Almost everyone who has had cancer fears that one day the cancer will come back, or recur. Although in most instances a recurrence (the return of symptoms or the reappearance of a tumor after previous removal) of cancer means a cure is not possible, many can be treated successfully. Even if a cure is not possible, many patients live a long time with an existing cancer.
What is cancer recurrence?
The ultimate goal of any cancer treatment is to remove or destroy all of the cancer cells in the body. When no cancer cells can be detected in the body, a cancer is considered to be in remission (the temporary or permanent absence of disease). A recurrence is defined as the return of cancer after a period of remission. Cancer recurs because undetected cancer cells can sometimes remain in the body after treatment. Over time, these undetected cells can multiply and grow large enough to be recognized and diagnosed. Depending on the type of cancer, this can happen in weeks, months, or even many years after the original cancer (or primary cancer) was treated.
Cancer can recur in the same place as the original cancer or elsewhere in the body. A cancer recurrence is classified by its location—where in the body it recurs, but is always referred to by the name of the original or primary tumor. Here are some examples:
- A local recurrence means the cancer has returned in or very close to the same place as the original cancer, but the cancer has not spread to other areas of the body. (For example, a patient treated for colon cancer is found to have a recurrence by colonoscopy in the same general area where the tumor started.)
- A distant recurrence means the cancer has spread, or metastasized, to organs or tissues distant from the site of the original cancer. (For example, if a patient treated for breast cancer now has cancer in her liver, then doctors will say she has metastatic breast cancer.)
The likelihood that a cancer will recur varies, depending on the type of the original cancer. When and where a cancer will recur also varies. Most cancers do have a predictable pattern of recurrence, and a doctor familiar with your medical profile will be able to give you more information about the likelihood of recurrence. Statistics allow doctors and patients to discuss frankly the chance or likelihood of a recurrence.
Diagnosing and treating recurrent cancer
Taking into account the possibility of recurrence, patients are routinely given a plan for follow-up care. Good follow-up care helps ensure that a cancer recurrence is detected early. Follow-up care begins after cancer treatment ends and usually includes visits to the doctor and a schedule for tests. Patients are also told which symptoms they should be aware of in order to report these to the doctor. Often, recurrences are actually identified by patients between scheduled doctor visits. If your doctor suspects that your cancer has recurred, he or she may order additional diagnostic tests such as laboratory tests, imaging studies, or biopsies.
Once a cancer recurrence is diagnosed, a treatment plan is developed. Whereas 50 years ago little could be done for a patient whose cancer had recurred, this is no longer true. In some cases, the recurrent cancer can be successfully eliminated from the body. In cases where this is not possible, the goals of treatment may include controlling tumor growth, limiting pain, managing side effects, and helping the patient to lead a normal, active life for as long as possible—often many years.
Many of the same factors that were considered when planning treatment for the original cancer will be considered in planning treatment for a recurrent cancer. These include the type, location, and size of the recurrent cancer, as well as a patient's overall health. Other factors considered include the type of treatment originally received, how the cancer and the body responded to treatment, and how long ago treatment ended. In some cases of recurrent cancer, treatment may need to be more intensive and aggressive. You may also be offered a different treatment or a new treatment that might not have been available when the original cancer was diagnosed. Some of the treatments available for recurrent cancer include:
When deciding among treatments, it is important to consider the goals and expected benefits of each treatment, as well as the possible risks, side effects, and impact on quality of life. As with any cancer treatment, seeking a second opinion can help in making a more informed health-care decision. Advances in cancer treatment are continually being made and seeking a second opinion helps when considering additional treatment options. When choosing a doctor to get a second opinion, it may be most productive to find a doctor who has a special research interest in or special knowledge of the disease.
Emotions and coping
If you are diagnosed with recurrent cancer, you may experience many of the same feelings you did when you were first diagnosed with cancer. Shock, disbelief, anxiety, fear, grief, and a loss of control are all common. You may also experience feelings of betrayal and anger—anger that this could happen to you more than once, anger at your doctor for not curing the cancer the first time, or anger at your body for potentially failing you. All these feelings and reactions are common and normal responses to what can be an especially difficult experience.
Many people with recurrent cancer also experience self-doubt about their original treatment decisions or post-treatment choices. It is important to remember that the choices you and your doctor made at the time of your original treatment were based on the information available to you and your doctor at the time—neither you nor your doctor could predict the future.
Understandably, patients diagnosed with recurrent cancer may feel that they cannot find the strength to cope with another round of tests and treatments. However, most find the strength and determination to undergo additional treatment, and many find themselves better prepared than at the time of the original diagnosis. Some of the factors patients with recurrent cancer find helpful include:
- An existing knowledge of cancer, which helps reduce some of the fear and anxiety related to the unknown
- Preexisting relationships with doctors, nurses, and clinic or hospital staff
- Knowledge of the medical system and how to negotiate it, including an understanding of medical terms
- An understanding of the medical insurance system
- Familiarity with cancer treatments and their side effects, as well as what works best to alleviate those side effects
- Familiarity with the availability of different types of support, including support from family and friends, support groups, and professionals trained in providing emotional support
- Knowledge of what types of stress-reducing methods work best, such as exercise, meditation, spending time with friends, etc.
Additional resources
National Cancer Institute (NCI): When Cancer Recurs: Meeting the Challenge
American Cancer Society (ACS): Helping Your Child Deal With a Cancer Recurrence or Progressive Illness in the Family
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