February is marked as Cancer Prevention Awareness Month and while it is well known that cancer in starts when cells begin to grow out of control, few know how to tackle the disease if it reoccurs. It is impossible for your doctor to know for sure if the cancer will recur because it can happen weeks, months, or even years after the primary or original cancer was treated.

What is cancer recurrence?

In an interview with HT Lifestyle, Dr Tejinder Kataria, Chairperson, Radiation Oncology at Cancer Institute, Medanta Hospital in Gurgaon, revealed, “Post the successful completion of treatment, if cancer is detected again, it is known as cancer recurrence. A cancer diagnosis is classified as a recurrence when a person has been cancer-free for at least a year.”

He added, “Unfortunately, a recurrence cannot always be foreseen. It depends on the type of cancer one was originally diagnosed with and treated for, also known as primary cancer. There are certain types of cancers that are much more prone to recurrence than others, such as breast cancer, lung cancer, colorectal cancer, ovarian cancer and kidney cancer.”

Asserting that cancer is classified as a recurrence if after surgery or radiation the patient has been disease-free for 6 months, Dr Tejinder Kataria pointed out that if it presents even at 3 months it is residual, which means that the previous tumour has not gone away. “However, between 3 to 6 months it is recurrence. Time interval between treatment to 3 months is when we expect the tumour to shrink. If it does not go down it is called a progression. If patient free for more than 6 months due to surgery or radiation it is called recurrence,” he said.

Types of cancer recurrence:

Highlighting about the three types of cancer recurrences, Dr Tejinder Kataria listed:

1. Local recurrence – When cancer appears in the same organ as the primary cancer.

2. Regional recurrence – When cancer occurs in organs close to where the primary cancer was detected.

3. Distant recurrence – When it occurs in another part of the body.

Another difference is between progression and recurrence. This depends entirely on the time frame within which the cancer is detected. When the cancer returns within a short period i.e., less than a year and proves to be more aggressive and resistant to treatment, it is known as progression.

Diagnosis:

Good news first, in most cases, cancer recurrence is detected early. Dr Tejinder Kataria shared, “Once the patient has successfully completed treatment for primary cancer, they are on a strict follow-up plan. Their plan entails scheduled and periodic screening, blood tests, administration of oral medication and physical examination. Due to an intensive and thorough follow-up, any indication, sign or symptom that cancer has recurred, helps detect it early and is confirmed through imaging studies, PET scans and biopsies.”

Treatment:

For the uninitiated, recurrent cancers may or may not respond to primary treatment rather than Don not respond at all. Therefore, the treatment needs to be modified depending on the type of recurrence, the extent and the location of the cancer. According to Dr Tejinder Kataria, surgery and radiation therapy can be used for localized recurrences whereas aggressive treatments such as chemotherapy, biological therapy or immunotherapy can be used more effectively against cancer that has metastasized. 

“Local ablative therapies like stereotactic, body radiotherapy and stereotactic radiosurgery are highly effective treatments for distant recurrence if the number of metastasis is less than 5 (oligometastatic disease),” he said. Dr Tejinder Kataria stressed that often the treatment of primary cancer causes significant stress on the patient and this further increases with an incident of recurrence. 

He revealed, “While this may cause a sense of fatigue and anxiety, patients should utilize their experience of fighting primary cancer to their benefit. In many patients, cancer can recur up to two to three times. However, cancer patients can live a good quality of life with proper medication, treatment and follow-ups.”