Real Housewife of NJ Amber Marchese Dealing with Reality of Second Breast Cancer

Amber Marchese is known for being a Reality TV star, appearing on the Real Housewives of New Jersey and Marriage Boot Camp: Reality Stars. But for the past year and a half, the realities of her life have made getting healthy her main priority.

In 2009, Marchese was diagnosed with cancer in her right breast, at the age of 31, and with no family history of breast cancer. She underwent a bilateral mastectomy, meaning that both breasts were removed. The surgery was followed by four months of strong chemotherapy, a year and a half of immunotherapy and six years of tamoxifen.

Six years later, in April 2015, she felt a lump in her right breast (she had originally undergone a double skin-sparing mastectomy with a TRAM flap). Marchese was shocked when a biopsy came back as cancer. She underwent surgery to remove the tumor. This was followed by radiation therapy – something she didn’t need to undergo the first time around.

Radiation oncologist, Dr. Atif Khan, from Robert Wood Medical Center, explained to Amber:

“Radiation beams can get to places where chemotherapy may not due to poor circulation and, as result, limited penetrance.” According to Amber: “This piece of the puzzle was very important in my case, especially, because if this was recurrent even after chemotherapy, perhaps my recurrence could have been because chemotherapy could not get to the area where the tumor was; in other words, no blood supply to the tumor. They targeted under my arm, around my breast, extending all the way up to the middle of my neck.”

Marchese also received Herceptin (trastuzumab) and Perjeta (pertuzumab) infusions every three weeks. These two drugs are used in the treatment of HER2+ breast cancer. About 20 percent of breast cancers are in this category. HER2 stands for “human epidermal growth factor receptor number 2. The HER2 gene is amplified in this form of breast cancer and acts like an accelerator for cancer cells. The actions of this gene are blocked by these drugs.

Marchese received her last doses of chemotherapy in early September 2016: “ I’m clean, I’m clear and I’m just ready to get on with life,” Amber told People magazine.

Recurrent Breast Cancer

Although breast cancer is the most frequently diagnosed cancer (other than skin cancer), and the leading cause of cancer deaths, in women, it also accounts for 41% of all female cancer survivors in the United States.

Despite recent advances in breast cancer treatment, there is still a small percentage of women who will go on to be diagnosed with breast cancer for a second time. The majority of breast cancer recurrences occur within the first five years after diagnosis, but some recurrences can occur years later.

Although the initial treatment for breast cancer is aimed at eliminating all cancer cells, a few may survive treatment and lay dormant. Given the right stimulus, these undetected cancer cells can be reactivated, multiply and become recurrent breast cancer.

Recurrent breast cancer can occur either near the site of the previous cancer, or at a distance from it. It is called a local recurrence if the new tumor grows in the breast that was already affected by cancer. “Locoregional” means that cancer cells have spread to tissue around the breast, such as in the skin, the chest wall, the armpit (axilla) or the tissues around the collar bone. Neighboring lymph nodes or blood vessels can also be affected. If a tumor grows in the previously healthy breast, it is considered to be a new, different tumor, a second primary breast tumor. Breast cancer that is found at distant sites, such as the lungs, bone or brain is considered metastatic breast cancer.

The risk of breast cancer returning after successful initial treatment will depend on factors such as:

  • How many lymph nodes were involved at the time of the original diagnosis
  • The size of the original tumor
  • How quickly the cancer cells grew
  • Whether the cancer cell growth is sensitive to hormones (ER+/PR+ tumors)
  • The woman’s age at the time the cancer was first diagnosed
  • Whether cancer cells have spread through the lymph vessels in the skin (inflammatory breast cancer).
  • The type of treatment used to treat the original tumor.
  • Whether all of the tumor tissue can be removed
  • Whether distant metastases have already formed
  • How long ago breast cancer was first diagnosed

About 5 to 10 percent of breast cancer patients will have local or locoregional recurrence after breast-conserving surgery (BCT) and radiotherapy within ten years of first being diagnosed with breast cancer. If the initial treatment was a mastectomy, about 5 out of 100 women will have a recurrence in the armpit or the chest wall within ten years.

For women without a genetic predisposition to breast cancer, such as those with BRCA1 or BRCA2 mutations, the risk of a second primary breast cancer is between 0.5 and 1.0% per year. For those women with these mutations the risk is much higher, with a lifetime risk as high as 65% for BRCA1 and 50% for BRCA2 carriers.

What are the symptoms of breast cancer recurrence?

Between 50 and 70% of women after a mastectomy will have recurrences only in the chest wall. Thirty to 40% have local and regional disease with involvement supraclavicular (above the clavicle, axillary (armpit) and internal mammary nodes as the most common lymph nodes involved. About one-third of recurrences after mastectomy present with distant disease. For this reason, all patients should be reevaluated to determine the stage of their cancer.

© Legger | Dreamstime.com

© Legger | Dreamstime.com

Local recurrence

Signs and symptoms of local recurrence within the same breast may include:

  • A new lump in your breast or an irregular area of firmness or thickness
  • Changes to the skin of your breast
  • Skin inflammation or area of redness
  • Discharge from the nipple

Signs and symptoms of local recurrence on the chest wall after a mastectomy may include:

  • One or more painless lumps on or under the skin of your chest wall
  • A new area of thickening or firmness along or near the mastectomy scar

Regional recurrence

Signs and symptoms of regional recurrence may include a lump or swelling in the lymph nodes located:

  • Under your arm
  • Near your collarbone
  • In the groove above your collarbone
  • In your neck

Distant recurrence

The most common sites of metastatic disease are the bones, liver and lungs.

Signs and symptoms include:

  • Persistent and worsening pain, such as chest or bone pain
  • A cough that doesn’t go away
  • Trouble breathing
  • Loss of appetite
  • Weight loss
  • Severe headaches
  • Seizures

What are the treatment options?

Surgical

Whenever possible, surgical removal of the tumor with a wide margin of cancer-free tissue is advised. Removal of involved or suspicious lymph nodes is also necessary.

For women who underwent breast-conserving surgery (with RT), a mastectomy is recommended.

Radiation Therapy

Radiation therapy (RT) is an important component of treatment for women with locoregional disease, especially if they did not receive RT as part of their treatment for the original cancer. RT is also important for women who may have chest wall involvement that cannot be safely removed surgically.

For women who underwent lumpectomy and RT with their original treatment, the role of re-irradiation is less clear, although some groups of researchers have had success in lower dose, more limited treatment.

Systemic Therapy

Systemic treatment with chemotherapy is typically given to women with metastatic disease. It also appears to be helpful in patients with ER-negative disease.

Patients with ER+ disease should receive hormone therapy, such drugs such as tamoxifen, Fulvestrant (Faslodex) or Toremifene (Fareston)

All patients with HER2+ disease are treated with a HER2-directed drugs such as Herceptin, Pertuzumab or Ado-trastuzumanb emtansine (Kadcyla).

Michele R. Berman, M.D. was Clinical Director of The Pediatric Center, a private practice on Capitol Hill in Washington, D.C. from 1988-2000, and was named Outstanding Washington Physician by Washingtonian Magazine in 1999. She was a medical internet pioneer having established one of the first medical practice websites in 1997. Dr. Berman also authored a monthly column for Washington Parent Magazine.

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