When Cancer Comes Back: Understanding Recurrence

When cancer comes back after treatment, doctors call it a recurrence or recurrent cancer. Finding out that cancer has come back can cause feelings of shock, anger, sadness, and fear.

But you have something now that you did not have before: experience. You have lived through cancer once. You know a lot about what to expect and how to prepare, and you know your health care team and the people at the hospital.

Maybe in the back of your mind you feared your cancer might return. You might now be thinking, "How can this be happening to me again?" Those feelings are understandable.

Remember that treatments may have improved since your first cancer. New drugs or methods may help with treatment or with managing side effects. In some cases, improved treatments have helped turn cancer into a chronic disease that people can manage and live with for many years.

Cancer that returns can affect all parts of your life, and you may feel weak or no longer in control. But you do not have to feel that way. You can take part in your care and in making decisions, and you can talk with your health care team and loved ones as you decide. This can help you feel a sense of control and well-being.

Recurrent cancer starts with cancer cells that the first treatment did not fully remove or destroy.

This does not mean the treatment you received was wrong. It just means a small number of cancer cells survived the treatment and were too small to show up in follow-up tests. Over time, these cells grew into tumors or cancer your doctor can now detect.

Sometimes a new, different type of cancer occurs in a person who has a history of cancer. This is called a second primary cancer, and it is different from recurrent cancer.

Doctors describe recurrent cancer by where it develops and how far it has spread:

• Local recurrence means the cancer is in the same place as the original cancer or very close to it.
• Regional recurrence means the tumor has grown into lymph nodes or tissues near the original cancer.
• Distant recurrence means the cancer has spread to organs or tissues far from the original cancer. When cancer spreads to a distant place, it is called metastasis. The cancer is still the same type; for example, colon cancer that comes back in the liver is still called colon cancer.

If your report or visit summary uses these words, see local recurrence vs distant recurrence.

To figure out the type of recurrence you have, you will have many of the same tests you had when your cancer was first diagnosed, such as lab tests and imaging. These tests show where the cancer has returned, whether it has spread, and how far.

Your doctor may call this new assessment "restaging." After the tests, the doctor may assign a new stage, adding an "r" to the front of it. The original stage at your first diagnosis does not change.

The steps you go through for treatment will most likely be the same as when you first had cancer, even if the treatment itself changes. Many people have a team of providers, which may include doctors, nurses, social workers, and dietitians.

There are many treatment choices for recurrent cancer. You may have the same or a different treatment than before. This depends partly on the type of cancer and the treatment you had, and also on where the cancer came back, whether it has spread, and your health now.

Chemotherapy, surgery, radiation, biological therapies, or a combination may be options. Your doctor may also suggest a clinical trial. It is important to ask questions about all your choices so you know the risks and benefits.

Palliative care is not only for people who stop treatment. It is symptom and quality-of-life support, and it can run alongside treatment meant to control the cancer. Asking for it does not mean giving anything up. Clinical trials are worth raising here too, not only at the end of care. Cancer that has come back, spread, stopped responding to a drug, or carries a biomarker that matches a study are all reasons to ask.

If you choose not to go through treatment again, palliative care can provide comfort care for you. Whatever you decide, your health care team is there to support you.

For a calmer first-step overview, see Cancer Came Back: What Now?.