True local recurrences do not metastasize

Abstract

Generally, the limits of local tumor control are in part connected with the term "field cancerization" and are known from oral, lung, prostate, or mammary cancer. With the example of breast cancer (BC), the problem of ipsilateral breast tumor recurrences (IBTR) after breast-conserving surgery will be reviewed. Three types of local recurrences are distinguished: true recurrences, new primaries, or residual tumors. Good data for BC allow the description of the time-dependent risk of these three types, relative to the diagnosis of the primary tumor, because the time of initiation and the growth duration of the IBTR can be estimated. Two hypotheses explain the data: first, local recurrences may be initiated years before the diagnosis of a primary tumor (PT) and can then appear as multifocal PT at diagnosis, and second, true local recurrences probably do not metastasize. The generalizability of these hypotheses for other tumors will be discussed.

Differential Prognostic Indicators for Locoregional Recurrence, Distant Recurrence, and Death of Breast Cancer

“…Locoregional recurrence of breast cancer could be a sign of disseminated disease from the beginning [14, 15] and cancer cell might have already invaded into the blood stream when breast masses were detected or might have invaded through lymph vessels into the lymph nodes. On the other hand it might be associated with incomplete removal of cancer cell, resulting in residual tumor [16]. The present findings agreed with previous studies reporting positive axillary lymph nodes >3 and lymphovascular invasion as prognostic factors for locoregional recurrence [9, 17].…”

Pathways to Breast Cancer Recurrence

“…In the context of ipsilateral breast tumor recurrences after breast conserving surgery, two interesting hypotheses have been proposed [24] which seek to better define our understanding of true tumor recurrences. First of all, it has been proposed that the local recurrences might actually initiate long before the diagnosis of primary tumor and may be recorded as multifocal primary tumor at the time of diagnosis, and, secondly, true local recurrences might actually never metastasize to distant organs.…”

Positive lymph nodes do not metastasize

“…A self-contained argument in the sense of the philosophy of science is the obvious inability of the other secondary foci, true local recurrences and distant MET, to metastasize [55,63]. Because pLN likewise cannot infiltrate the regional neighborhood, it is important to question why a pLN should be able to initiate a focus in a distant organ.…”