Dealing with it right at onset helps.
“More than 10 million Americans are living with cancer, and they demonstrate the ever-increasing possibility of living beyond cancer.” - Sheryl Crow
Despite the incredible advances made in diagnosis and treatment, cancer can come back. When this happens it is called a recurrence or relapse. It is important to understand what remission means before we can understand recurrence.
After you are diagnosed with cancer and undergo treatment you are monitored at a clinically appropriate interval which can be weeks, months or years to evaluate treatment response and monitor your health as related to side effects of cancer treatment.
When there is no evidence, either through blood work or through radiological scans of cancer in your body, you are considered to be in remission. Remission can be of two types:
When there is no evidence, either through blood work or through radiological scans of cancer in your body, you are considered to be in remission.
Remission can be of two types:
Complete Remission: when treatment results in complete removal of cancer cells from your body
Partial Remission: when the cancer only partially responded to treatment such that there are cancer cells remaining in your body.
As our understanding of cancer treatment improves, it is important to remember that like other chronic diseases, cancer can go through multiple cycles of remission and recurrence which can last decades.
A cancer recurrence means it's the same cancer coming back after some period of time. In rare cases, you may be diagnosed with a new cancer that's completely unrelated to your first cancer.
This is referred to as a second primary cancer. Molecular pathology has become fundamental not only for tumor diagnosis and prognosis but also to drive therapeutic decisions.
Advances in molecular biomarkers can help determine if the recurrence is closely related or similar to your original cancer or a completely different type.
Recurrence occurs because a few of the original cancer cells survived the initial treatment. Sometimes this is because cancer cells spread to other parts of the body and were too small to be detected during the follow-up immediately after treatment.
In spite of the best efforts of your cancer care team to rid you of your cancer, some cells from your cancer remained.
These cells could be in the same place where your cancer first originated, or they could be in another part of your body. These cancer cells may have been inactive or dormant for a period of time, but eventually they continued to multiply, resulting in the reappearance of the cancer. When cancer spreads to a new part of the body, it’s still named after the part of the body where it started.
For example, breast cancer might come back in the liver or in the bones. In both cases, it’s a breast cancer recurrence, which is called recurrent breast cancer. The cancer in the liver and bones is treated like breast cancer.
There are 3 types of Recurrence:
Local recurrence: cancer came back in the same location it first started.
Regional recurrence: cancer came back in lymph nodes near to the location it first started.
Distant recurrence: cancer came back to another part of the body that is not in the vicinity of where it first started.
Cancer recurrence also depends on the type of cancer, your initial stage and grade, as well as a multitude of other factors that are not well understood. In general, the more time that goes by, the lower the risk of recurrence.
Cancer is most likely to recur in the first two years after treatment, and once you get to five years of living cancer-free after treatment, it’s considered to be a significant milestone to be celebrated. Recurrence after that five-year mark is rare but not unheard of. It is called late recurrence.
Whether you are a survivor or an active patient undergoing treatment, you always worry about recurrence and its impact on your life. It is important that you stay vigilant for any signs that suggest that cancer may have returned. These include:
- A nagging cough that does not go away despite usual over-the-counter remedies
- New or unusual pain not related to an identifiable injury
- Shortness of breath in the absence of hard physical activity
- Chills or fever
- Nausea, vomiting, diarrhea
- Loss of appetite/ unexplained weight loss
- Frequent headaches
- Blood in your bowel movements or in your urine
- Sores that do not heal or unusual skin changes
- Pain while swallowing or hoarseness
In addition to being aware of these signs, going to your follow-up appointments and getting all the tests your cancer care team recommends, even ones not directly related to your cancer, are important ways to take charge of your health.
If you are diagnosed with a recurrence, your cancer care team will take into account several factors before deciding on a course of treatment. These can include:
- Your goals for treatment
- The type of cancer, where the recurrence is located, and its extent are usually determined by scans such as PET-CT.
- Your overall health status and how it can impact further treatment
- The type of treatment you originally received and how well it worked
- Side effects you experienced with the original treatment
- Length of time since finishing treatment
- Whether a clinical trial is appropriate for you based on your quality of life, expected risks, side effects, and mutually agreed goals of treatment.
Facing a cancer recurrence can be frightening and depressing. The lack of control over your health and uncertainty about your future can be especially traumatic. You may worry about what it means to you, your loved ones, your job, and your finances.
This is a time where doubts may surface about your original treatment protocol. It helps to remember that your cancer care team followed the standard of care as defined by the National Cancer Institute, the American Society of Clinical Oncology, the American Society of Hematology, and several other national and international consortiums that base treatment on proven data and are constantly working to improve treatment outcomes.
Your cancer care team made treatment decisions based on the evidence provided at the time, and neither you nor your medical staff are capable of foreseeing the future.
If you are worried about recurrence, here is a list of questions that can help you start the conversation with your cancer care team:
- What follow-up care plan should I follow to watch for a possible recurrence?
- What is the chance that my cancer will return?
- What records do I need to keep about my treatment?
- What symptoms of a cancer recurrence should I watch out for?
- Which doctor should I talk with if I suspect a cancer recurrence?
- What can I do to take care of myself and be as healthy as possible?
- Can you suggest a support group or counseling service that might help me?
Reason to hope: A new imaging test using FFNP as an imaging agent in PET-CT scans could help guide treatment decisions for some people with advanced breast cancer, the results of a small NCI-funded clinical study suggest. The test is designed to identify tumors that should respond to hormone-blocking therapies.
https://www.nature.com/articles/s41467-020-20814-9
