylactic mastectomy, to try and avoid another cancer in the future...or at least make it more identifiable. It is scary, even second time round. Especially when you read here other people’s diagnoses. Best of luck for tomorrow.

Dx 10/2003, IDC, Left, 2cm, Stage IIA, Grade 2, 1/19 nodes, ER+/PR+, HER2+, Dx 3/9/2021, IDC, Left, <1cm, Stage IA, Grade 2, ER+/PR+, HER2+, Chemotherapy AC + T (Taxol) Chemotherapy Taxol (paclitaxel)
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Apr 12, 2021 08:06PM - edited Apr 12, 2021 08:07PM by NoBananas

This Post was deleted by NoBananas.
Dx 10/2003, IDC, Left, 2cm, Stage IIA, Grade 2, 1/19 nodes, ER+/PR+, HER2+, Dx 3/9/2021, IDC, Left, <1cm, Stage IA, Grade 2, ER+/PR+, HER2+, Chemotherapy AC + T (Taxol) Chemotherapy Taxol (paclitaxel)
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Apr 12, 2021 11:16PM RedMoon wrote:

Thanks so much for the info Beesie. What you said makes a lot of sense, and also makes me feel more hope about tomorrow. But I also think I was almost in denial about my first cancer. I just wanted to have my life back. This one is hitting me harder and I think I'm realizing that cancer will likely be part of my life forever. Just need to find a way to accept that and not dwell in it. Hope you are doing OK.


Surgery 9/6/2017 Lumpectomy; Lymph node removal: Sentinel Dx 4/2021, IDC, Left, <1cm, Grade 2, ER+/PR+, HER2- Surgery 5/20/2021 Lumpectomy: Left; Lymph node removal: Left Radiation Therapy Whole breast: Breast
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Apr 12, 2021 11:23PM RedMoon wrote:

NoBananas

I get what you are saying, some of the stories on here scare me. But there are lots of inspirational ones too. But I totally get the importance of venting and having a place to talk about your worst fears and meltdowns, Lord knows I struggle with that too. Interesting choice to have a mastectomy so any future cancer would be more visible. If I am reading your post correctly you had a second prophylactic mastectomy after the first mastectomy? Is a prophylactic mastectomy different? I'm asking because I'm thinking along the same lines, I don't want this to keep happening - not sure I have a whole lot of control over it though.



Surgery 9/6/2017 Lumpectomy; Lymph node removal: Sentinel Dx 4/2021, IDC, Left, <1cm, Grade 2, ER+/PR+, HER2- Surgery 5/20/2021 Lumpectomy: Left; Lymph node removal: Left Radiation Therapy Whole breast: Breast
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Apr 13, 2021 02:56AM NoBananas wrote:

RedMoon, when I was 42, I was dx with an invasive ductal carcinoma, in my left breast. My surgeon easily talked me into a mastectomy. Nearly 18 yrs later, a small lump, about the size of a pinhead, caught my eye in the mirror. On my mastectomy chest, just above where the scar would have been. (That disappears over time). So after seeing a doctor and having an ultrasound on it, plus biopsy, the elderly radiographer (about my age, hahaaa) came in to chat to me about it. He said he’d seen so many women come back with a second and third breast cancer, and thought I should consider a prophylactic mastectomy, to help reduce the amount of breast tissue that a new cancer can form in. He also stated it was rare for a new lump to form on a mastectomy. When I met the surgeon, he reinforced the same idea. So, I had a mastectomy on the right hand side, and a lumpectomy into the old mastectomy on the left hand side. Excepting for the seroma that has formed under the lumpectomy, the lumpectomy was pretty simple surgery. The advantage of having a totally flat chest now, is when a lump forms, it is easy to see. They will keep doing ultrasounds every year, but no more mammograms. The small lump grew into a 6mm lump. When I went to have the surgery, the surgeon drew a small circle around it. It was that easy to see, sticking out. Like a tiny baked bean laying flat on top of my chest (under the skin, of course).

Oops, back to your question, is a prophylactic surgery different? Yes, because they don’t take your lymph nodes from under your arm, so no cutting of nerves under there. No problems with lifting your arm (except for the stitches). Still had those horrid drains, but three weeks after surgery, and drains are gone, I’m feeling pretty good! Big positive with a flat chest, is there would be no way you could miss seeing a 2cm tumour forming under your skin. Hope this helps with your decision making, RedMoon!

Dx 10/2003, IDC, Left, 2cm, Stage IIA, Grade 2, 1/19 nodes, ER+/PR+, HER2+, Dx 3/9/2021, IDC, Left, <1cm, Stage IA, Grade 2, ER+/PR+, HER2+, Chemotherapy AC + T (Taxol) Chemotherapy Taxol (paclitaxel)
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Apr 13, 2021 09:32AM moth wrote:

Always important to remember the counterintuitive fact that mastectomy does not prevent metastatic recurrence and does not improve survival.

In fact survival is better in lumpectomy pts when compared with same "type"

https://link.springer.com/epdf/10.1245/s10434-020-...


I take weekends off

Initial dx at 50. Seriously?? “Sometimes the future changes quickly and completely and we’re left with only the choice of what to do next." blog: Never Tell Me the Odds

Dx 12/2017, IDC, Left, 1cm, Stage IA, Grade 3, 0/5 nodes, ER-/PR-, HER2- Surgery 12/12/2017 Lumpectomy; Lumpectomy (Left); Lymph node removal Chemotherapy 2/13/2018 AC + T (Taxol) Radiation Therapy 8/13/2018 Whole breast: Breast Dx 2/2020, IDC, Left, Stage IV, metastasized to liver/lungs, Grade 3, ER-/PR-, HER2- Chemotherapy 3/18/2020 Taxol (paclitaxel) Immunotherapy 3/18/2020 Tecentriq (atezolizumab) Chemotherapy 11/25/2020 Abraxane (albumin-bound or nab-paclitaxel) Radiation Therapy 12/8/2020 External Hormonal Therapy 12/15/2020 Femara (letrozole) Radiation Therapy 3/2/2021 External Local Metastases 3/2/2021 Radiation therapy: Bone Targeted Therapy 1/1/2022 Trodelvy (sacituzumab govitecan-hziy) Chemotherapy 6/1/2022 Other
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Apr 13, 2021 11:14AM beesie.is.out-of-office wrote:

moth, that's true, but a MX does significantly reduce the risk of a new primary, which is what RedMoon is facing with her new diagnosis.

Of course a MX unfortunately doesn't eliminate the new primary risk completely. But from reading this site (not representative, I know), it seems that a lot of us who develop a second primary go on to develop a subsequent recurrence or another new primary - and it's interesting that the radiologist who NoBananas spoke to said the same thing. So significantly reducing this risk is an important consideration, particularly since you never know how aggressive a new diagnosis might be.





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Apr 13, 2021 04:00PM RedMoon wrote:

Really interesting discussion. Thank-you all for your input. I really appreciated your comments Beesie about my original question. Felt so much better after reading that - and the surgeon confirmed everything you said.

I saw surgeon today. Apparently I have two other tiny lumps that they didn't biopsy (because they weren't suspicious enough) and he wants to consult the oncologist before surgery. They may want to biopsy them before proceeding. So I may not have the option of lumpectomy even if I wanted it. We talked about mastectomies, and he suggested a mastectomy with immediate reconstruction (mainly because the wait times for delayed reconstruction here are upwards of two years). Not sure I want immediate reconstruction? It sounds like they take other parts of you (from your back or stomach) and move it over to the breast. Sounds like a much more involved surgery - plus I've heard it's harder to see new cancers if you have reconstruction? I'm 62 and I don't need boobs.

Surgery 9/6/2017 Lumpectomy; Lymph node removal: Sentinel Dx 4/2021, IDC, Left, <1cm, Grade 2, ER+/PR+, HER2- Surgery 5/20/2021 Lumpectomy: Left; Lymph node removal: Left Radiation Therapy Whole breast: Breast
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Apr 13, 2021 05:31PM NoBananas wrote:

RedMoon, I just turned 60, and thought the same as you, I don’t need boobs. It’s eliminated the paranoia of checking my breast all the time for a new lump, and hoping I hadn’t missed anything. The problem with BC, is you don’t have a lot of time to make these decisions before surgery. I am sure you will choose something you will be happy with.

Dx 10/2003, IDC, Left, 2cm, Stage IIA, Grade 2, 1/19 nodes, ER+/PR+, HER2+, Dx 3/9/2021, IDC, Left, <1cm, Stage IA, Grade 2, ER+/PR+, HER2+, Chemotherapy AC + T (Taxol) Chemotherapy Taxol (paclitaxel)

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