When cancer recurs

Now’s the time to harness your resources and experience.

Even though the possibility of recurrence had probably been somewhere in the back of your mind, the news that the cancer has returned can be the realization of your worst fears. Whether you’ve been cancer-free for years or have only recently begun to settle back into your normal routine, you may be questioning whether you’re ready to begin the battle all over again. Now is the time to take stock of the skills and resources you’ve developed throughout your journey — and realize that you’re better prepared than you may think.

When cancer comes back

No matter how successful cancer treatment is, it sometimes leaves a few undetectable cancer cells behind. During remission, these cells lie dormant, but sometimes an unpredictable change in your immune system can wake them up. Recurrence begins when these remaining cancer cells start to multiply and form a new tumor.

There are three types of recurrence — local, regional, and distant — each describing the location of the new tumor. Even if cancer recurs distantly, in a completely new part of your body, your doctor will still refer to it as the type of cancer with which you were originally diagnosed. For example, breast cancer recurring in the bones would be called breast cancer with bone metastasis.

If the cancer resurfaces after only a short period of time, usually within one year, you are most likely experiencing a progression rather than a recurrence of the original cancer, because the cancer may not have ever been dormant. The shorter the period of remission, the more aggressive the remaining cancer cells.

Same cancer, different approaches

You may wonder why, if the cancer is the same, you can’t just follow the same course of treatment as before. For many reasons, you may benefit from a new approach the second time around.

For one thing, the cells of a recurrent tumor contain high levels of P-glycoprotein (P-gp), a drug-resistant gene that means they don’t always respond well to the cancer-fighting substances used in the initial treatment. So a recurrence often requires a more creative approach.

Sometimes, if your earlier treatment caused harmful side effects, your doctor may switch treatments to prevent further damage to your healthy cells. For example, an effective form of radiation therapy may not be appropriate if surrounding tissues can’t withstand further injury.

The goal of treatment may also change with recurrence. While completely destroying the cancer may no longer be an option, many new drugs aim to keep the illness under control and improve your quality of life. Sometimes you may take one drug until exhausting its healing power, and then switch to another — each new drug providing months or years of good health.

Don’t rush it

You may feel as if you want to get started as soon as possible, but you need to take your time and collect as much information as you can. Most recurrences move slowly enough to leave you a few weeks to seek out a second opinion and review your options.

In some cases you may even have more choices than when you were first diagnosed. The scientific community may have created new, more effective treatments. You may also qualify for clinical trials that you might not have been eligible for before.

Most importantly, make sure to ask why your doctor suggests each treatment. You need to make an informed choice and feel completely confident in your plan of action.