Key Messages:

• A recurrence is when the cancer comes back after treatment. It may come back in the same place as the original cancer or elsewhere in the body.
  
  
• Planning treatment for a recurrent cancer is similar to planning treatment for a primary cancer, but the specific treatment might be different.
  
  
• If you are diagnosed with recurrent cancer, you may experience a wide range of emotions, many that are similar to when you were first diagnosed with cancer.

It is common for people who have been treated for cancer to fear that one day the cancer will come back, or recur. Many times a recurrence of cancer can be treated successfully. Even if completely removing the cancer is not possible, many patients live a long time with an existing cancer.

About cancer recurrence

The ultimate goal of any cancer treatment is to remove or destroy all of the cancer cells in the body. When cancer cells can no longer be found in the body, a cancer is considered to be in remission, meaning the disease is temporarily or permanently gone. A recurrence is when the cancer comes back after remission. Cancer recurs because small areas of cancer cells are difficult to find and can sometimes remain in the body after treatment. Over time, these cells may multiply and grow large enough to be found and diagnosed. Depending on the type of cancer, this can happen in weeks, months, or even many years after the primary (original) cancer was treated.

Cancer can come back in the same place as the original cancer or elsewhere in the body. A cancer recurrence is classified by where in the body it recurs, but it is still named for the area where the primary cancer began.

• A local recurrence means the cancer has returned in or very close to the same place as the primary cancer, but the cancer has not spread to other areas of the body. For example, if cancer comes back near the colon after a person has been treated for colon cancer, it is called a local recurrence.
  
  
• A distant recurrence means the cancer has metastasized (spread to organs or tissues further away from where the primary cancer began). For example, if a patient treated for breast cancer now has cancer in her liver, then doctors will say she has metastatic breast cancer (not liver cancer).

The likelihood that a cancer will come back depends on the type of the primary cancer. When and where a cancer will recur also varies. Many cancers have a predictable pattern of recurrence, and a doctor familiar with your medical history and situation can give you more information about the likelihood of a recurrence.

Diagnosis and treatment

After treatment for the primary cancer ends, your doctor may give you a plan for follow-up care to help monitor your recovery and find a recurrence. Follow-up care begins after cancer treatment ends and usually includes visits to the doctor and a schedule for tests. However, there may not always be tests available that can help find a recurrence. Sometimes there may be specific signs or symptoms of recurrence, but these aren’t reliable, and it can be hard to know what’s normal and what’s a possible sign of recurrence. Talk with your doctor about the signs and symptoms to watch for. 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.

If the cancer has come back, your doctor will develop a treatment plan. Recurrent cancer often can be successfully treated, whereas 50 years ago little could be done for a patient whose cancer had returned. If it is not possible to remove all of the recurrent cancer, treatment can often control tumor growth, reduce pain, manage side effects, and help the patient to lead a normal, active life for as long as possible—often for many years.

Planning treatment for a recurrent cancer is similar to planning treatment for a primary cancer. Your doctor will consider the type, location, and size of the recurrent cancer, as well as your overall health when recommending a treatment plan. In addition, the doctor also considers the type of treatment you originally received, how the cancer responded to treatment, the side effects from the original treatment, and how long ago treatment ended. You may also be offered a different treatment, a clinical trial, or a new treatment that was not available when the original cancer was diagnosed. Palliative care may be offered to lessen your symptoms.

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 the effect on quality of life.

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 emotions. 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 because you feel it has failed 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 choices after treatment. 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. But, many patients find that they are better prepared than at the time of the original diagnosis, which helps them find the determination to undergo treatment. Some of the factors patients with recurrent cancer find helpful include:

• Knowledge of the cancer, which helps reduce some of the fear and anxiety related to the unknown
  
  
• Previous relationships with doctors, nurses, and clinic or hospital staff
  
  
• Greater knowledge of the medical system and how to negotiate it, including an understanding of medical terms
  
  
• A better understanding of the medical insurance system
  
  
• Familiarity with cancer treatments and their side effects, as well as what works best to lessen those side effects
  
  
• Familiarity with different types of support, including support from family and friends, support groups, and professionals trained in providing emotional support
  
  
• Knowledge of the types of stress-reducing methods that work best, such as exercise, meditation, or spending time with friends.

More Information

Coping With Fear of Recurrence

Coping With Guilt

Last Updated: May 13, 2010