Cancer Recurrence

What is recurrence in cancer?

Recurrent cancer is cancer that comes back after treatment. Cancer may come back months or years after you’ve finished treatment. It can come back after being in remission. (Remission means you don’t have cancer symptoms and tests don’t find signs of cancer.) At times, healthcare providers may recommend treatments to manage recurrent cancer. Depending on your situation, you may live for many years with recurrent cancer.

What are types of recurrent cancer?

Healthcare providers characterize recurrent cancer by its location. The different recurrence types are:

• Local recurrence. The same kind of cancer has come back to same place as the original cancer. For example, if you had a prostatectomy, you may develop recurrent cancer where your prostate was located.
• Regional recurrence. The cancer returns to lymph nodes or tissues near the original cancer. Some cancer sub-types are more likely to recur regionally, such as recurrent triple negative breast cancer.
• Distant recurrence. The same cancer from the original tumor has spread to organs or tissues located far from the original tumor. For example, lung cancer often recurs in the central nervous system (brain).

Which types of cancer are more likely to come back?

Any type of cancer may come back. Beyond that, it’s hard to say which are more likely to recur. One analysis of recurrent cancer research concluded the following cancers had high recurrence rates:

• Ovarian cancer.
• Metastatic melanoma, meaning melanoma that spread or metastasized before diagnosis.
• Peripheral T-cell lymphoma (PTCL), a type of non-Hodgkin lymphoma.

Regardless of cancer type, it’s important to remember recurrence rates are like cancer survival rates: they’re estimates that vary. Factors such as cancer type and initial cancer treatment significantly change cancer recurrence estimates. If you have recurrent cancer, your healthcare provider is your best resource for information on what you can expect.

What are symptoms of recurrent cancer?

Many symptoms mimic recurrent cancer symptoms. If you’re monitoring your health, ask your healthcare provider about common symptoms for the type of cancer you have. They’ll explain which symptoms may require tests to rule out recurrent cancer. Contact your provider if you notice:

• You have symptoms that are similar to your initial cancer symptoms. For example, there may be a bump or lump where your cancer started.
• Pain that doesn’t go away.
• A cough that doesn’t go away.
• Unexplained weight loss.
• Unusual bleeding and bruising.
• Fever that doesn’t go away.
• Frequent headaches.
• Shortness of breath (dyspnea).
• Blood in your poop or pee.
• Nausea and vomiting.
• Trouble swallowing (dysphagia).

Why does cancer come back (recur)?

Cancer is a moving target, making it hard for any treatment to capture and kill all cancerous cells. For example, surgery to remove a cancerous tumor may miss some cells because they were too small to detect. Cancer constantly evolves as cells mutate and change. In some cases, cancer treatment may not work against all cancer cells. Those cells can keep on growing despite treatment until a healthcare provider detects them during follow-up examinations.

How is recurrent cancer diagnosed?

Healthcare providers diagnose recurrent cancer with many of the same tests they use in their original diagnosis. Tests to diagnose recurrent cancer may include:

Blood tests

Blood tests for cancer recurrence typically include:

• Complete blood count. This test analyzes the number of blood cells and platelets in your blood sample. This is one way providers monitor your overall health and look for changes that may be signs of cancer recurrence.
• Immunophenotyping. This test identifies specific cells. If you have a recurrent blood cancer such as leukemia, your provider may use immunophenotyping to learn more about your condition.
• Liquid biopsy. This test looks for cancer cells or DNA from cancerous tumor cells that may appear in your blood.
• Tumor marker tests. Tumor markers are substances that cancer cells or other cells release in response to cancer. Providers may use these tests to watch for signs of recurrent cancer.

Imaging tests

If you have recurrent cancer, your provider may use imaging tests to learn more about cancerous tumors that develop from the original tumor. Imaging tests may include:

• Computed tomography (CT) scan. Providers may use this test to look for recurrent cancer or determine tumor size and location.
• Magnetic resonance imaging (MRI). MRIs create detailed images of particular areas inside your body and may help providers detect recurrent cancer.
• Positron emission tomography (PET) scan. PET scans look for areas of your body that are using high amounts of glucose. Glucose is a type of sugar. Cancer cells take up more glucose than normal cells.

Urinalysis

Urinalysis measures the content of your pee and measures the blood cells, sugar and protein in your pee. Providers may use urinalysis to monitor for recurrent bladder or kidney cancer.

Biopsies

Providers do biopsies to diagnose cancer, including recurrent cancer. In biopsies, providers obtain tissue samples that medical pathologists examine under a microscope for signs of cancer. Biopsy types include:

• Image-guided biopsy. Providers use CT scans or ultrasounds to visualize the tumor, and use a needle to take a small sample of the cancerous lesion.
• Endoscopic or laparoscopic biopsy. Providers use an endoscope or laparoscope to see inside your body. An endoscope is a thin, flexible tube with a camera on the tip, along with a cutting tool to remove your sample. Providers don’t make incisions to insert an endoscope. A laparoscope is a slightly different scope that’s inserted through a small incision in your abdomen (belly). These tools let providers obtain tissue without making large cuts in your skin.
• Excisional or incisional biopsy: For these open biopsies, a surgeon cuts into your body and removes the entire tumor (excisional biopsy) or a part of the tumor (incisional biopsy) to test or treat it.
• Bone marrow biopsy. Providers take a sample of blood and bone from inside the bone marrow to evaluate for recurrent cancer.

What are treatments for recurrent cancer?

Recurrent cancer treatment varies depending on your situation. Your provider may:

• Repeat first-line or initial treatment.
• Do surgery to remove new tumors.
• Use different chemotherapy drugs or combinations of drugs.
• Try a different kind of treatment, such as targeted treatments or immunotherapy.

If you have recurrent cancer, your provider will discuss your options, including what you can expect treatment to accomplish. Typically, recurrent cancer treatments manage cancer and keep it from getting worse or spreading, and they aren’t expected to cure it. Factors that affect treatment decisions include:

• The type of cancer you have.
• When it came back. Cancer that comes back relatively quickly after treatment may be more difficult to treat.
• Where cancer came back. In general, recurrent cancer that comes back at or near the original cancer may be easier to treat than cancer that recurs in organs or tissues far away from the original tumor.
• Your overall health. Different or more intensive cancer treatment for recurrent cancer may have significant side effects. Your overall health plays a role in how well you’ll do during treatment.

No matter what treatment you choose, consider palliative care to help you manage cancer symptoms and treatment side effects. Palliative care acts like an extra layer of support and symptom control while you receive cancer treatments.

What is the prognosis for recurrent cancer?

Your prognosis or expected outcome depends on your situation. Many factors that affect treatment choices also affect your prognosis, such as the type of cancer you have, how you responded to treatment and managed side effects, and your overall health. Your healthcare provider is your best resource of information about your prognosis.

What’s it like to live with recurrent cancer?

Recurrent cancer may feel like déjà vu. You’ve been through cancer once, and now it’s back. This time around, however, you may feel discouraged and overwhelmed by having to deal with cancer again. Your feelings are real and they matter. If you’re living with recurrent cancer, one of the first things you should do is give yourself time and space to understand your situation. Then start thinking of steps you can take to live as well as possible with recurrent cancer. Here are some suggestions:

• Ask your provider about cancer survivorship programs. These programs focus on helping people understand and manage the challenges of living with cancer.
• Eat a nutritious, balanced diet. Ask your provider about talking to a nutritionist who can help you create a food plan tailored to your needs.
• Get some exercise. Exercise helps to ease stress and build strength and endurance. But be sure to ask your provider before starting an exercise program.
• Develop or continue good lifestyle habits. If you use tobacco products or beverages that contain alcohol, try to stop.
• Get enough sleep. Cancer and cancer treatment can take a toll on your body. Make sure that you get enough sleep. Talk to your provider if you’re having trouble sleeping.
• Consider advance care planning, including advance directives. In advance care planning, you think ahead about your health and consider what you’d want to happen if you couldn’t speak for yourself. Advance directives are legal documents that provide written instructions about your end-of-life wishes and who can make medical decisions on your behalf.

What’s the difference between recurrent cancer and second cancer?

If you’ve had cancer, you may develop a second cancer. This is a completely new and different cancer. Recurrent cancer, on the other hand, is the same type as the original cancer that has come back.

Can recurrent cancer go back into remission?

Yes. In some cases, people go through cycles of remission and recurrence. When cancer comes back, healthcare providers may try the same or different treatments with the goal of putting cancer back into remission.

I have recurrent cancer. I’m not sure I want more treatment. How do I decide?

That’s not an easy decision. If you’ve just learned you have recurrent cancer, you should take some time to understand your treatment options and to think about what you want for yourself, your family and others who care about your well-being. Here are some steps that may help you with your decision:

• Take time to understand your treatment options and potential side effects. Your oncologist and care team will give you as much information as you think you need to make decisions.
• Talk to your family and other people you love so they know about your situation. Regardless of your decision, you’ll want your family and others to understand your decision and know what you would want for your own care.
• Think about obtaining a second opinion from another cancer specialist. Other hospitals can sometimes offer different treatment options for you.
• Ask your provider about participating in a clinical trial. Clinical trials are research projects to determine if a new treatment is safe and effective.

I’ve decided I don’t want treatment for recurrent cancer. What happens now?

There are many reasons why people decide to stop cancer treatment. Get input from your provider, your family and other loved ones, but know that you have the final say about continuing or stopping treatment at any point.

Is hospice care an option if I stop cancer treatment?

It may be, but it depends on your overall health and your prognosis. In general, providers recommend hospice care if they believe treatment won’t cure your condition and they believe you have less than six months to live. Here’s what you can expect if your provider recommends hospice care:

• Holistic end-of-life care. Cancer changes everyone it touches, including your family and caregivers. Hospice care helps you and your family. Healthcare providers will take care of your physical needs and other specialists will support you with mental, emotional, spiritual and psychological help.
• Comfort care. You’ll receive medication and other treatments to help you manage pain and condition side effects.
• Caregiver support. Your primary caregivers may need help with your care. They may need help managing their own physical and mental health. Hospice will connect your family with the resources they need.
• Medical supplies and equipment. Some people receive hospice care at home and need special beds and other equipment. Hospice may also provide short-term care in a facility or in an inpatient hospice facility.

A note from Cleveland Clinic

If you had successful cancer treatment, you may have known there was a chance cancer could recur (come back) after treatment. Even so, you may still be shocked and upset to learn that once again, you have cancer. You may feel hopeless and afraid. However, there’s always hope with cancer, and recurrent cancer is no exception. There’s hope for new treatments or a chance to participate in a clinical trial. In addition, even if treatment can’t slow recurrent cancer, there’s hope for living as you choose, regardless of how long you live. If you have recurrent cancer, your oncologist and healthcare team will support your choices and be there to help you as much as they can.