The American Cancer Society defines a cancer recurrence as “the return of cancer after treatment and after a period of time during which the cancer cannot be detected.” Most doctors will say a cancer has recurred if the disease returns after having been undetectable for more than a year. However, the period of time is not strictly defined. For cancer survivors, the fear of cancer coming back is part of everyday life.
It is impossible to predict whether cancer will come back, but doctors know that aggressive, fast-growing cancers like mesothelioma are more likely to recur, as are advanced and widespread cancers. Some believe mesothelioma recurrence is unavoidable because the disease spreads through the lining of the lungs and abdomen, close to the organs, and is difficult for doctors to remove in its entirety.
Cancer Recurrence and Cancer Progression
Cancer recurrence is different from cancer progression. Most doctors will say cancer has progressed if it comes back less than three months after treatment. Progression likely happens because the cancer is resistant to treatment, or because surgeons left behind small, undetectable clusters of cancer cells that continued to grow.
Recurrent cancer also starts with cancer cells missed by the first treatment, or when normal cells once again develop DNA damage. When cancer recurs, it may be in the same place, or a local recurrence. It may also develop near the original disease site, such as the lymph nodes, which is called a regional recurrence. Sometimes the same cancer will spread to a different part of the body, which is called a distant recurrence; in this case, doctors will say the cancer has metastasized.
Tips for Coping with Recurrence
Learning that cancer has returned may be more upsetting than the original diagnosis, as recurring cancers may be harder to treat or control, and may require more aggressive treatment. The American Society of Clinical Oncology (ASCO) says “shock, disbelief, anxiety, fear, anger, grief and a sense of loss of control are common emotions.”
However, patients facing a recurring cancer diagnosis are well-equipped to navigate a second round of treatment. They are well-versed in the disease and treatment options, they understand the medical and insurance systems, and have existing relationships with doctors and other healthcare professionals.
For those patients, here are some simple tips to consider when facing cancer recurrence:
Talk to Your Doctor
Some patients begin to second-guess their original treatment decisions, or start to doubt their doctor’s judgment. In this case, The American Cancer Society (ACS) recommends patients talk to their doctors, and if the concerns can’t be resolved, to find a new health care team. If patients feel unsure about whether to continue treatment at all, seek out a second opinion. Patients should remember that ultimately, the decision about whether to pursue aggressive treatment or seek out supportive and palliative care is up to them.
Seek Support and Alternative Therapy
Other patients worry about the financial consequences of a recurring cancer diagnosis, or question whether they will have the physical and emotional stamina to endure more chemotherapy, radiation or surgery. There are many places to find support.
The ACS recommends finding an individual counselor or support group, as studies show that patients who take part in support groups experience an improved quality of life, including better sleep and a boost in appetite.
A 2007 study found that spiritual support also significantly improved cancer patients’ quality of life. “As physical health wanes, spiritual health may increasingly play a central role in determining patient well-being,” the authors wrote.
For an alternative therapy option, meditation has also been shown to improve mental health when fighting cancer. A sweeping 2009 study showed patients who practiced a form of meditation called Mindfulness Based Stress Reduction (MBSR) showed lower levels of anxiety, depression, stress and distress.
Acknowledge Your Feelings
Experts roundly agree that patients should not blame themselves for the recurrence. The ACS says “there is nothing you could have done to make sure the cancer would not come back.” Those who feel guilty for making lifestyle choices like smoking or tanning must work to forgive themselves.
Patients should accept that anguish and sorrow are a normal response to a recurring cancer diagnosis, and reject “positive attitude myths” that suggest they are responsible for their own illness because they think negative thoughts.
“This kind of message is destructive to people who are dealing with cancer and recurrence,” the organization says. “They are fighting for their lives and then are told they are responsible for their own illness.” Which is, of course, not the case.