When you have cancer, have undergone difficult treatment, and now you think that everything is over, that everything is fine... there is probably nothing more heartbreaking than finding out that the same cancer has come back. This is truly an unimaginable challenge that many people face. So, what does it mean for cancer to come back, or 'recur'? Why does it happen? What do we need to know in such a situation? Let's understand all this simply, as if we were talking to a close friend.
Simply put, what does cancer recurrence mean?
Cancer recurrence is when the cancer you had before comes back after you've been treated. This can happen within a few months or even years after treatment.
Sometimes your doctor may tell you that you are in 'remission' . This means that you have no symptoms of cancer and no cancer cells can be found on tests. However, even in remission, cancer can still come back.
But remember, a recurrence of cancer doesn't mean it's all over. With today's advanced treatments, many people have been able to control their recurrence and live well for years.
What are the ways cancer can recur?
Doctors classify the ways in which cancer recurs, based on where it comes back. It can happen in three main ways.
| Resurfacing type | Simple explanation |
|---|---|
| Local Recurrence | This means that the cancer comes back in or near the same place it was before . For example, after surgery to remove prostate cancer, cancer cells can grow back in the same place where they were removed. |
| Regional Recurrence | This is when the cancer comes back to the lymph nodes or tissues near where it was before. Some types of cancer, for example, certain subtypes of breast cancer (triple negative breast cancer), are more likely to come back this way. |
| Distant Recurrence | This is when the cancer spreads to another organ or tissue far away from where it was first found. For example, someone with lung cancer may have the same cancer spread to the brain and recur. |
What types of cancer are most likely to recur?
In fact, any type of cancer can recur. Therefore, it is not possible to say for sure that only lung cancer recurs. However, research has found that some types of cancer are more likely to recur. These include:
- Ovarian cancer
- Skin cancer that has spread to other parts of the body at the time of diagnosis (Metastatic melanoma)
- Peripheral T-cell lymphoma (PTCL), a type of cancer called non-Hodgkin lymphoma
However, it's important to remember that these percentages are just estimates , no matter what type of cancer you had. This risk varies depending on many things, such as the type of cancer you had, the stage it was at when it was first discovered, and the initial treatment you received. Therefore, only your doctor can give you the best information about this.
What are the symptoms of cancer coming back?
Sometimes, the symptoms of cancer coming back can be similar to those of other common illnesses. That's why it's important to pay attention to your body after treatment. Talk to your doctor about what symptoms you might experience if your type of cancer comes back. If you have any of the symptoms below, tell your doctor right away.
| Symptoms to watch out for |
|---|
| - The same symptoms that were present when the cancer was first present reappear (for example, a new lump or tumor appears where the cancer was) |
| - A constant pain that doesn't subside. |
| - A persistent cough that doesn't get better. |
| - Losing weight for no reason. |
| - Bruising more than usual or bleeding abnormally. |
| - Fever that doesn't go down. |
| - Frequent headaches . |
| - Difficulty breathing (Dyspnea). |
| - Bleeding with stool or urine . |
| - Nausea and vomiting . |
| - Difficulty swallowing (Dysphagia). |
Why does cancer recur?
This is a little hard to understand. Think of cancer cells as enemies in hiding. The treatments we give (such as surgery, chemotherapy, radiation) destroy every cancer cell we can see and find.
However, sometimes, a few very small, undetectable cancer cells may remain somewhere in the body. For example, when a cancerous tumor is removed during surgery, there may be a few cells left around it that are invisible to the naked eye and difficult to detect, even under a microscope.
These remaining cells, which remain dormant for a period of time, start to grow again after months or years. That's when we say the cancer has recurred.
How do you detect a cancer that has recurred?
To find out if cancer has come back, doctors use the same types of tests that were used to diagnose the cancer in the first place.
Blood Tests
- Complete Blood Count (CBC): This measures the number of red cells, white cells, and platelets in your blood. This can give you some idea of your overall health and whether cancer has returned.
- Tumor Marker Tests: These tests look for certain substances (tumor markers) in the blood that are produced by cancer cells or other cells in the body in response to cancer. If these levels increase, it may be a sign that the cancer has come back.
- Liquid Biopsy: This is a new technique. A test that looks for cancer cell fragments or cancer DNA that have accumulated in your blood.
Imaging Tests
- Computed Tomography (CT) scan: This takes detailed pictures of the inside of the body to find out if there are any new cancerous tumors, how big they are, and where they are.
- Magnetic Resonance Imaging (MRI): This can also produce very clear pictures of the inside of the body. This is especially useful for finding tumors in areas like the brain and spinal cord.
- Positron Emission Tomography (PET) scan: This involves injecting a special type of sugar into the body. Cancer cells absorb this sugar more quickly than normal cells, so the scan can easily identify areas of cancer.
Biopsies
The most important test to be 100% sure whether a cancer has returned is a biopsy. This involves taking a small piece of tissue from the suspicious area and examining it under a microscope to see if there are any cancer cells.
What are the treatments for recurrent cancer?
Treatment for cancer that has come back varies greatly depending on your situation. Your doctor may decide to do things like:
- Repeating the same treatment (e.g. chemotherapy) as the first one.
- Surgical removal of newly formed cancerous tumors.
- Using different chemotherapy drugs or drug combinations.
- Trying a different type of treatment, such as targeted treatments or immunotherapy.
When deciding on treatment, we also consider the following factors:
- The type of cancer you have: Not all cancers are the same.
- When the cancer came back: If the cancer came back shortly after treatment, it may be more difficult to treat.
- Where the cancer has come back: Treating cancer that has come back in the same place it was originally may be easier than treating cancer that has spread to a distant organ.
- Your overall health status:Your body needs to be strong enough to withstand the side effects of new treatments.
Along with these treatments, it's important to consider palliative care . This doesn't cure the cancer, but rather helps you stay as comfortable as possible by managing symptoms such as pain, nausea, and fatigue caused by cancer and the side effects of treatment.
Living with a cancer relapse
It's like an old memory coming back to haunt you. After fighting cancer once and thinking you've won, you have to start the same battle again. It's normal to feel frustrated, scared, and hopeless at this point. Those feelings are real, and they matter.
As soon as you find out that your cancer has returned, give yourself some time to think about it and understand the situation. Then, start thinking about what you can do to live with it as well as possible.
- Eat a nutritious, balanced diet. It's best to seek the help of a nutritionist to create a meal plan that's right for you.
- Get some exercise. Even something as simple as walking can help reduce stress and increase physical strength. However, be sure to check with your doctor before starting any exercise regimen.
- If you smoke or drink alcohol, try to stop doing those things.
- Sleep well. Rest is essential for the body.
How do I decide whether I want to get treatment again or not?
This is not an easy decision. Here are some steps that can help you in this time:
1. Understand your treatment options and their side effects: Talk to your oncologist and medical team. Ask any questions you need to know.
2. Talk to your family and loved ones about this: Their support will strengthen you in any decision you make.
3. Consider getting a second opinion from another specialist: There may be different treatment options that are right for you at another hospital.
4. Ask your doctor if you can participate in clinical trials: These are studies that investigate the safety and effectiveness of new treatments.
Ultimately, the decision to seek treatment or not is yours. Your doctor, your family, and everyone else should consider your opinions, but the final decision is yours. Everyone is obligated to respect that decision.
Take-Home Message
- Cancer recurrence is the return of the same cancer after treatment.
- This can be in the same place where the cancer was before (local), nearby (regional), or distant (distant) in the body.
- Be on the lookout for symptoms like unexplained weight loss, persistent pain or cough, and new lumps. If you have any concerns, see your doctor immediately.
- There are treatment options for cancer that has recurred. Don't give up hope.
- The decision to seek treatment or not is yours. Get all the information you need, talk to your friends, and make the decision that feels right for you.
- Don't go through this journey alone. Get support from your medical team, family, and friends.
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