Common Complications of Early-Stage Breast Cancer

Complications From Surgery, Chemotherapy, Radiation Therapy, and More

woman with breast cancer with one of the potential treatment complications
Istockphoto.com/Stock Photo©KataryzynaBialasiewicz  

If you talk to many people with breast cancer, you will learn that coping with the disease involves more than fighting cancer alone. In fact, the side effects and complications of cancer and cancer treatments are often as challenging as the cancer itself. What side effects and what complications may occur when you are treated for early-stage breast cancer? Let's look at the possible complications related to surgery, chemotherapy, and radiation therapy, as well as the "psychological" and social complications you may experience.

Side Effects vs. Complications

It's important to contrast side effects and complications, though we will discuss both. Side effects are symptoms that are fairly common and often expected. An example of a side effect is hair loss during chemotherapy. Complications, in contrast, are less common and not expected, though known to occur at times. An example would be the development of heart failure or leukemia due to chemotherapy.

While it's likely that you will have side effects related to treatment, keep in mind that many people do not experience any of the complications below. We don't want this list to frighten you, but hope that having this knowledge will alert you that something could be wrong, so that you seek out medical help as soon as possible if needed. Let's begin by looking at the specific treatments you may receive.

Side Effects and Potential Risks of Surgery

Whether you have a mastectomy or a lumpectomy, you can expect some side effects. After the surgery, you will be sore for several days. If you have had a lymph node dissection, you will likely be restricted in your arm movements for some time. Of course, surgery means that you will have a scar.

Possible complications, in contrast, may include:

  • Infection: Any time a person has surgery, there is a risk of bacteria being introduced into the incision which can cause an infection. Your surgeon will ask you to watch for any symptoms, such as a fever, redness, or tenderness. If you have had a mastectomy or lymph nodes removed, you may have one or several surgical drains in place. While these drains can reduce other complications, they may also be an avenue for bacteria to enter your body.
  • Reaction to anesthesia: Most breast cancer surgery is done under general anesthesia, and carries a small risk of complications.
  • Seroma:seroma is a collection of fluid in the area where your breast tissue was removed. The purpose of drains is to remove this fluid, but, even with drains, a seroma may sometimes occur.
  • Hematoma: If there is an area in your incision which continues to bleed, a hematoma (collection of blood) may form.
  • Blood clots: Surgery is a risk factor for the development of blood clots in your legs. If untreated, these clots can break off and travel to your lungs (pulmonary emboli). While not common after breast cancer surgery, getting up and walking and avoiding prolonged bed rest can reduce your risk. (Chemotherapy also increases the risk of blood clots.)

    Longer term complications may include:

    • Frozen shoulder: Some women develop restricted movements in their shoulder following breast cancer surgery. If movements are further restricted, you may end up with a frozen shoulder. Physical therapy is very effective in treating this condition, but prevention is always best. Some surgeons recommend that women see a breast cancer physical therapist (especially one who is certified through the Star program for cancer rehabilitation) after they have healed from surgery, to make sure they aren't having any problems.
    • Lymphedema: Lymphedema is a condition in which the lymphatic vessels in the armpit are damaged during surgery. It occurs more often when a lymph node dissection is done. Symptoms include one arm that is much more swollen than the other. Choosing a surgeon who performs a large number of breast cancer surgeries can reduce your risk, as well as being careful to avoid injuries to the arm on the side of your breast cancer. The potential of lymphedema is why your surgeon will tell you to avoid having blood draws or having your blood pressure checked on the side of your breast cancer.
    • Poor cosmetic results: While not necessarily a physically damaging complication, poor cosmetic results can be emotionally challenging. If this occurs, there are often many options people have for revision of their surgery, as well as reconstructive options.

    Complications due to breast reconstruction:

    • Reconstruction carries the risk of the same complications as an initial breast cancer surgery such as infection, bleeding, and blood clots.
    • Capsular contracture: Our bodies recognize when there is something abnormal in our tissues, and often attempt to wall off that abnormality. Plastic surgeons have been looking into ways of reducing the risk of capsular contracture after breast reconstruction. When it occurs, a breast implant may become hard, displaced, and tender. If you do develop this condition, however, there are surgeries that can be done.

    Complications From Chemotherapy

    The side effects of chemotherapy are fairly well known. The more common effects include hair loss, bone marrow suppression (resulting in a low level of red blood cells, white blood cells, and platelets), and nausea. Chemotherapy kills off rapidly dividing cells such as cancer cells, but cells in your hair follicles, bone marrow, and digestive tract are rapidly dividing as well.

    There have been significant advances in managing the side effects of chemotherapy in recent years. Medications which are given can often prevent nausea and vomiting, and you may receive injections of Neulasta or Neupogen to keep your neutrophil count (a type of white blood cell) high enough to reduce your risk of infection.

    Complications, as well as side effects which may persist after treatment include:

    • Infections (febrile neutropenia): Serious infections may occur if your white blood cell count is too low and needs aggressive treatment. Infections due to chemotherapy-induced neutropenia are one of the more dangerous side effects throughout chemotherapy treatment.
    • Peripheral neuropathy: Peripheral neuropathy is an annoying pins-and-needles feeling, along with numbness, that women may note in their hands and feet. Unfortunately, this can persist long after treatment, though researchers are looking at ways to reduce the risk. It is often caused by "taxane" drugs such as Taxol (paclitaxel).
    • Chemobrain: Difficulty with cognitive function, such as a reduction in short-term memory (losing your keys) and problems with multitasking is a concern for some women (and men) after chemotherapy, and has been coined "chemobrain." This area has been receiving a lot of attention, and some oncologists believe that mental exercises, even if it is just doing crossword puzzles, may help.
    • Infertility. Infertility after cancer treatment is common, and most women stop having their periods after chemotherapy. For young women, periods may return after a time, but this is not a guarantee of fertility. If you are thinking you would like to become pregnant after you complete treatment, talk to your oncologist before you begin. There are options available, such as freezing embryos, which allow some women to give birth even after breast cancer treatment.

      More serious complications include:

      • Heart disease: Heart disease may occur even decades after receiving chemotherapy. The drug Adriamycin (doxorubicin) may cause heart failure in 1 to 2 out of 100 women receiving the drug. Another drug that may cause heart problems is Herceptin (trastuzumab) and your heart function should be monitored closely while taking it. You will likely have a heart test prior to beginning chemotherapy to get a baseline on which to compare. Symptoms of heart failure include shortness of breath, reduced endurance, swelling of your legs, and sometimes coughing up a pink, frothy liquid.
      • Secondary cancers such as leukemia: The chemotherapy drugs used for breast cancer are also known carcinogens (cancer-causing agents). While there is a small risk (1 in 100) of developing a secondary cancer (often soft tissue sarcoma or acute myelogenous leukemia or AML), the benefits of chemotherapy often far outweigh these risks.

      There are also less common, but occasional long-term side effects of chemotherapy.

      Complications From Hormonal Therapy

      Both tamoxifen (for pre-menopausal women) and aromatase inhibitors (for postmenopausal women or for premenopausal women who have had ovarian suppression therapy) can cause hot flashes. There is a difference between the two, however, as tamoxifen has estrogen-like effects on some tissues and anti-estrogen effects on others.

      Aromatase inhibitors, in contrast, reduce the formation of estrogen in the body and therefore many of the symptoms are those of lack of estrogen. Medications classified as aromatase inhibitors include Arimidex (anastrozole), Femara (letrozole), and Aromasin (exemestane).

      Both categories of medications may cause hot flashes, vaginal dryness, and discomfort. Tamoxifen can cause some muscle pain, but aromatase inhibitors are well known for causing muscle and joint pain in nearly half of people using the medication. On the positive side, both categories of medications reduce the risk of breast cancer recurrence by half. And, if those hot flashes are driving you just a little crazy, you may be relieved to know that there's a silver lining, and hot flashes are linked with higher survival rates in people using hormonal therapy.

      Complications from tamoxifen may include:

      • Uterine cancer: Unlike breast tissue, tamoxifen can stimulate uterine (endometrial tissue). According to the American Cancer Society, the risk of uterine cancer is low, around 1 in 500 after the age of 50, and can often be detected in the early stages if it occurs. The most common symptom is vaginal bleeding.
      • Blood clots: Both blood clots in the legs (deep vein thrombosis) and pulmonary emboli (blood clots that travel to the lungs) may uncommonly occur.
      • Cataracts: Fortunately, cataracts are relatively easy to treat with surgery.

      Complications from aromatase inhibitors may include:

      • Osteopenia and osteoporosis. Aromatase inhibitors cause bone loss, and often fractures due to that bone loss in the spine, hip, and other areas. The recent addition of bisphosphonates (such as Zometa) to therapy for some women may reduce this risk in the future.
      • Heart problems. Heart disorders such as heart rhythm disorders, heart valve problems, and pericarditis are more common in women on aromatase inhibitors, but there is no increased risk of serious and life-threatening problems like heart attacks and strokes.

      Complications From Radiation Therapy

      Radiation therapy is often used following a lumpectomy, or in women who have had a mastectomy with positive lymph nodes. Common side effects include skin redness and rashes, as well as fatigue.

      Complications of radiation therapy may include:

      • Infections: Redness and even blisters can be a relatively normal side effect, but open sores can increase the risk of developing a serious infection. Those who have radiation after immediate reconstructive surgery are at a greater risk of developing an infection.
      • Fibrosis: Radiation therapy changes the texture of skin so that it is less flexible. This can result in changes in your breast tissue (fibrosis), and capsular contracture if you have had early reconstruction. Radiation may also cause inflammation in the lungs (radiation pneumonitis) which can lead to pulmonary fibrosis.
      • Heart disease: Radiation therapy can damage the heart, though radiation therapists try to align the radiation you will receive to minimize the exposure to your heart. A newer technique called respiratory gating can reduce exposure of the heart to radiation even more, via the use of controlled breathing. The combination of heart-related effects of radiation and that due to chemotherapy should be considered. Some oncologists believe that women who have had these therapies (especially the combination of chemotherapy with Adriamycin and radiation after a mastectomy) should consult a cardiologist, especially if they develop any symptoms that could suggest heart disease.

        There are also some less common but concerning long-term side effects of radiation therapy, like an increased incidence of lung and esophageal cancers. While most often the benefits of radiation therapy outweigh the risk of these complications, a  2017 study suggested that for women who smoke, the risks of radiation combined with smoking might outweigh the benefits. Those who smoke should quit prior to radiation therapy, and if not possible, should talk carefully with their radiation oncologist about the wisdom in doing radiation.

        Psychological/Social Side Effects and Complications

        Being diagnosed with breast cancer is a huge psychological adjustment. Studies suggest that it doesn't matter if you have a highly curable small tumor, or a large, advanced stage tumor; receiving the diagnosis of the "C word" changes your life in seconds.

        Relationships often change, and distant friends may become close, while some of your closest friendships may slip away. Everyone handles cancer in a loved one in a different way.

        Sometimes cancer leads to depression, and the suicide rate is higher in people with cancer than the general population. Adding these feelings to cancer fatigue, and coping with cancer is challenging.

        We are learning that a strong social support system is important enough that it has even been linked with survival for breast cancer, and should be addressed as much as physical concerns you may have. Many people find that talking with a therapist is helpful during the adjustment period. Make sure you talk to your doctor if you are having difficulty coping.

        Reducing Your Risk of Complications

        It's important to note that there are several things you can do to lower your risk of developing complications during early-stage breast cancer treatment.

        If you smoke, quit. Smoking interferes with wound healing and increases your risk of an infection (and everything that goes along with an infection). It also enhances any heart disease risk due to treatment.

        Practice infection prevention during chemotherapy. Even if you receive a medication to keep your white blood count high, be careful to wash your hands, avoid crowded places, and stay away from people who are sick.

        Stay abreast of the latest research on breast cancer. With more people surviving, we are learning more about long-term issues related to treatment, as well as how to minimize their risk.

        Be aware of your body and any symptoms you have. Many of the potential complications of breast cancer treatment are treatable, and treatment is often most effective when begun sooner rather than later.

        Cancer Rehabilitation

        With more people surviving cancer, we are learning that many cancer survivors are coping with the late effects of treatment. In recent years, a program has been set up called the "Star Program for Cancer Rehabilitation." This program is now available at many cancer centers. It is designed to minimize any long-term effects of cancer, and help you address any physical or emotional symptoms which are holding you back from your "new normal" life.

        A Word From Verywell

        Looking at the list of potential complications of cancer treatment, in addition to the side effects you may expect, can be intimidating. Remember that these complications are uncommon, and you are much more likely to get through your treatment without experiencing many or any of these. The bottom line, even when there are risks, is that studies have found that the benefits of these treatments in keeping your cancer away far outweigh the potential risks.

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