Finishing cancer treatment and going into remission is a huge victory for any cancer survivor, but it also can cause new concerns and worry. “Many people worry about cancer recurrence or the long-term side effects of cancer treatment,” said Margaret Terhar, MD, FACS at Comprehensive Cancer Centers of Nevada and The Breast Center at Sunrise Hospital. Other concerns include physical changes caused by cancer treatments, early menopause or psychological effects. “It’s important to remember that most women are able to go on and live entirely normal, happy, healthy lives after cancer, but there can be lingering effects.”

Will I need hormonal therapy?

Most women will need to take anti-estrogen medications for five to 10 years afterward. “Nearly 80 percent of breast tumors are estrogen-receptor positive, which means they’re sensitive to estrogen, and estrogen can stimulate cell growth, so anti-estrogen medications can help keep recurrence down,” Terhar said.

The most common places for breast cancer to spread are to the brain, bones, liver or lungs.

Are there special care requirements after breast cancer?

Patients usually require continued care. This includes:

• Follow-ups with their surgeon and medical oncologist

• Regular mammograms

• Blood work

• Ultrasounds, MRIs or medication, depending on the specifics of their cancer

The difference between curing, remission and recurrence

“Remission is a term better used to describe cancers that frequently occur, like blood cancers, but breast cancer can usually be curable if it’s limited to the breast tissue and lymph nodes,” Terhar said. A patient’s chance at recurrence depends on multiple factors, such as their age when diagnosed, the size and aggressiveness of the tumor. Doctors often will be able to tell a patient what their reasonable chances are for a recurrence.

If there were to be a recurrence, there are typically two types:

• Local recurrence: Cancer returns to its original site

• Systemic (or distant) recurrence: Cancer comes back and has spread to a different location of the body.

Possible long-term side effects

“Cancer treatment can cause many, many different side effects, and they can be different for every survivor,” Terhar said.

Side effects immediately after treatment can include:

• For people who lose their hair during chemotherapy, it may grow back a different texture, color and may be thinner or thicker.

• For women who were diagnosed pre-menopause, chemotherapy or anti-estrogen treatments can cause early menopause.

• Many women either gain or lose weight during chemotherapy, and maintaining a steady weight after cancer treatment can be very difficult.

Other common long-term side effects can include:

• Radiation causing mild changes in the pigment and texture of the skin.

• Some chemotherapy can cause heart problems or osteoporosis.

• Peripheral neuropathy, caused by chemotherapy, can give patients weird or painful sensations in their hands/feet.

• Continued pain or tenderness at the site of the tumor removal. This can last throughout life for many women and is perfectly normal.

• Increasingly less common is lymphedema, a swelling in the arm, which can occur in breast cancer patients after developing scar tissue following a lymph node biopsy. The current use of sentinel node biopsy has greatly reduced this problem.

Possible psychological effects

Being diagnosed with cancer and undergoing cancer treatment are deeply emotional and personal processes. While some people may feel empowered by their fight with cancer, others may be left feeling lonely and upset. “I see many patients who experience the typical five stages of grief after being diagnosed,” Terhar said. She also explains that other common feelings are fears of recurrence and feelings of being isolated after having gone through such a personal event. There also are instances of patients experiencing post-traumatic stress disorder after fighting cancer, which can include panic attacks and flashbacks. “Breast cancer can be different for any woman experiencing it, both physically and psychologically. Any emotional response to cancer is normal and can be treated and worked through until the patient is able to live happily again,” Terhar said.