What if Cancer Comes Back?

You or a loved one endured multiple rounds of chemo, possibly daily radiation therapy, side effects and other stresses of cancer treatment. You made it through the woods. Yet one persistent worry never leaves your mind: What if it comes back?

No other concern is more universally shared by patients and survivors. And hardly any cancer topic is equally more misunderstood. Can we as patients help prevent it? And what does being a cancer “survivor” really mean?

What is cancer?

Our bodies are made up of trillions of cells. In perfect orchestration, healthy cells divide to create new cells when old or damaged cells die. Sometimes, this process breaks down.

“Cells may start dividing and multiplying out of control,” explains Dr. Matteo Trucco, a pediatric cancer expert at Sylvester Comprehensive Cancer Center, part of the University of Miami Health System. “If they cluster and create a growth of new tissue, it’s called a tumor.”

Dr. Trucco adds that “benign” tumors are made of cells that can’t spread into nearby tissues or organs. Malignant tumors are made of cells that can invade other areas near the tumor. They can even use our blood vessels or lymph systems as superhighways—traveling to other areas of the body to form new tumors.

Three types of “new” cancers

There are three different names for cancers that either return after treatment, spread to other parts of the body or arise months or years later.

• Recurrent cancers – when your original cancer comes back after successful first treatment.
  It is also known as a relapse. It can occur at any point in time. The cells resurfacing are either the same type of tumor cells as before, or mutated versions. You had breast cancer? The new tumor is still made of breast cancer cells, just more of them. If they are growing where your first cancer was, they are called local relapse or recurrence. If they traveled to a different part of the body, they are called a distant relapse. The cells traveled, or metastasized. (If a prostate cancer patient now has a new tumor in his lungs made of prostate cancer cells, the new cancer is not lung cancer. It is called metastatic prostate cancer in the lung.)
• “A secondary cancer is ‘caused’ by the treatment needed to treat the first (primary) cancer,” explains Dr. Trucco. “Young patients treated for Hodgkin’s disease receive radiation therapy to the neck and chest, for example. It is the standard of care. They could later develop thyroid cancer, or other ailments, however. This is because as successful as many radiation, chemotherapy and even immunotherapy drugs are, they are still toxic therapies. Even when we decrease exposure of these treatments to healthy cells, some risk remains.”
• Second primary cancers – Unlike a secondary cancer, a second cancer is indeed a new cancer.
  A person who was treated for one cancer could have a completely different cancer anytime in his or her life. Second primary cancers are unlikely to be related to the first cancer or its treatment.

But I thought I was cured?

“Our cells are living entities,” explains Dr. Trucco. “We may have targeted the tumor cells perfectly. The cells were destroyed. But cancer cells are microscopic in size and mobile—they can move around the body.”

Dr. Trucco adds that sometimes, even before initial diagnosis, some cancer cells have already packed up and moved. They may have found a place either around the corner from their cancer cell friends, or farther away in the body. Then, when their fellow cancer cells are blasted by treatments, they are safely watching from a distance. These clever cells may later start dividing, multiplying and creating new cells and tumors. It’s then and only then that your cancer care team can see them and plan a new treatment plan accordingly.

“The other reason some primary cancer cells show up unexpectedly is that they are able to adapt and change,” explains Dr. Trucco. “Cancer cells can learn how a therapy works. They can mutate to become resistant to treatments. If a cell has protected itself from an attack of chemo or radiation, and escapes, it can someday grow again.”

Become an informed, engaged survivor

Currently, neither science nor medicine can always prevent metastatic (spreading), recurring (relapsing) or secondary cancers.

However, patients can take steps to help prevent a second (unrelated) cancer or recurrent cancer.

The most important step is for any patient to realize that even after five years of being cancer-free, the journey is not over. It just shifts into long-term survivorship.

Vigilance is crucial to catching cancers and other ailments, such as heart disease, diabetes, and skin cancer, when they are still able to be treated successfully. Survivorship programs help patients stick to follow-up appointments, offer nutrition, exercise and stress reduction assistance, referrals to genetic counselors, online and phone support lines, discounted or free tickets to entertainment events and more.

For questions or more information regarding the Sylvester Survivorship program or survivor events, please contact Sylvester Survivorship Care.

John Senall, a contributing writer for UMiami Health News, is a former hospital and comprehensive cancer center communications director.

Tags: cancer, Dr. Matteo Trucco, metastatic, recurrence, relapse, secondary, Survivorship, Sylvester Comprehensive Cancer Center