What is cancer recurrence?

This page was reviewed under our medical and editorial policy by

Vijay Trisal, MD, Chief Medical Officer; Surgical Oncologist, City of Hope | Duarte

This page was updated on July 18, 2023.

Even after removal and treatment, cancer sometimes returns. Doctors call this a cancer recurrence. It may resurface in the same area where it was first found or turn up at another spot in the body.

  • Local recurrence means it’s in the same spot.
  • Regional recurrence refers to the original cancer showing up in tissue or lymph nodes near the original site.
  • Distant recurrence means the cancer has been found in tissue away from the original location.

Your care team names the cancer based on where it originated. So if you had cancer in a breast and it recurred in your bones, it’s still considered breast cancer. When cancer spreads to one or more spots in your body, it’s said to have metastasized.

Cancer may return weeks to years after initial treatment. This risk exists even though no remaining cancer could be found with scans or tests.

Sometimes cancer cells survive radiation and chemotherapy and become resistant to these treatments. In general, the shorter the time between when cancer is first treated and when it reappears, the more aggressive the cancer tends to be.

Recurrence differs from developing a second form of cancer, which is far less common.

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:

  • A patient has recently been diagnosed with cancer.
  • A patient has recently completed treatment.
  • A patient has achieved no evidence of disease (NED) status.

Even in the case of NED status, new symptoms or routine follow-up testing may suggest a recurrence.

When cancer comes back, is it worse? Is recurrent cancer more aggressive?

Recurrent cancer may be more aggressive than the original cancer if it’s already spread to other parts of the body or if it’s become resistant to chemotherapy or radiation therapy. The sooner the cancer returns, the biology of the tumor tends to be more aggressive.

Does cancer always come back?

While cancer doesn’t always return, recurrence is common for some hard-to-treat forms of cancer. These recurrences usually follow certain patterns of local, regional or distant disease. Patients should be aware of these potential developments to look for signs of recurrence so it may be diagnosed as early as possible.

There’s no way to guarantee that cancer won’t return. That said, recurrences are less likely the more time has passed from the original cancer.

Today, many treatments are available to help manage the disease for the rest of a patient’s life. The likelihood of recurrence depends on:

  • The type of cancer
  • How fast it grew initially
  • How advanced it was when doctors first discovered it

Cancer may be more likely to return if it had already spread when it was first detected.

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. Even after a patient undergoes treatment for a recurrence, there's no guarantee that the cancer won't recur again, nor is it possible to tell how many times it may recur.

Risk of recurrence

How likely is the chance of your cancer recurring? It depends upon a few factors, including:

  • Type of cancer
  • Stage of cancer
  • Grade of original tumor
  • Previous treatment
  • Your age and health
  • Family history

Oncologists rate the development of cancer in stages. How staging is performed varies, but the higher the number, the more the cancer has progressed. Once the condition of the primary tumor and any lymph node and metastatic involvement are analyzed, an overall staging number from 1 to 4 is assigned. These are also often divided into substages indicated by letters.

As an example of how staging affects recurrence rate, a large study of Swedish colon cancer patients, published in the Diseases of the Colon & Rectum journal, found that within five years after initial treatment, the recurrence rates were 5 percent for stage 1, 12 percent for stage 2, and 33 percent for stage 3.

Which cancer has the highest recurrence rate?

Cancers with the highest recurrence rates include:

With recurrent breast cancer, most local recurrences happen within five years after treatment of an initial tumor, according to the Susan G. Komen Foundation. The risk for distant or metastasized recurrence remains the same whether you had a lumpectomy and radiation therapy or a mastectomy.

Your tumor’s grade refers to the appearance of tumor cells under a microscope. Tumor cells that resemble normal tissue—called “well-differentiated”—are likely to grow more slowly than those that are abnormal in appearance, termed “undifferentiated” or “poorly differentiated.” The scale for grading typically runs from one to three, with the higher numbers associated with faster-growing tumors and a higher chance of recurrence.

Diagnosis and treatment

As a person who already had cancer, you’ve probably undergone follow-up examinations and various scans and blood tests. If signs are detected that the cancer may have returned, doctors may order more tests and a biopsy (tissue sample) to determine whether the suspicious site is cancerous and whether it’s a recurrence or something new.

If you become aware of physical symptoms you think may indicate cancer has returned, contact your doctor to get checked. Symptoms vary with the type of cancer and location, and they may be caused by reasons other than cancer. Some cancer symptoms include:

  • Lumps or swelling
  • Sores that don’t heal
  • Night sweats
  • Extreme fatigue
  • Unexplained loss or gain of 10 pounds or more
  • Persistent cough or hoarseness
  • Changes in bowel or urinary habits
  • Bloody stools or urine
  • Pain when urinating
  • Problems with swallowing
  • Abdominal pain
  • Nausea
  • Jaundice (yellowish cast to your skin or the white of your eyes)

How your medical team treats the recurrence depends on the type of cancer, whether the cancer is local or has spread and factors such as whether it’s resistant to chemotherapy or other therapies.

For example, with prostate cancer, where the only sign of recurrence is an increase in a specific protein created in the prostate (called prostate-specific antigen or PSA), your doctor and you may decide to simply keep track of it and not intervene unless further progression is seen. If prostate cancer has spread to other parts of the body, hormone therapy, targeted therapy or immunotherapy may be recommended.

Your doctor may use the terms “complete remission” or “partial remission/partial response” after you have undergone treatment.

  • Complete remission means tests show no detectable cancer in the body.
  • Partial remission/partial response means the cancer has responded but has not been eliminated.

If the cancer has returned and spread to distant sites, it’s called metastatic cancer. Common sites for distant tumors are the bones, liver and lungs, but cancer may spread to any tissue. Metastatic cancer symptoms depend on the size and location of tumors—and not all metastatic cancer results in symptoms.

Below are some common areas of the body and the associated symptoms.

  • Bones: Broken bones and pain
  • Liver: Jaundice or swollen abdomen
  • Lungs: Difficulty breathing
  • Brain: Dizziness, headaches or seizures

If you’re diagnosed with recurrent cancer that has spread to distant sites, treatment usually focuses on trying to control its growth. Efforts to maintain quality of life and reduce discomfort, called palliative care, may also be made. If your cancer progresses and can no longer be controlled, you and your doctor may discuss end-of-life care.

Your doctor may suggest a clinical trial, which evaluates the safety and effectiveness of new approaches to treating cancer, either with new drug development, new technologies or by using existing treatments in new ways.

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 cancer’s spread—and don’t forget to inquire about their possible side effects. If you’re interested in entering a clinical trial, your doctor may recommend one that's appropriate for you.

You may consider trying supportive care 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 you’re taking. If you're taking vitamins or supplements that may interfere with your treatments, your doctor may ask you to stop taking them temporarily.

When describing your prognosis, your doctor may use statistical terms, like those below, about estimating survival of cancer.

  • Disease-free or recurrence-free survival: The percentage of patients with no detectable cancer during a set time period
  • Cancer-specific or disease-specific survival: How many patients died from the disease
  • Overall survival: The percentage of patients with the same type and stage of cancer who have survived during a set time period after diagnosis

Finding support

Learning that your cancer has returned may be frightening and depressing, and it may fill you with uncertainty about the future. You’ve already gone through this trauma before—now it’s back. You may worry about what it means to you, your family, job and finances.

Sharing your feelings with other people in similar circumstances may help. By joining a support group, you may ask peers how they deal with issues related to cancer. Participating in a support group may improve your quality of life and reduce anxiety and the risk of depression. If you desire professional help, psychological counseling may assist you with difficult feelings and examine your experience with cancer.

Some patients find a sense of control over their diagnosis by making healthier choices about diet, exercise and mental self-care. You may also take strength from your past experience with cancer, the knowledge you gained from it, and the relationships you formed with your care team.

Since excess weight has been linked to a higher risk of cancer, your care team will recommend that you follow a balanced, nutrient-rich diet and maintain a healthy weight. Avoid or limit red meat, refined grains, sugars and alcohol. Eat plenty of vegetables of various colors, and be sure to include beans and peas, which contain fiber and protein.

Ask your doctor what level of exercise is appropriate for you. Activity improves your physical condition—not only your strength and endurance—and it may also lower symptoms of pain, fatigue, nausea and diarrhea and decrease the risk of recurrence. It may better your mental outlook, lessen anxiety and raise your self-esteem.

Help is out there. The U.S. Centers for Disease Control and Prevention and the National Cancer Institute have websites packed with information on cancer treatments, statistics and advice for patients and caregivers.

The American Cancer Society and other nonprofit organizations provide information and services tailored to patients, families and caregivers. Some organizations are dedicated to a specific type of cancer, such as breast cancer, leukemia and lymphoma. Organizations may be local or regional, and some offer rides to treatment appointments, financial advice or assistance, free meals, or help with household chores. Your care team may be able to guide you toward what’s available in your area.

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