If a patient has been successfully treated for cancer, but it returns, they have what is called recurrent cancer. A recurrent cancer could come back in the same location as the primary (original) cancer, or in a different location.
Cancer Recurrence is Stratified into 3 Categories
- Local Recurrence
A cancer that recurs in the same part of the body as the primary tumor. - Regional Recurrence
A cancer that recurs in the lymph nodes that drain the area of the primary tumor (regional lymph nodes). - Distant (Metastatic) Recurrence
A cancer that recurs in another part of the body, some distance from where it started (often the lungs, liver, bone, or brain).
The best way to handle the possibility of recurrence is for patients to remain vigilant for several years following the end of their treatment. Patients should see a doctor regularly for follow-up visits and imaging to maintain surveillance and detect any potential recurrence as early as possible.
Similar to the initial diagnosis, the earlier the cancer is detected, the better the prognosis will be.
Optimizing Outcomes
If recurrent cancer is identified at an early stage, a patient’s prognosis is often better, since treatment options are more effective for less advanced cancers.
To improve the likelihood of identifying recurrent cancer as early as possible, patients should follow-up with their doctors on a regular basis.
Patients should visit their head and neck specialist on a regular schedule (or earlier if they have any concerning symptoms). This allows doctors to check for signs of recurrence. The best timeline for follow-up will be determined by the doctor.
Standard Follow-up Schedule
- For the first year, go every 1–3 months.
- For the second year, go every 2–6 months.
- For the third to fifth year, go every 4–8 months.
- After five years, start going once annually.
Doctors may select a scan to be performed in the first 6 months after treatment. The first scan serves as a “baseline” study for the purpose of comparing future studies. This will depend on the type and location of the cancer. Imaging could range from something as simple as a quick chest X-ray to more extensive tests such as a CT, MRI, or PET scan. If something suspicious comes up, a patient may need a biopsy.
A patient should take all possible steps to reduce the risk of cancer recurrence. Smoking and/or excessive alcohol consumption are known risk factors for developing many types of cancer. Stopping smoking and drinking may reduce a patient’s risk of cancer recurrence. A patient’s doctors will be able to recommend counseling services to help with quitting.
Managing Recurrent Cancer
Patients with recurrent cancer are likely to have an even more challenging treatment journey than they did the first time around.
Whether a patient is diagnosed with local, regional, or metastatic recurrent cancer determines their treatment options, treatment course, and treatment goals:
Local and Regional Recurrence
- Local and regional recurrences may be treated with surgery, radiation, systemic therapy, or a combination of multiple treatment types.
- Whether or not the original tumor was treated with radiation will affect the treatment plan for the recurrent cancer.
- Genetic and molecular testing may be used to provide options for targeted therapies.
- The treatment goals for local and regional recurrences are to cure the disease.
Distant (Metastatic) Recurrence
- The treatment of metastatic recurrences is very complex, and patients should have extensive conversations with their doctors regarding the best treatment course.
- For some patients, doctors may recommend a clinical trial as a potential treatment option.
- The treatment goals will be different for each patient, and may focus on improving survival or reducing symptoms (palliative care).
- The prognosis for metastatic disease is generally very poor.
Fear of Recurrence
Fear and uncertainty regarding the possibility of a recurrence are normal and extremely common among both patients and caregivers. Some people experience fear of upcoming doctors appointments or imaging scans used to screen for cancer recurrence. It is not actually the tests themselves that cause stress, but rather the possibility of receiving bad news. It is important to remember that these tests and scans are the best way to learn if the cancer has come back, and that the earlier a recurrence is caught, the better the chances are for a successful treatment.
Feelings of fear and anxiety are completely normal for cancer patients, and almost all patients experience them at some point. These feelings are generally most intense the first year after treatment, and tend to get better over time.
