Describing Cancer And Cancer Recurrence
What does it mean if the doctor says, The cancer is controlled?
A doctor may use the term controlled if your tests or scans show that the cancer is still there, but its not changing over time. Controlled means that the tumor doesnt appear to be growing. Another way of defining control would be calling the disease stable. Some tumors can stay the same for a long time, even without any treatment. Some stay the same size after cancer treatment and are watched to be sure that they dont start growing again.
What does it mean if the doctor says, The cancer has progressed?
If the cancer does grow, the status of your cancer changes and your doctor might say that the cancer has progressed. Most clinical trials define a tumor as progressive when there is a 25% measured growth in the tumor. Your doctor may be referring to a different amount of growth or spread, so ask for more details if youd like to know.
What Are The Chances Of Recurrence
The chances of your melanoma coming back depend on its stage.
Those who have had melanoma are at greater risk for developing another melanoma. It can return in the same spot or elsewhere on your body, even 10 years after initial treatment.
Some cancer cells may remain inside your body that screening tests cant detect. If these cells grow into a tumor, its known as a recurrence.
Doctors classify melanoma in one of four stages:
- In Stages 1 and 2, it involves the skin only.
- In Stage 3, it has spread from the skin to the lymph nodes.
- In Stage 4, it has spread from the skin to other organs.
The likelihood of recurrence varies by stage. It is less likely to recur at lower stages, Dr. Tarhini says.
The recurrence rate increases as the stage advances even after successful surgery, he says.
The stage also affects your prognosis. The lower the stage, the higher the likelihood is of curing your melanoma.
At Stage 1, over 90 percent of patients can be cured, says Dr. Tarhini. As the stage progresses, the likelihood of cure is less. However, with recent advancements in immunotherapy and targeted therapy for melanoma, even at Stage 4 , we are very optimistic that we can cure many patients.
What To Ask Your Doctor
Recurrent cancer and its prognosis, testing and treatment are complicated topics. Speak with your oncologist about any concerns you have to gain a better understanding about your cancer, its stage and available treatments. Ask how certain treatments may reduce tumors or control the cancers spreadand dont forget to inquire about their possible side effects. If youre interested in entering a clinical trial, your doctor may point you toward any that are enrolling patients.
You may consider trying integrative therapies to alleviate cancer symptoms. Let your doctor know which of these you want to pursue so he or she can determine whether they may interfere with your medical treatments.
You should also tell your doctor about any vitamins and supplements youre taking. Your oncologist may tell you to avoid certain products or treatments because they may not help or may be harmful.
When describing your prognosis, your doctor may use statistical terms, like those below, about estimating survival of cancer.
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Treatments And Recurrence: Early And Late
Treatments also play a role in both early and late recurrences. While chemotherapy can significantly reduce the risk of recurrence in the first five years, it has much less influence on the risk of late recurrence.
Hormonal therapy reduces the risk of recurrence in the first five years , but can also reduce the risk of late recurrences. It is this reduction in risk that has led to recommendations to extend hormonal therapy for people at high risk beyond five years.
Extending hormonal therapy from five years to 10 years has been shown to reduce the risk of late recurrence, but the risk of recurrence needs to be weighed against the side effects of continued therapy.
A 2019 study found that people with luminal A tumors continued to have significant benefit from tamoxifen therapy for 15 years post-diagnosis.
The addition of bisphosphonates to an aromatase inhibitor in post-menopausal women with early-stage breast cancer may improve survival, but it’s too early to determine the effect on late recurrences. Bisphosphonates reduce the risk of bone metastases, but the most common sites of distant late recurrence are the brain, liver, and lungs.
Risk Of Late Recurrence Is Underestimated
A survey led by the Canadian Breast Cancer Network found that women often underestimate their risk of late recurrence. In the survey, only 10% were aware of the risk of recurrence after five years of tamoxifen therapy, and 40% felt that they were cured after hitting the five-year mark.
Many breast cancer survivors underestimate their risk of late recurrence.
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Risk Factors For Distant Recurrence
There are several risk factors that raise the risk of recurrence overall . These include:
- Tumour size: Larger tumours are more likely to recur than smaller ones both early and late.
- Positive lymph nodes: Tumours that have spread to lymph nodes are more likely to recur at any time than those that have not.
- Age at diagnosis: Breast cancer recurrence is more common in younger women.
- Treatments received and response to treatments: Both chemotherapy and hormonal therapy reduce the risk of recurrence
- Tumour Characteristics: More aggressive cancers are more likely to recur than less aggressive tumours , especially in the first five years. We also take into account the receptor status and an estimate of proliferation .
There are also factors that do not appear to affect the risk of recurrence. Recurrence rates are the same for women who have a mastectomy or lumpectomy with radiation and are also the same for women who have a single vs. double mastectomy.
How Is Breast Cancer Recurrence Managed Or Treated
Your treatment depends on the type of cancer recurrence, as well as past treatments. If cancer develops in a reconstructed breast, your surgeon may want to remove the breast implant or skin flap.
Treatments for local and regional breast cancer recurrence may include:
- Mastectomy: Your surgeon removes the affected breast and sometimes lymph nodes.
- Chemotherapy:Chemotherapy circulates in blood, killing cancer cells.
- Hormone therapy:Tamoxifen and other hormone therapies treat cancers that thrive on estrogen .
- Immunotherapy:Immunotherapy engages your bodys immune system to fight cancer.
- Radiation therapy: High-energy X-ray beams damage and destroy cancer cells.
- Targeted therapy: Treatments target specific cancer cell genes or proteins.
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At What Point Are You Considered Cancer Free
In a complete remission, all signs and symptoms of cancer have disappeared. If you remain in complete remission for 5 years or more, some doctors may say that you are cured. Still, some cancer cells can remain in your body for many years after treatment. These cells may cause the cancer to come back one day.
Local Recurrence After A Lumpectomy
Local recurrence after a lumpectomy can most often be treated successfully.
Treatment generally includes surgery, most often a mastectomy. Radiation therapy may be given if it wasnt part of the initial breast cancer treatment.
Treatment may also include chemotherapy, hormone therapy, HER2-targeted therapy and/or other drug therapies.
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Treatment Options For Recurrent Melanoma
Most treatment options are on the table for recurrent melanoma.2 Treatment will be chosen based on stage of the original tumor, previous treatment, and where the cancer recurs.
You may be treated with a primary treatment, followed by adjuvant treatment. Adjuvant treatment kills any cancer cells that remain. You will start with the treatments that are most likely to work . If they are not working or they stop working, âsecond-lineâ therapies are offered. Second-line therapies may be in a different drug class than first-line therapy. They may be less effective or have more severe side effects.
Cancer confined to a skin tumor may be removed with surgery, injected with medication, or treated with radiation therapy or topical medication.2 Melanoma on the arm or leg may be treated with chemotherapy in that limb. If cancer recurs in the lymph nodes, they will be removed with surgery, if possible. Adjuvant treatment options include radiation, interferon-alfa, YervoyÂ® , or biochemotherapy.
Metastatic disease may be treated with systemic medications:
Can I Lower My Risk Of Cancer Coming Back Or Getting New Skin Cancers
If you have skin cancer, you probably want to know if there are things you can do that might lower your risk of the cancer coming back, or of getting a new skin cancer.
People who have had skin cancer are at higher risk for developing another skin cancer. Because of this, its important to limit your exposure to UV rays Rays?) and to examine your skin every month for signs of possible new skin cancers. Seeing your doctor regularly for skin exams is also important. Skin cancers that are found early are typically much easier to treat than those found at a later stage.
Smoking has been linked to an increased risk of squamous cell skin cancer, as well as to many other types of cancer. If you smoke and are thinking about quitting, call the American Cancer Society for information and support at 1-800-227-2345.
Adopting other healthy behaviors such as eating well, being active, and staying at a healthy weight might help as well, but no one knows for sure. However, we do know that these types of changes can have positive effects on your health, including lowering your risk for many other types of cancer, as well as other diseases.
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Keeping Health Insurance And Copies Of Your Medical Records
Even after treatment, its very important to keep health insurance. Tests and doctor visits cost a lot, and even though no one wants to think of their cancer coming back, this could happen.
At some point after your cancer treatment, you might find yourself seeing a new doctor who doesnt know about your medical history. Its important to keep copies of your medical records to give your new doctor the details of your diagnosis and treatment. Learn more in Keeping Copies of Important Medical Records.
The Myth And Stigma Of The 5
Many people still believe that breast cancer, even hormone-positive disease, is essentially cured after five years this can lead to misunderstandings in families. Loved ones who don’t understand late recurrence may downplay your feelings, or criticize you when you think “brain tumor” each time you get a headache.
Until information on late recurrence becomes more widely known, and even though it’s frustrating, you may need to educate loved ones about the risk, and why you should be concerned when you develop new or unexplained symptoms.
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Common Questions About Cancer Recurrence
For cancer patients, cancer recurrence is often one of the biggest fears. Many questions about recurrence come to mind if:
- Cancer is suspected.
- A patient has recently been diagnosed with cancer.
- A patient has recently completed treatment.
- A patient has achieved no evidence of disease status.
Even in the case of NED status, new symptoms or routine follow-up testing may suggest a recurrence.
Cancer Cells Can Hide
There are a few theories that have been proposed to account for what seems to be a cancer cell’s ability to “hide” for an extended period of time. For example, 20% to 45% of estrogen-receptor-positive breast cancer recurrences occur years or even decades after cancer has been successfully treated.
- One theory is the idea of cancer stem cells, a subset of cancer cells. These cells divide more slowly than regular cancer cells, which makes them more resistant to treatments such as chemotherapy. While cancer treatments may kill off many regular cells, stem cells could remain alive, ready to grow again.
- Another concept is dormancy. Sometimes cancer cells can lie dormant and, given the right circumstances, begin to grow again. These dormant cancer cells may remain inactive for long periods of time before entering a rapid growth phase.
A strong immune system can help keep cancer cells dormant. If the immune system is not functioning well .
Angiogenesis, which is the ability of a tumor to make blood vessels to feed it and allow it to grow, promotes cancer survival.
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Moving On After Skin Cancer
Some amount of feeling depressed, anxious, or worried is normal after being diagnosed with cancer. Some people are affected more than others. But everyone can benefit from help and support from other people, whether friends and family, religious groups, support groups, professional counselors, or others. Learn more in Life After Cancer.
Recurrent Cancer: When Cancer Comes Back
When cancer comes back, you have the experience to face it that you didnt have before.
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 didnt have beforeexperience. Youve lived through cancer already and you know what to expect. Also, remember that treatments may have improved since you were first diagnosed. New drugs or methods may help with your treatment or in 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.
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Treatment For Recurrent Cancer
The type of treatment that you have for recurrent cancer will depend on your type of cancer and how far it has spread. To learn about the treatments that may be used to treat your recurrent cancer, find your type of cancer among the PDQ® cancer treatment summaries for adult and childhood cancers.
The Risk Of Cancer Returning After Radiation Therapy
- READ TIME3 Minutes
Ben Brewer is the name of a brave young man featured on 9 News for his 11-year battle with cancer. The report states that young Ben was diagnosed with blastoma at the age of two. He had undergone various treatments including chemotherapy and as of last year, liquid radiation. He has relapsed three times prior to the radiation therapy.
Ben, his family, and his medical team truly believed they had seen the last of the blastoma after the radiation treatment. He was featured on 9 News as the radioactive boy due to his bravery with the complex and often, isolating treatment.
Ben was cancer free from 2014 until September 2015, when scans confirmed the presence of five new spots in various parts of his body. As he and his family discuss options with the doctors at Childrens Hospital Colorado, we cant help but wonder why cancer sometimes comes back after radiation therapy, as stringent as the treatment is.
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Treatment For Ovarian Cancer Recurrence
The effectiveness and type of treatment for recurrent ovarian cancer depends on what kind of chemotherapy the patient received in the past, the side effects associated with previous treatments, the extent of the recurrent cancer and the length of time since the last treatment was finished called the time to recurrence, which researchers often call progression-free survival.
The time to recurrence is the amount of time between your response to a prior platinum-based chemotherapy and the time of the recurrence.
- If the time to recurrence is less than six months, the ovarian cancer is classified as platinum-resistant, and the woman will be treated with usually one other type of chemotherapy drug. Women are encouraged to consider participating in a clinical trial that might offer an opportunity to take a new investigational drug that could be helpful.
- If the time to recurrence is more than six months, the ovarian cancer is classified as platinum-sensitive and the woman will be treated with a platinum-based drug again and another chemotherapy agent.
During treatment for recurrence, it is very important to have a continual dialogue with your doctor about the benefits of treatment, with respect to remission and survival, versus the risks of the side effects that hurt the quality of your life. If you do choose treatment in recurrence, there are several options based on your previous treatments.
Impact Of Late Recurrence
The impact of late distant recurrence cannot be stressed enough. Once breast cancer is metastatic, it is no longer curable. While there are some long term survivors with stage 4 breast cancer , the average life expectancy is currently only around three years.
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When Cancer Comes Back After Treatment
Bowel cancer that comes back after treatment is called recurrent bowel cancer. The cancer can come back in the bowel close to the original site or in another part of the body . Areas of secondary cancer are also called metastases .
This page tells you why bowel cancer can come back, what signs to look out for, how recurrent cancer is diagnosed and how it is treated. There is also information on coping with recurrent bowel cancer.
Speak to your healthcare team if you are worried about your cancer coming back or if you have any questions about your treatment and care.
How Many Times Can Cancer Come Back
If treatment for cancer recurrence leads to tests that show no evidence of disease, patients may want to know how many more times it may come back. Though the disease may be managed again with more treatment, further recurrence remains possible even after treatment, and theres no way to tell how many times it may recur.