Recurrent Cancer

Why and Where Cancer Returns

When cancer comes back, doctors call it a recurrence (or recurrent cancer). Some things you should know are:

* A recurrent cancer starts with cancer cells that the first treatment didn't fully remove or destroy. Some may have been too small to be seen in follow-up. This doesn't mean that the treatment you received was wrong. And it doesn't mean that you did anything wrong, either. It just means that a small number of cancer cells survived the treatment. These cells grew over time into tumors or cancer that your doctor can now detect. * When cancer comes back, it doesn't always show up in the same part of the body. For example, if you had colon cancer, it may come back in your liver. But the cancer is still called colon cancer. When the original cancer spreads to a new place, it is called a metastasis (meh-TAS-tuh-sis). * It is possible to develop a completely new cancer that has nothing to do with your original cancer. But this doesn't happen very often. Recurrences are more common.

Doctors define recurrent cancers by where they develop. The different types of recurrence are:

* Local recurrence. This means that the cancer is in the same place as the original cancer or is very close to it. * Regional recurrence. This is when tumors grow in lymph nodes or tissues near the place of the original cancer. * Distant recurrence. In these cases, the cancer has spread (metastasized) to organs or tissues far from the place of the original cancer.

Local cancer may be easier to treat than regional or distant cancer. But this can be different for each patient. Talk with your doctor about your options.

Taking Control: Your Care and Treatment

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

Talking With Your Health Care Team

Many people have a treatment team of health providers who work together to help them. This team may include doctors, nurses, oncology social workers, dietitians, or other specialists. Some people don't like to ask about treatment choices or side effects. They think that doctors don't like being questioned. But this is not true. Most doctors want their patients to be involved in their own care. They want patients to discuss concerns with them.

Here are a few topics you may want to discuss with your health care team:

* Pain or Other Symptoms. Be honest and open about how you feel. Tell your doctors if you have pain and where. Tell them what you expect in the way of pain relief. * Communication. Some people want to know details about their care. Others prefer to know as little as possible. Some people with cancer want their family members to make most of their decisions. What would you prefer? Decide what you want to know, how much you want to know, and when you've heard enough. Choose what is most comfortable for you. Then tell your doctor and family members. Ask that they follow through with your wishes. * Family Wishes. Some family members may have trouble dealing with cancer. They don't want to know how far the disease has advanced. Find out from your family members how much they want to know. And be sure to tell your doctors and nurses. Do this as soon as possible. It will help avoid conflicts or distress among your loved ones.

Other Tips for Talking With Your Health Care Team

* Speak openly about your needs, questions, and concerns. Don't be embarrassed to ask your doctor to repeat or explain something. * Keep a file or notebook of all the papers and test results that your doctor has given you. Take this file to your visits. Also keep records or a diary of all your visits. List the drugs and tests you have taken. Then you can refer to your records when you need to. Many patients say this is helpful, especially when you meet with a new doctor for the first time. * Write down your questions before you see your doctors so you will remember them. * Ask a family member or friend to go to the doctor's office with you. They can help you ask questions to get a clear sense of what to expect. This can be an emotional time. You may have trouble focusing on what the doctor says. It may be easier for someone else to take notes. Then you can review them later. * Ask your doctor if it's okay to tape-record your talks. * Tell your doctor if you want to get dressed before talking about your results. Wearing a gown or robe is distracting for some patients. They find it harder to focus on what the doctor is saying.

Treatment Choices

There are many treatment choices for recurrent cancer. Your treatment will depend partly on the type of cancer and the treatment you had before. It will also depend on where the cancer has recurred. For example:

* A local recurrence may be best treated by surgery or radiation therapy. This means that the doctor removes the tumor or destroys it with radiation. * A distant recurrence may need chemotherapy, biological therapy, or radiation therapy.

It's important to ask your doctor questions about all your treatment choices. You may want to get a second opinion as well. You may also want to ask whether a clinical trial is an option for you.