When your cancer comes back

No wonder you’re filled with that whirlwind of emotions you’d hoped you’d left behind – perhaps shock, anxiety, anger and fear. You may be wondering whether you received the right treatment. You may even feel compelled to get a second opinion. But what you really need to do is get an answer to that very important question that’s overwhelming you right now: where to from here?

Cancers recur because microscopic disease may evade detection in the early stages, explains Specialist Physician and Medical Oncologist Dr Keo Tabane. “The cancer can recur locally at the operation site or at a completely new site, and may or may not be operable again. It’s important at recurrence, that your doctor must, as far as possible, confirm the diagnosis with a biopsy - as cancers sometimes mutate when they relapse and a confirmation of the biology of the cancer needs to be made. Following this, scans must be performed to assess the extent of disease using either CT scans or a PET-CT, and to see if the recurrence is potentially operable. This is because in some cancers such as colon cancers, surgery can your prolong life and offer a cure. Treatment of your recurrent cancer may involve surgery, chemotherapy or radiation- alone or combined - depending on the type of cancer and its location.”

Right now, as with every stage of a cancer diagnosis, the best thing you can do is to empower yourself by becoming informed. Dr Tabane advises asking your medical team the following questions:

• Is this still curable?
• Is this the only site of disease recurrence or has the cancer spread?
• Can it be surgically removed?
• What treatment will I need?
• Am I well enough to receive treatment again?
• Can I continue working or should I retire?
• Are there any other treatments available?
• How long will I have treatment? (In most cases the treatment goes on until “disease progression” - meaning until the cancer gets worse again and the treatment is no longer effective, or if a you experience intolerable side effects)
• Is there a clinical trial available for my diagnosis?

Of primary importance is to discuss the aim of the treatment with your doctors as they need to be aware of your expectations and goals. Is it to live longer or is it focused on quality of life even at the cost of a shorter life expectancy? How will the treatment affect you in terms of side effects and is this in line with what you want?  Bearing all of this in mind, your medical team will once again tailor a treatment plan for you based on your wishes and needs. If the treatment is going to be prolonged, treatment holidays can also be discussed.

Now is also the time to talk about palliative care with your medical team, says Dr Tabane. “Even though this is an uncomfortable conversation to have as it often creates anxiety, studies have shown that if palliative care is introduced earlier, patients tend to live longer.  Remember that the purpose here is for planning and is not an exact reflection of what’s going to happen as doctors do not have accurate tools to determine life expectancy. Palliative care specialists work together with your medical team to help with management of pain and other symptoms in order to improve your quality of life”. 

Counselling is essential right now too. It’s important to see a counsellor who has experience with cancer patients as there are feelings that are particular to a cancer recurrence compared to a new diagnosis. These include feelings of disillusionment, fear, confusion and coming face to face with the prospect of potential mortality. A support network of patients who are in a similar position may be of benefit so ask your medical team to put you in touch with one if possible.