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12 steps to help cope when cancer returns

When cancer returns
Here are some steps you may take to help feel more empowered after a cancer recurrence.

Many cancer patients live with the thought that their cancer may return. And that’s understandable. Depending on several factors, many cancers may return years after treatment has ended. The chances of your cancer recurring may vary depending on your age and overall health and on several other factors, including:

  • The type or subtype cancer
  • The stage of the original cancer
  • The type of treatment you had
  • How long it’s been since your treatment

The news that your cancer has returned probably leaves you with a lot of new questions and concerns. Among the biggest challenges during this time is uncertainty about what’s ahead. It may help first to understand what cancer recurrence is and how it’s treated or managed.

What is cancer recurrence?

A recurrence, or recurrent cancer, develops when the same cancer resurfaces in the body after a period of time following treatment and post-treatment scans that showed no evidence of disease. Although it’s possible to develop a new cancer unrelated to the original cancer, recurrence is more common.

Put another way, a recurrence is a regrowth of the original disease. It means a small number of cancer cells may have been left behind after treatment. The cancer cells may have been too small to be detected in follow-up tests. Or sometimes, they lie dormant, buried in bone or a distant organ. Over time, these cells may become active, divide and grow into detectable tumors.

Although cancer recurrence is generally unpredictable, aggressive cancers and those originally diagnosed in advanced stages tend to return more often.

Types of cancer recurrence include:

Local recurrence, when the cancer returns to the same location as the original cancer

Regional recurrence, when the cancer returns to the lymph nodes or tissues near the primary site

Metastasis, sometimes called distant recurrence, when the cancer returns to organs or tissues far from the original site, most often the liver, lungs, lymph nodes and bones

Even when cancer has spread to a new location, it’s still named after the part of the body where it originated. For example, breast cancer that has spread to the bones is breast cancer with bone metastases. Metastatic cancer is considered advanced if it has aggressively spread to many places in the body, is affecting vital organs or cannot be removed.

What about treatment?

When cancer recurs, it doesn't mean that the treatment you received was wrong or that you did something to cause the recurrence. Cancer may return even if you've taken steps to reduce your risk of recurrence, such as eating right, exercising and seeing your doctor for follow-up visits.

You may have heard that cancer is more difficult to treat the second time around. However, a cancer recurrence does not mean you are without options and hope. Advanced treatment methods and technologies, as well as clinical trials, may provide new options to help treat recurrent cancer and/or manage its symptoms.

Although local cancer may be easier to treat than regional or distant cancer, all three come with their own options. Surgery and radiation therapy are common treatment options for cancer that recurs locally. If the cancer returns to a distant site, treatment may depend on whether the cancer may be removed with surgery. If it can’t, various forms of chemotherapy, radiation therapy or immunotherapy may be options.

Sometimes, the goal of treatment is to relieve symptoms. Palliative treatments are intended to help relieve cancer-related pain and other side effects, and to help improve quality of life. These treatments are much like the treatments used to fight cancer.

Your treatment options may depend on the cancer type, your previous treatments, the length of time between the original diagnosis and recurrence, the location of the recurrence, the extent of spread and your age, overall health and personal goals. It’s important to weigh the potential pros of a new treatment against the possible cons, such as side effects, to decide what may be best for you.

Adjusting to the news

News of cancer recurrence may be upsetting for you and your loved ones. With the return of cancer come the shock, fear and uncertainties that accompanied your first diagnosis. You may wonder about your future and feel discouraged at the thought of having to undergo treatments again. You may still be recovering physically and emotionally from your previous battle with the disease. You may be disappointed in your health care team, or blame yourself for past treatment decisions or lifestyle choices. You may feel anxious, sad, guilty, desperate or angry. These feelings are all a normal part of cancer recurrence.

Everyone handles cancer recurrence differently. While it may be difficult to accept the news at first, know that you’re not alone. Here are some 12 steps you may take to help cope with the situation and help feel more empowered after a cancer recurrence:

Acceptance. You may wonder if you did anything to make the cancer come back. Although this feeling is normal, you shouldn’t blame yourself. Try not to focus on what could have been. Instead, try to accept the situation and use your inner strength to move forward.

Do what is right for you. When cancer returns, your treatment goals may change, or they may be the same as with your first diagnosis. Think about what’s important to you now and make thoughtful decisions about your treatment. And, let your cancer team know your goals. Only you can decide what’s best for you.

Set goals. Develop a plan that helps you live your life as fully as possible. It may help to set both short-term and long-term goals. Set small goals for each day, such as taking a walk, making a phone call, having lunch with a friend, reading a chapter of a book, etc. With places to go and things to do, you may feel more productive and fulfilled while getting your mind off cancer.

Use lessons learned from the past. You’ve already battled cancer before. You’re more experienced and knowledgeable this time around. Use what you learned in the past to deal with your present situation. Remember that as difficult as it was, you got through it. The same coping skills you used during your initial treatment may give you the strength and confidence you need now.

Manage your symptoms. The symptoms of cancer recurrence may impact your quality of life. It’s essential that you work with your cancer team to manage your symptoms, such as pain, fatigue, difficulty sleeping, etc. Improving physical symptoms may also improve your mood and overall well-being.

Seek emotional support. Feeling angry and upset about a cancer recurrence is normal. It’s important to find support so you can express these feelings. Aside from sharing with family and friends, it helps to share feelings and concerns with others who are dealing with cancer recurrence and have been where you are now. In addition to support groups, you may also decide to seek private counseling.

Nurture your spiritual well-being. Spirituality is a source of strength for many people. Cancer recurrence may make you think about your beliefs. You may find comfort in exploring more deeply what’s meaningful to you. Praying, meditating, spending time in nature or writing in a journal are just a few of the ways you may nurture your spiritual well-being.

Share with your loved ones. Your loved ones may also need time to adjust to the news, come to terms with their own feelings and adjust to changing family roles. Remind your family and friends that you’re still the same person you always were. Let them know that they can support you just by listening and being at ease with you.

Plan ahead. Even when you’re healthy, it helps to be prepared and make provisions for your family if the worst happens. Although it’s difficult to talk about these issues, if you haven’t already done so, you may decide to update your affairs through an advance directive or living will. Planning ahead may also help you worry less about the future, take control of the situation and protect those you love most.

Be open with your cancer team. Speak openly about your needs and concerns with your cancer team. Take the time to discuss the available options with your doctors and your family members. Even if you’re happy with your current doctor, this might be a good time to get a second opinion to explore options you may not know are available to you. You need to be comfortable with your decisions.

Do things you enjoy. Try to participate in activities that matter most to you. Creative outlets, such as drawing, painting, music and poetry, may help you express yourself and relieve stress. You may also choose to keep a journal, read a book, watch a funny movie, go fishing, make a scrapbook and spend time with family and friends.

Stay hopeful. When cancer returns, it may change the way you look at life. It's important to stay hopeful. You may have hope for new treatment options, for relief from symptoms or for good times with family and friends. Hope may motivate you and make you feel empowered.

Learn how some treatments may increase risk of second cancers.