Life After Cancer: Understanding Cancer Recurrence

Why does cancer come back?

Cancer can come back if it wasn’t fully removed during the initial treatment (such as surgery). Just a few tiny cancer cells may be left behind. They can't be seen on scans or tests. They aren’t found until they grow.

Cancer can also come back if some of the cells become resistant to treatment and survive. This can happen with chemotherapy and radiation therapy. Over time, these cells grow enough to be found and cause symptoms.

What is my risk for the cancer returning?

Healthcare providers have no sure way of knowing if a person’s cancer will ever come back. Your risk of cancer recurrence depends on the type of cancer, your overall health, your age, the treatments used, and many other things. Your healthcare provider can tell you more about your personal risk and if there are treatments that can help reduce your risk for recurrence.

How cancer comes back

Cancer can come back (recur) in these ways:

• Local recurrence. This is when the cancer is growing in the same place it was before.

• Regional recurrence. This is when the cancer is growing close to the first place it grew. It may come back in the lymph nodes or other nearby tissues.

• Distant recurrence. This is when the cancer is now growing in another part of your body.

No matter where it’s growing, cancer that has recurred is still called by the name of the original cancer. Lung cancer that's come back and is growing in bones is called recurrent lung cancer, not bone cancer. Ovarian cancer that comes back in the liver is still called ovarian cancer. It’s not liver cancer.

In cancer recurrence, the cancer cells that come back in the new place look a lot like or even the same as the cancer cells in the original cancer.

This means treatment for recurrent cancer is based on what works best for the first type of cancer. So recurrent lung cancer in the bone is treated like lung cancer, not bone cancer.

Can I prevent the cancer from coming back?

There's no sure way you can keep cancer from returning. Still, you can do many things to stay healthy, which might help lower the risk of a recurrence. And staying healthy can help make sure that, if cancer does come back, you'll be better able to deal with it.

To be as healthy as possible, you can:

• Eat a healthy diet with plenty of vegetables, fruits, and whole grains.

• Limit the amount of processed and red meat in your diet.

• Get to or stay at a healthy weight. Ask your healthcare provider for help.

• Get exercise every day.

• Don’t use any form of tobacco. Ask your healthcare provider for help quitting if needed.

• Stay away from alcohol. If you choose to drink, limit alcohol to 1 drink a day for women, 2 for men.

• Limit refined grains and sugary drinks.

Checking for returning cancer

You'll see your cancer treatment team regularly. Tests will be done to check for signs of cancer recurrence. This is part of your follow-up care plan. These visits may be every few months at first, and then more spread out as time goes by. Make sure to keep these appointments. Your healthcare providers will ask you how you're feeling and what, if any, symptoms you have. Physical exams and blood tests will be done. Imaging tests, such as ultrasound, MRI, or CT scans, may be done, too.

Talk with your healthcare team about what symptoms you should watch for that may mean the cancer has come back. Tell your healthcare team if you notice any of the cancer symptoms you had before. And tell them if you have new symptoms that don’t go away, such as:

• New or unexplained pain

• Lumps or swelling

• Unplanned weight loss

• Easy bleeding or bruising

• Fever or chills

• Blood in your urine or stool

• Nausea, vomiting, or diarrhea

• A cough that doesn’t get better

• Breathing problems or shortness of breath

• Headaches

Keep in mind that these symptoms can be caused by many other things. They could even be late side effects of cancer treatment. And you'll still have problems that have nothing to do with cancer, such as colds, infections, aches, and sprains. Many of these can be easily treated. But the only way to know for sure is to see your healthcare provider.

If your cancer comes back

If cancer comes back, your healthcare team will work with you on a treatment plan. You may have treatment that's a lot like the first time, or treatment may be different. Your treatment choices will depend on:

• The type of cancer and where it's growing

• The type of treatment you had before

• How long it's been since you finished treatment

• How well the first treatment worked

• Side effects that you had before

• The goals of treatment

• Your overall health

• Your preferences

Coping with cancer's return

Learning that cancer is back can be very upsetting. It's normal to feel fear, anger, sadness, grief, and worry. You may have doubts about your original treatment, or the choices you or your healthcare provider made. You may wonder if you should have done something different or could have done something to keep the cancer from coming back. It’s important to know that there’s nothing you can or can’t do to prevent cancer recurrence. And no one can predict if it will happen.

Keep in mind that because you've been through cancer treatment, you already have many tools for coping with cancer again. These include:

• Support systems in place, such as family, friends, and cancer support groups

• Understanding of how the medical system and health insurance works

• Experience working with your healthcare providers

• Knowledge about treatments and how to manage side effects

Working with your healthcare team

The most important thing about watching for and coping with cancer recurrence is working with your healthcare team. Your team can give you information and support, help you stay healthy, and guide you through the follow-up process as needed.

Getting support

It’s normal to worry about cancer coming back. But if you have a lot of stress and worry about whether your cancer may return, ask for help. For instance, it can help to join a support group. Talk with your healthcare team about nearby groups or online support. Talking with people dealing with similar issues can be comforting and give you a chance to express your worries to people who really know how you feel. Your team can also refer you to a counselor. Get help. Don't let your fear of cancer recurrence keep you from enjoying life.