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Treating recurrence

By: Eileen Coan

Many people want to do anything possible to treat cancer that has come back. Your doctor will talk with you about different treatment options and how effective each one is likely to be. You might also decide to get a second opinion or get treated at a comprehensive cancer center that has more experience with your type of cancer.

Be sure you understand the goal of each treatment you are taking. Is it to control the cancer? Is it to cure? Is it to make you more comfortable? Clinical trials usually are offered for patients with a cancer recurrence, too. It's also important to know the goal of the clinical trial and its odds of helping you.

It's very important to check on your insurance coverage along with the medical care options you are thinking about. If you need information quickly, please contact your American Cancer Society directly at 1-800-227-2345. Cancer Information Specialists are there 24 hours a day to answer your questions.

"Why can't I have the same treatment for my recurrence as I did for my first cancer?"

Some people do end up having some of the same types of treatment that they had for their first bout with cancer. For example, a woman with breast cancer that recurs in the area of the original cancer may have surgery again to remove the tumor. She may also get radiation therapy, especially if it had not been given before. Next, she and her doctor may consider chemotherapy and/or hormone therapy.

Treatment decisions are based on:

  • Type of cancer
  • When it recurs
  • Where it recurs
  • How much it has spread
  • Your overall health
  • Your personal values and wishes

For example, your doctor will probably not suggest radiation or surgery for cancer that has spread throughout the body because these local treatments can only treat cancer that's in a limited number of places.

Another thing to think about is that cancer cells can become resistant to chemo. Tumors that come back often do not respond to treatment as well as the first tumors did. For example, if the cancer came back within 2 years of getting chemo, it's possible the cancer was able to grow despite treatment. It may be resistant to this type of chemo and not respond as well as it did the first time. Sometimes doctors will say, "The cancer has already seen this drug, so we will try another drug." This means that they feel you have gotten all the help you can from a certain drug and that another one will probably kill the cancer cells better because it works in a different way.

Sometimes your doctor will not want to use a certain drug because of the risk of its side effects, or because you've had that drug in the past. For example, certain chemo drugs can cause heart problems or nerve damage in your hands and feet. To keep giving you that same drug would risk making those problems worse or even lead to long-term side effects.

Ask your doctor why a certain course of treatment is recommended for your recurrence at this time. Do you have 2 or 3 treatment options? Discuss these choices with your nurse or doctor, with members of your support group, and especially with members of your family. Only you can make the best decision for you.

"My doctor has recommended surgery for my cancer recurrence but we can't schedule the surgery for a month and a half. I want this thing out! How long is too long to wait – how much will the cancer spread while I am waiting for the doctor to work me into his schedule?"

Research is still being done on questions like this, but for most cancers there is some time, certainly a few weeks, before you must decide on your treatment for recurrence. Remember that cancer cells multiply until they grow enough to form a tumor or something that can be seen in a blood test or on a scan. This takes time. Usually there is some time to make a thoughtful decision about the right treatment option for you. Try not to panic when you learn about the recurrence. Talk to your doctor if you are worried about waiting to start treatment. You might even want to take the time to get a second opinion. And be sure to discuss all the options with your healthcare team and your family. You need to be comfortable with your decision.

"Exactly what are the chances of treatment working this time? What are the chances of the cancer coming back again after this treatment? It seems like it will just go on and on and keep coming back…"

This question is very hard to answer. There is no way to answer with exact percentages. The answers depend entirely on your situation and many different factors. Some of these include the type of cancer you have, the length of time between the original diagnosis and recurrence, the aggressiveness of the cancer cell type, your age, your overall health status, how well you tolerate treatment, the length of time you are able to take treatment, and the types of treatment you get.

Scientists are studying genetic tests that may predict how likely it is that cancers such as breast, colon, and melanoma will come back. There are formulas that can help estimate the chance of recurrence for a few types of cancer. Prostate cancer is one type of cancer for which recurrence projections can be made, based on stage and grade of cancer at the time of diagnosis. Still, for most people with cancer, the uncertainty of recurrence cannot be avoided. This is one reason recurrence is so hard to cope with. There are no guarantees that you can hold on to.