Completing treatment can be both stressful and exciting. Youwill likely be relieved to finish treatment, yet it is hard not to worry about cancer coming back. (When cancer returns, it is called recurrence.) This is a very common concern among those who have had cancer. For more information on this please refer to our document, Living With Uncertainty: The Fear of Cancer Recurrence.

It may take a while before your confidence in your own recovery begins to feel real and your fears are somewhat relieved. Even with no recurrences, people who have had cancer learn to live with uncertainty.

Follow-up care

After treatment is completed, it is very important to go to all scheduled follow-up appointments. During these visits, your doctors will ask about any symptoms and may do physical exams and order lab or imaging tests as needed to look for recurrences or side effects. Almost any cancer treatment can have side effects. Some may last for a few weeks to several months, but others can be permanent. You should never hesitate to tell your doctor or other members of your cancer care team about any symptoms or side effects that concern you.

At first, your follow-up appointments will probably be scheduled for every few months. The longer you have been free of cancer, the less often the appointments are needed. After 5 years, they are typically done about once a year.

Mammograms of your opposite breast will be recommended yearly and the breast that had the cancer will be evaluated as well with a mammogram if it has not been completely removed by a mastectomy.

If you are taking an aromatase inhibitor, you may be at increased risk for thinning of the bones. Your doctor may want to monitor your bone health and may consider testing your bone density.

Other tests such as blood tumor marker studies, blood tests of liver function, bone scans, and chest x-rays are not usually needed unless symptoms or physical exam findings suggest it is likely the cancer has recurred.

If exams and tests suggest cancer may have recurred, imaging tests such as a chest x-ray, CT scan, PET scan, MRI scan, bone scan, and/or a biopsy may be done. Your doctor may also measure levels of blood tumor markers such as CA15-3 or CA27-29. The blood levels of these substances go up in some men if their cancer has spread to bones or other organs such as the liver.

If cancer does recur, treatment will depend on the location of the cancer and what treatments you've had before. It may include surgery, radiation therapy, hormone therapy, chemotherapy, targeted therapy, or some combination of these. For more information on how recurrent cancer is treated, see the section "How is breast cancer in men treated?" For more general information on dealing with a recurrence, you may also want to see our document, When Your Cancer Comes Back: Cancer Recurrence.

Lymphedema

Lymphedema, or swelling of the arm due to buildup of fluid, may occur any time after treatment for breast cancer. Any treatment that involves axillary lymph node dissection or radiation to the axillary lymph nodes carries the risk of lymphedema because normal drainage of lymph fluid from the arm is changed.

One of the first symptoms of lymphedema may be a feeling of tightness in the arm or hand on the same side that was treated for breast cancer. Any swelling, tightness, or injury to the arm or hand should be reported promptly to your doctor or nurse.

There is no good way to predict who will and will not develop lymphedema. It can occur right after surgery, or months, or even years later. The possibility of developing lymphedema remains throughout a man's lifetime.

With care, lymphedema can often be avoided or, if it develops, kept under control. Injury or infection involving the affected arm or hand can contribute to the development of lymphedema or make existing lymphedema worse, so preventive measures should focus on protecting the arm and hand. Most doctors recommend that men avoid having blood drawn from or blood pressures taken on the arm on the side of the lymph node surgery or radiation.

To learn more, see our document, Lymphedema: What Every Woman With Breast Cancer Should Know (the information also applies to men).

Emotional aspects of breast cancer

It is important that your focus on tests and treatments does not prevent you from considering your emotional, psychological, and spiritual health as well. Once your treatment ends, you may find yourself overwhelmed by emotions. This happens to a lot of people. You may have been going through so much during treatment that you could only focus on getting through your treatment.

Now you may find that you think about the potential of your own death, or the effect of your cancer on your family, friends, and career. You may also begin to re-evaluate your relationship with your spouse or partner. Unexpected issues may also cause concern, for instance, as you become healthier and have fewer doctor visits, you will see your health care team less often. That can be a source of anxiety for some.

This is an ideal time to seek out emotional and social support. You need people you can turn to for strength and comfort. Support can come in many forms: family, friends, cancer support groups, church or spiritual groups, online support communities, or individual counselors.

Almost everyone who has been through cancer can benefit from getting some type of support. What's best for you depends on your situation and personality. Some people feel safe in peer-support groups or education groups. Others would rather talk in an informal setting, such as church. Others may feel more at ease talking one-on-one with a trusted friend or counselor. Whatever your source of strength or comfort, make sure you have a place to go with your concerns.

The cancer journey can feel very lonely. It is not necessary or realistic to go it all by yourself. And your friends and family may feel shut out if you decide not to include them. Let them in -- and let in anyone else who you feel may help. If you aren't sure who can help, call your American Cancer Society at 1-800-227-2345 and we can put you in touch with an appropriate group or resource.

Seeing a new doctor

At some point after your cancer diagnosis and treatment, you may find yourself in the office of a new doctor. Your original doctor may have moved or retired, or you may have moved or changed doctors for some reason. It is important that you be able to give your new doctor the exact details of your diagnosis and treatment. Make sure you have the following information handy:

• A copy of your pathology report(s) from any biopsy or surgery
• If you had surgery, a copy of your operative report(s)
• If you were hospitalized, a copy of the discharge summary that doctors must prepare when patients are sent home
• If you had radiation therapy, a summary of the type and dose of radiation and when and where it was given
• If you had systemic therapy (hormone therapy, chemotherapy, or targeted therapies), a list of your drugs, drug doses, and when you took them

It is also important to keep your health insurance. Even though no one wants to think of their cancer coming back, it is always a possibility. If it happens, the last thing you want is to have to worry about paying for treatment.

Lifestyle changes to consider during and after treatment

You can't change the fact that you have had cancer. What you can change is how you live the rest of your life -- making healthy choices and feeling as well as possible, physically and emotionally. Having cancer and dealing with treatment can be time-consuming and emotionally draining, but it can also be a time to look at your life in new ways. Maybe you are thinking about how to improve your health over the long term. Some people even begin this process during cancer treatment.

Make healthier choices

Think about your life before you learned you had cancer. Were there things you did that might have made you less healthy? Maybe you drank too much alcohol, or ate more than you needed, or smoked, or didn't exercise very often. Emotionally, maybe you kept your feelings bottled up, or maybe you let stressful situations go on too long.

Now is not the time to feel guilty or to blame yourself. However, you can start making changes today that can have positive effects for the rest of your life. Not only will you feel better but you will also be healthier. What better time than now to take advantage of the motivation you have as a result of going through a life-changing experience like having cancer?

You can start by working on those things that you feel most concerned about. Get help with those that are harder for you. For instance, if you are thinking about quitting smoking and need help, call the American Cancer Society at 1-800-227-2345.

Diet and nutrition

Eating right can be a challenge for anyone, but it can get even tougher during and after cancer treatment. For instance, treatment often may change your sense of taste. Nausea can be a problem. You may lose your appetite for a while and lose weight when you don't want to. On the other hand, some people gain weight even without eating more. This can be frustrating, too.

If you are losing weight or have taste problems during treatment, do the best you can with eating and remember that these problems usually improve over time. You may want to ask your cancer team for a referral to a dietitian, an expert in nutrition who can give you ideas on how to fight some of the side effects of your treatment. You may also find it helps to eat small portions every 2 to 3 hours until you feel better and can go back to a more normal schedule.

One of the best things you can do after treatment is to put healthy eating habits into place. You will be surprised at the long-term benefits of some simple changes, like increasing the variety of healthy foods you eat. Try to eat 5 or more servings of vegetables and fruits each day. Choose whole grain foods instead of white flour and sugars. Try to limit meats that are high in fat. Cut back on processed meats like hot dogs, bologna, and bacon. Get rid of them altogether if you can. If you drink alcohol, limit yourself to 1 or 2 drinks a day at the most. And don't forget to get some type of regular exercise. The combination of a good diet and regular exercise will help you maintain a healthy weight and keep you feeling more energetic.

Weight

Most studies done in women have found that those who are overweight or obese at the time of diagnosis are more likely to have their disease recur and are more likely to die from breast cancer. Some studies have found that women with a history of breast cancer who gained significant amounts of weight after diagnosis were also more likely to relapse and more likely to die than were women who gained less weight. However, other recent studies have not found an effect of weight gain on prognosis.

While these studies have not been done in men with breast cancer, you should be aware of the possible link between weight and breast cancer outcomes. Talk to your doctor about what your ideal weight should be and ways to get to it and stay there. In some cases, a modest weight loss program may even be started during treatment, if the doctor approves.

Rest, fatigue, work, and exercise

Fatigue is a very common symptom in people being treated for cancer. This is often not an ordinary type of tiredness but a "bone-weary" exhaustion that doesn't get better with rest. For some, this fatigue lasts a long time after treatment, and can discourage them from physical activity.

However, exercise can actually help you reduce fatigue. Studies have shown that patients who follow an exercise program tailored to their personal needs feel physically and emotionally improved and can cope better. Also, recent studies in women suggest that breast cancer survivors who are physically active have lower rates of recurrence and lower death rates than those who are inactive.

If you are ill and need to be on bed rest during treatment, it is normal to expect your fitness, endurance, and muscle strength to decline some. Physical therapy can help you maintain strength and range of motion in your muscles, which can help fight fatigue and the sense of depression that sometimes comes with feeling so tired.

Any program of physical activity should fit your own situation. An older person who has never exercised will not be able to take on the same amount of exercise as a 20-year-old who plays tennis 3 times a week. If you haven't exercised in a few years but can still get around, you may want to think about taking short walks.

Talk with your health care team before starting, and get their opinion about your exercise plans. Then, try to get an exercise buddy so that you're not doing it alone. Having family or friends involved when starting a new exercise program can give you that extra boost of support to keep you going when the push just isn't there.

If you are very tired, though, you will need to balance activity with rest. It is okay to rest when you need to. It is really hard for some people to allow themselves to do that when they are used to working all day or taking care of a household. (For more information about fatigue, please see our documents, Fatigue in People With Cancer and Anemia in People With Cancer.)

Exercise can improve your physical and emotional health.

• It improves your cardiovascular (heart and circulation) fitness.
• It strengthens your muscles.
• It reduces fatigue.
• It lowers anxiety and depression.
• It makes you feel generally happier.
• It helps you feel better about yourself.

And long term, we know that exercise plays a role in preventing some cancers. The American Cancer Society, in its guidelines on physical activity for cancer prevention, recommends that adults take part in moderate to vigorous physical activity for at least 30 minutes on 5 days or more of the week. Moderate activities are those that take about as much effort as a brisk walk. Vigorous activities use larger muscle groups, make you sweat, and cause a noticeable increase in heart rate and breathing.

What happens if treatment is no longer working?

If cancer continues to grow after one kind of treatment, or if it returns, it is often possible to try another treatment plan that might still cure the cancer, or at least shrink the tumors enough to help you live longer and feel better. On the other hand, when a person has received several different medical treatments and the cancer has not been cured, over time the cancer tends to become resistant to all treatment. At this time it's important to weigh the possible limited benefit of a new treatment against the possible downsides, including continued doctor visits and treatment side effects.

Everyone has his or her own way of looking at this. Some people may want to focus on remaining comfortable during their limited time left.

This is likely to be the most difficult time in your battle with cancer -- when you have tried everything medically within reason and it's just not working anymore. Although your doctor may offer you new treatment, you need to consider that at some point, continuing treatment is not likely to improve your health or change your prognosis or survival.

If you want to continue treatment to fight your cancer as long as you can, you still need to consider the odds of more treatment having any benefit. In many cases, your doctor can estimate the response rate for the treatment you are considering. Some people are tempted to try more chemotherapy or radiation, for example, even when their doctors say that the odds of benefit are less than 1%. In this situation, you need to think about and understand your reasons for choosing this plan.

No matter what you decide to do, it is important that you be as comfortable as possible. Make sure you are asking for and getting treatment for any symptoms you might have, such as pain. This type of treatment is called "palliative" treatment.

Palliative treatment helps relieve these symptoms, but is not expected to cure the disease; its main purpose is to improve your quality of life. Sometimes, the treatments you get to control your symptoms are similar to the treatments used to treat cancer. For example, radiation therapy might be given to help relieve bone pain from bone metastasis. Or chemotherapy might be given to help shrink a tumor and keep it from causing a bowel obstruction. But this is not the same as receiving treatment to try to cure the cancer.

At some point, you may benefit from hospice care. Most of the time, this is given at home. Your cancer may be causing symptoms or problems that need attention, and hospice focuses on your comfort. You should know that receiving hospice care doesn't mean you can't have treatment for the problems caused by your cancer or other health conditions. It just means that the focus of your care is on living life as fully as possible and feeling as well as you can at this difficult stage of your cancer.

Remember also that maintaining hope is important. Your hope for a cure may not be as bright, but there is still hope for good times with family and friends -- times that are filled with happiness and meaning. In a way, pausing at this time in your cancer treatment is an opportunity to refocus on the most important things in your life. This is the time to do some things you've always wanted to do and to stop doing the things you no longer want to do.

Last Medical Review: 01/14/2010
Last Revised: 01/14/2010