Cancer is a sneaky disease. Just when you thought it was beaten, it returns. Some of us will endure a third recurrence, or more. The most critical thing to keep in mind is that a recurrence does not necessarily mean death is imminent.

Just like when we were first diagnosed, knowledge is our ally. The information below will help you make the best decisions on your journey back to good health.

What is a recurrence?

The most common type of recurrence is when our cancer returns after we’ve been treated. Sometimes surgery or radiation just doesn’t get all the cancer cells. Some cells are so small, you can’t even see them under the most powerful microscope.

Another type of recurrence is when cancer cells escape the original site and hide somewhere else in our bodies, multiply, and rear their ugly heads several months or years down the road. This type or recurrence is called second primary cancer.

Types of recurrence

Where your cancer recurs depends on the original type of cancer and stage. Cancer recurs in one of three ways:

• Local recurrence -- the cancer reappears in the same place where doctors first found it.
• Regional recurrence -- the cancer returns in the lymph nodes or tissue near the original site.
• Distant recurrence -- the cancer has metastasized, or spread, to areas far away from the original location.

The following data from the American Cancer Society and the Mayo Clinic shows where the top ten cancers are likely to spread:

Breast:

Most likely to spread to: Bones, lungs, liver, brain, skin

Colon/Rectal:

Most likely to spread to: Liver, lungs, bones

Kidney:

Most likely to spread to: Lungs, bones, liver, brain, skin

Lung:

Most likely to spread to: Other side of lung, adrenal glands, liver, bones, brain

Ovarian:

Most likely to spread to: Liver, lungs

Pancreatic:

Most likely to spread to: Liver, lungs, bones, brain

Prostate:

Most likely to spread to: Bones, lungs, liver

Soft tissue:

Most likely to spread to: Lungs, bones, brain

Stomach:

Most likely to spread to: Lungs, liver, bones

Thyroid:

Most likely to spread to: Lungs, liver, bones

What are the symptoms of a recurrence?

The symptoms of a recurrence will be different according to where and how the cancer returns. If cancer returns to the original place where it started, symptoms will be similar to the ones that led to the first cancer diagnosis.

For example, if a woman had breast cancer and it went into remission, a symptom of recurrence would be a lump in her breast. If the cancer has moved to another location, symptoms can be anything from severe pain in the bones to a persistent cough.

How is cancer recurrence diagnosed?

Our doctor will schedule a series of follow-up exams to check whether our cancer has returned. They use the same tests to detect a recurrence as they did when you were first diagnosed.

For example, those of us with prostate cancer will return to the urologist every six months for PSA blood tests. If our PSA rates rise above zero, then the doctor may suspect our cancer has returned.

These checkups are something we will do for the rest of our lives, because we know cancer can return at any time. The quicker the doctor determines our cancer has returned, the easier it is to treat again. We can also stay aware of any cancer symptoms we start to experience.

How is recurrent cancer treated?

Researchers and physicians have made many gains in treating cancer recurrences. Local recurrences and regional recurrences may still be curable; however, most distant recurrences are not. When our cancer has spread too far from its original site, doctors try to shrink the tumor or at least keep it under control, treatments that can extend our life and relieve pain.

Our treatment options for a cancer recurrence depend on what treatments we received the first time and the location of the new cancer. We face the same decisions in how to treat our recurrence that we did when cancer first turned our lives upside down. Some of us might consider joining a clinical trial with experimental medications and treatment, although clinical trials don’t guarantee cures.

How do we cope when cancer comes back?

All the uncertainties have returned, but we’re a battle-hardened veteran at this point. We know all the challenges that confront us. We will endure many of the same emotions that struck us when we were first diagnosed: fear, distress, anxiety, self-doubt, and anger.

The feelings that come with a recurrence of cancer can actually be more pronounced than when we were first diagnosed. However, the same coping mechanisms we used before will work again.

We’ll turn to a best friend, a family member, or support group for emotional support and advice. We've built relationships with doctors, hospitals and cancer specialists who know us well. From our first battle with cancer, we grew to trust them totally. With their help, we know how to win.

See also

• The fear and reality of recurrence
• Prevention techniques
• Healthy living
• The list of carcinogens