When cancer comes back

You underwent cancer treatment and spent some time in remission. But now you’ve received the news that your cancer has come back. That’s called a recurrence.

How likely is that to happen? It depends. Talk to your cancer care team about your situation. Recurrence chances are different for each type of cancer, according to the American Cancer Society (ACS). It also depends on other things, such as the stage of cancer you had and how long it’s been since you were first diagnosed.

For example, a recent study found that just 5% of patients who had stage 1 colon cancer had a recurrence within five years. But that number increased to 33% in those with stage 3 cancer.

Getting cancer again can be scary. Lots of people feel anger, says Claire Conley, Ph.D., a psychologist who specializes in cancer. “The first time you have cancer, you might be thinking, Why me?” she says. “The second time, it’s Why me again? People may feel like they won’t be able to get back on track after being derailed for a second time.”

But here’s some positive news: You’ve been through it before. You can use the skills you learned to get through it again. Here are three strategies that can help.

1. Learn about cancer recurrence

Recurrence isn’t the same as getting a second kind of cancer. The same cancer might come back in the place it originally started, or somewhere else in your body, says the ACS.

For example, if you had breast cancer and it comes back in your liver, it’s still called breast cancer. Lab tests will show whether the same cancer has returned, or whether you have a completely different cancer.

Based on exams and tests, your cancer team divides recurrences into groups. They’re based on where the recurrence happens. These groups help them figure out what your treatment will be.

• Local recurrence. This happens in the same place as your original cancer. “Cancer returns at the spot where we thought we’d taken it all out,” says surgical oncologist Debashish Bose, M.D. “That means that at a microscopic level, there was disease left behind.” It just took a little while until your doctor noticed it.
• Regional recurrence. This means that there’s cancer in the lymph nodes close to your original cancer. (Your lymph nodes have cells that fight infection.)
• Distant recurrence. This is when the original cancer happens in another part of your body. “It hasn’t spread directly from where the primary tumor was,” explains Dr. Bose. “It is actually a different, separate site of disease.”

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2. Lean on your cancer care team

You probably already have a cancer care team. They will likely work with you again to map out a treatment plan for your recurrence. “Most of the time, the patient is finding this out from the people who have been treating them,” Dr. Bose says.

Keeping up with your follow-up care might be the reason your recurrence was found. Your team looked for signs that the cancer may have returned. To do that, they may have used regular scans or other tests. “One of the more common ways a recurrence is discovered is because of that process,” says Dr. Bose.

Your previous cancer experience can make it easier to deal with treatment now. You might already know your way around the hospital or the medical system, says Conley. “The second time around, you have some information that you didn’t have the first time.”

Treatments may also have improved since your first bout with cancer, says the National Cancer Institute. There may be new drugs or treatment methods that can help.

3. Find ways to cope with cancer again

Remember all the lessons you learned the first time? You’ll need to lean on them again. When you have a cancer recurrence, you and your care team may focus on your physical health. But don’t forget your emotional health, says Conley. Try these strategies:

Let yourself off the hook. “People often blame themselves if they experience a recurrence,” Conley says. Her main message: “It’s not your fault.” Let go of the guilt and just do your best.

Focus on what you can control. Forget about the things that are out of your hands. Instead, pay attention to what you can control. You can control your everyday lifestyle choices, including healthy eating and physical activity, says Conley.

Keep moving. Getting exercise while you’re in treatment can boost your energy and help you cope with side effects, according to the ACS. Your care team will likely encourage you to be as active as possible.

Channel your emotions. Conley says that many second-time cancer patients feel upset and frustrated. “It’s okay to be angry,” she says. That’s only natural. But she encourages patients to listen to that emotion. “Try to channel it into something that’s helpful or productive for you.”  

For example, one of her patients was upset that a recurrence of cancer had hurt her career. So, she channeled her anger into a new career. She became a cancer advocate, helping others cope with the challenges of cancer.

Be ready for questions. Expect lots of questions from friends, family, and coworkers. People might even offer medical advice you don’t want. Decide in advance what you do and don’t want to talk about. Practice your answers, such as: “Sorry, I’d rather not talk about it” or “My doctor and I have a good plan in place.”

Ask for help. “You might not get the same outpouring of support that you did the first time around,” says Conley. “But don’t be afraid to ask people for help.” Be very clear about what you need, she recommends. For example, ask for practical help, such as meals or rides to the doctor. Or you may just need someone to listen.

Find a support group. Being with others in the same situation can be comforting and practical. Try to find a support group for people with recurrent cancer, rather than one focusing on first-time cancer. Online support groups can be helpful too. Check with your care team or find a group through the American Cancer Society.

Consider seeing a therapist. A mental health professional who specializes in working with cancer patients can help. Ask your care team for a recommendation. Or check with your insurance plan to find a counselor in your network.

Learning that your cancer has come back can be a lot to take in. But remember: Each person’s cancer is different. Keep in touch with your care team, who will recommend the best treatment for you.  

Additional sources:
Recurrence odds: American Cancer Society
Recurrence risk study: Journal of Diseases of the Colon and Rectum 
Recurrence facts: American Cancer Society
Recurrence and new treatments: National Cancer Institute
Exercise and treatment side effects: American Cancer Society

Blue Cross and Blue Shield of Kansas City is an independent licensee of the Blue Cross and Blue Shield Association.