SALT LAKE CITY — She's in her late 80s now, and almost two decades have passed since she was diagnosed with — and for a while cured of — breast cancer.

Now it's back but not contained this time.

It has moved to her liver and her bones, she said in a call Saturday to the Deseret News/Intermountain Health Hotline. What does the future hold for her? she asked.

Surgeon Bill Rees and oncologist Elizabeth Prystas, both of LDS Hospital, fielded calls that ranged from questions about appropriate screening to cancer recurrence questions like that one.

One woman said she'd had breast cancer years ago and now has some pain in part of her breast. Does that mean anything?

Maybe, she was told. Get checked.

Because that first woman is quite elderly and her cancer has metastasized in multiple systems, Prystas talked to her about not only some treatment options but also hospice care — a concept the woman had never heard of. Hospice is end-of-life and palliative support.

In cases where a cure is highly unlikely, "it's not fun, but we owe that (conversation) to our patients," Prystas said.

There's no question that a breast cancer recurrence is harder to deal with than most breast cancer the first time around. Much as bacteria becomes resistant to antibiotics, cancer cells can become resistant to the treatments employed against them.

"Most things work for a while, then stop working," Prystas said.

Fortunately, there are a number of treatments that can be employed.

But with recurrence, all is not lost.

"If you have a tumor in the bone, stage 4, we say it's not curable, but it is treatable," Rees said. "Is there hope for long-term survival? Yes."

Both doctors said they have seen patients who lived a decade or more after a breast cancer recurrence. Some don't; some do. It's hard to predict who will fall into which category.

What can't be lost in any discussion, though, Prystas said, is quality of life.

That applies not only to having the cancer, but to perceptions about treatments, said Rees, who said some patients still avoid potentially life-saving treatment because they've heard about side effects of treatments — or they experienced them firsthand with earlier disease.

Huge strides have been made in managing side effects such as nausea. It's common now for people to be able to continue working while having treatment.

"We have better drugs and support care," he said.

The hotline tackles a different health topic the second Saturday of each month.