Fear of recurrence is the greatest concern among cancer survivors. This is partially due to the unpredictability of the disease and the wide variety of ways that cancer works in the body. When cancer returns after a period of remission, it's considered a recurrence. This can happen weeks, months, or even years after the primary, or original cancer was treated.
Why does cancer recur?
Cancer recurs because small areas of cancer cells can remain in the body after treatment. Over time, these cells may multiply and grow large enough to cause symptoms which need tests to find them. It is impossible for your doctor to know whether the cancer will recur.
How do I know if my cancer will recur?
Whether or not you will have a second cancer depends on many different things. These may include age when treated, the treatment received, genetic make-up, family history and lifestyle. Though the risk might be higher in such cases, the actual number of people who will get a second cancer is relatively small and each cancer survivor’s experience is unique.
Is cancer remission the same as being cured?
If treatment has killed every cancer cell and therefore none can be detected, cancer can be said to be cured. But it is difficult to know if complete cure has taken place due to our inability to detect small amounts of cancer.
The term “cure” can only be used in hindsight. Years after the cancer has gone into remission, if it has not returned (or relapsed), it is said to have been cured. However, a secondary cancer could occur if the same conditions that triggered the first are present.
In which ways can cancer recur?
If cancer returns to the same primary location it is called a local recurrence. If the cancer is detected in surrounding lymph nodes to the original location, it is a regional recurrence. If the cancer has spread to distant parts of the body, it is called metastatic recurrence. Metastatic cancer is also called stage four.
How is recurrent cancer diagnosed?
Knowing the general symptoms of cancer is a great way to help you detect a second cancer early. The earlier a second cancer is diagnosed, the more likely it can be successfully treated. In some cases, second cancers cannot be prevented. Some types of cancer may not present any symptoms.
Regular check-ups and screenings can help detect problems early. Depending on the type of cancer, there might be a need for blood tests, or imaging scans. After being treated for initial cancer you will be advised to watch out for specific signs, or symptoms of recurrence. A careful examination and conversation with the doctor at recommended intervals should provide good follow-up care.
How does cancer metastasise?
Cancer metastasises when diseased cells break away from the main tumour and enter the bloodstream, or lymphatic system. These systems carry fluids around the body. This means that the cancer cells can travel far from the original tumour and form new tumours when they settle and grow in a different part of the body.
Is a metastasis different from the original cancer?
No, a cancer that has spread to another area is given the same name as the original cancer. For example, a breast cancer that spreads to the liver is called metastatic breast cancer, not liver cancer. This is because the cancer started in the breast and the treatment used is for breast cancer.
Is metastasised cancer curable?
Advances in treatment allow doctors to manage cancer symptoms and shrink cancerous tumours but metastatic cancer is rarely curable. The goal for treating a spread cancer is to reduce tumour size and relieve some symptoms that patients experience. This allows doctors to prolong an individual’s life and in many cases allows a person to live a high quality life.
What cancers are likely to recur?
Some cancers are difficult to treat and have high rates of recurrence. Glioblastoma, an aggressive brain tumour, recurs in nearly all patients, despite treatment. The rate of recurrence among patients with ovarian cancer is also high at 85 per cent.
Colorectal cancer metastasises in 30 percent the patients after a five year survival period. Early detection is important as only about five to ten percent of women with stage one or two breast cancer have a recurrence after the initial treatment.
Is the PET scanner recommended for early detection of recurrence?
Yes, Positron emission tomography (PET) is used in cancer patients for staging, restaging, and monitoring for treatment response. These scans are also often used to detect recurrence in asymptomatic patients, though there is no evidence demonstrating improved survival.
Dr Komen is a consultant radiation oncologist at Aga Khan University Hospital
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