The evidence-based recommendations described below outline the standard follow-up procedures for breast cancer surveillance and are intended to assist you in providing optimal cancer follow-up care for your patient; these recommendations are not intended to be a substitute for clinical judgement.
Once a patient has been discharged from Cancer Care Alberta, their primary care provider is asked to organize the following surveillance activities:
More information about surveillance activities is found in the Breast Cancer Transfer of Care Physician Letter.
Signs and symptoms of breast cancer recurrence include the following:
Symptoms / Signs | Actions / Investigations |
---|---|
New mass in breast | Mammography +/- ultrasound (+/- biopsy). |
New suspicious rash or nodule on chest wall | Refer to surgeon, dermatology or interventional radiology for consideration of biopsy. |
New palpable lymphadenopathy | Refer to surgeon or interventional radiology for biopsy. |
New persistent bone pain | Plain x-ray of affected site(s) and bone scan. |
New persistent cough or dyspnea | Chest x-ray and/or CT chest. |
New hepatomegaly or RUQ abdominal pain or jaundice | Ultrasound and/or CT scan of abdomen and liver enzymes. |
New persistent headache or new concerning neurologic deficits | CT/MRI of brain. |
New onset seizures | Seizure management (as required) and CT/MRI of brain. |
Back pain with limb weakness, change in reflexes, change in sensation, or loss of bowel/bladder control | MRI of spine. |
Symptomatic hypercalcemia | IV hydration and bisphosphonate therapy. |
Contact the treating oncologist to determine how to refer the patient back to the cancer centre. If the oncologist's contact information is not available, search “breast cancer” in the Alberta Referral Directory for the most up-to-date information and instructions for referral. Contact information can also be found in the Provincial Breast Health Referral Pathway.
Following treatment for breast cancer, your patient may present with some of the complications outlined below. Continue to monitor and address concerns related to cancer therapy.
Complication | Treatment-Related Causes | Actions |
---|---|---|
Fatigue |
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Fatigue should start to improve within months of treatment completion. Persistent or recurrent fatigue warrants further work-up to rule out other potential causes. For more information refer to the Cancer-Related Fatigue Guideline. |
Peripheral neuropathy |
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Chemotherapy related peripheral neuropathy should improve over months. Painful paresthesias may respond to gabapentin or amitriptyline. If neuropathy is progressive/persistent, consider additional investigations and referral to neurology. |
Lymphedema |
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Early symptoms include arm heaviness or discomfort and may be present with/without overt swelling. Referral to local rehabilitation therapy services (e.g. physiotherapy) or tertiary lymphedema clinic can be made. Calgary Rehabilitation Oncology - Physiotherapy or Cross Cancer Institute Rehabilitation Oncology - Physiotherapy. |
Cardiac dysfunction |
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If patient is symptomatic or has clinical signs treat accordingly and evaluate further with ECG and MUGA or echocardiogram. Consider a referral to cardiology if significant abnormalities are noted. |
Acute Leukemia / Myelodysplasia |
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If your patient has concerning clinical symptoms, perform CBC + differential (with peripheral blood smear) and refer to hematology if significant persistent cytopenias or blast cells are noted. |
Deep venous thrombosis (DVT) or pulmonary embolus (PE) |
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Confirm with ultrasound of affected extremity (DVT) or CT for PE. Stop Tamoxifen and commence anticoagulation. Consult medical oncologist for direction. |
Endometrial carcinoma |
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Endometrial ultrasound, endometrial biopsy if abnormal vaginal bleeding. Stop Tamoxifen. Refer to gynecology and consult medical oncologist for direction. Routine surveillance ultrasounds in asymptomatic individuals is discouraged. |
Osteopenia/ Osteoporosis |
|
Bone density assessment (DEXA scan) and management as per OP guidelines. |
Endocrine Therapy
More information about endocrine therapy, including side effects, is found in the Breast Cancer Transfer of Care Physician Letter.
Bisphosphonate Therapy
More information about bisphosphonate therapy is found in the Breast Cancer Transfer of Care Physician Letter.
Sexual Health
Information about Sexual Health concerns, such as menopause symptoms, self-image concerns and family planning, is found in the Breast Cancer Transfer of Care Physician Letter.
Genetic Counselling
Patients should be encouraged to report any changes in their family history of cancer. All women from high-risk families should be offered a referral for genetic counselling. For more information, see AHS Clinical Genetic Services.
Note: The information on this page was adapted from the AHS Guideline Resource Unit's Follow-Up Care for Early-Stage Breast Cancer guideline, and the accompanying Breast Cancer Transfer of Care Physician Letter. Also available is the Breast Cancer Transfer of Care Patient Letter.