"Your cancer has returned. Cancer may have spread to your lung." To cancer survivors, this is probably the most devastating news. And it happened to me less than 2 years after my first cancer diagnosis.
Cancer recurrence or relapse is something that most cancer survivors hope would never happen to them. After the end of cancer treatment, no survivor would wish to go through the agony of cancer again. The second time can be more distressing than the first. But when cancer returns, what should you do?
My experience with cancer recurrence
2006 - diagnosed with Stage 2 nasopharyngeal cancer, underwent radiotherapy
2007 - CT scan picked up tiny nodules on right lung, metastasis suspected
2008 - underwent lung resection (keyhole surgery) to remove 3 malignant nodules
2010 - CT scan showed no tumour in lungs & other parts of body
What is cancer recurrence? (source : http://www.mayoclinic.com/)
When cancer returns after a period of remission, it's considered a recurrence. A cancer recurrence happens because, in spite of the best efforts to rid you of your cancer, some cells from your cancer were left behind. These cells could be in the same place where your cancer first originated, or they could be in another part of your body. These cancer cells may have been dormant for a period of time, but eventually they continued to multiply, resulting in the reappearance of the cancer.
A cancer recurrence means it's the same cancer coming back after some period of time. In rare cases you may be diagnosed with a new cancer that's completely unrelated to your first cancer. This is referred to as a second primary cancer.
Why does cancer recur? **
2007 - CT scan picked up tiny nodules on right lung, metastasis suspected
2008 - underwent lung resection (keyhole surgery) to remove 3 malignant nodules
2010 - CT scan showed no tumour in lungs & other parts of body
What is cancer recurrence? (source : http://www.mayoclinic.com/)
When cancer returns after a period of remission, it's considered a recurrence. A cancer recurrence happens because, in spite of the best efforts to rid you of your cancer, some cells from your cancer were left behind. These cells could be in the same place where your cancer first originated, or they could be in another part of your body. These cancer cells may have been dormant for a period of time, but eventually they continued to multiply, resulting in the reappearance of the cancer.
A cancer recurrence means it's the same cancer coming back after some period of time. In rare cases you may be diagnosed with a new cancer that's completely unrelated to your first cancer. This is referred to as a second primary cancer.
Why does cancer recur? **
- tumour too big
- tumour cells resistant
- geographic miss
- cancer already spread at time of diagnosis (but too small to be picked up)
Where does cancer recur? (source : http://www.mayoclinic.com/)
Your cancer can recur in the same place it was originally located, or it can migrate to other parts of your body. Recurrence is divided into three categories:
Your cancer can recur in the same place it was originally located, or it can migrate to other parts of your body. Recurrence is divided into three categories:
- Local recurrence. This means the cancer reappears in the same place it was first found, or very close by. The cancer hasn't spread to the lymph nodes or other parts of the body.
- Regional recurrence. A regional recurrence occurs in the lymph nodes and tissue located in the vicinity of your original cancer.
- Distant recurrence. This refers to cancer that has spread (metastasized) to areas farther away from where your cancer was first located.
Where your cancer recurs depends on your original cancer type and stage. Some cancer types commonly recur in specific areas. For recurrent nasopharyngeal cancer (NPC), the common sites of relapse are ** :
- nasopharynx
- neck
- distant sites (esp lung, liver & bones)
- combinations of above
- Through tissue. Cancer invades the surrounding normal tissue.
- Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
- Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
Recurrent nasopharyngeal cancer (NPC) (source : http://www.cancer.gov/)
Recurrent nasopharyngeal cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the nasopharynx or in other parts of the body.
Recurrent nasopharyngeal cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the nasopharynx or in other parts of the body.
Treatment options for recurrent NPC (source : http://www.cancer.net/)
Recurrent NPC is treated with radiation therapy, chemotherapy, or in some instances, surgery. Chemotherapy is used for people whose cancer has recurred in distant sites and who were previously treated with radiation therapy only. Chemotherapy may also be used together with radiation therapy (chemoradiotherapy) to improve the effectiveness of the radiation therapy. In addition, a clinical trial of biologic therapy may be an option.
Recurrent NPC is treated with radiation therapy, chemotherapy, or in some instances, surgery. Chemotherapy is used for people whose cancer has recurred in distant sites and who were previously treated with radiation therapy only. Chemotherapy may also be used together with radiation therapy (chemoradiotherapy) to improve the effectiveness of the radiation therapy. In addition, a clinical trial of biologic therapy may be an option.
The following factors may influence the treatment options **:
- disease-free duration - if less than one year, usually no radiotherapy
- extent of recurrence - if too large, radiotherapy is not feasible
- number of previous radiotherapy - not more than 2 courses of RT can be given per patient's lifetime
NPC metastases **
- affect 30% or more of NPC survivors
- bone is most frequent site, followed by lung & liver
- most appear within 18 months of first cancer diagnosis
- usually treated with chemotherapy
- cure & long-term survival possible in some cases
References
** Notes taken from a talk presented by Dr T Tan at NPC support group in Apr 2009 on "Management of NPC Recurrence".
MayoClinic
http://www.mayoclinic.com/health/cancer/CA00050
National Cancer Institite, USA
http://www.cancer.gov/cancertopics/pdq/treatment/nasopharyngeal/Patient/page2
American Society of Clinical Oncology
http://www.cancer.net/patient/Cancer+Types/Nasopharyngeal+Cancer
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