5 Questions to Ask Your Doctor If Your Cancer Comes Back

Words no one wants to hear are “your cancer has come back.” No matter how long it’s been since your last treatment, learning your cancer has returned can leave you with a lot of questions.

When cancer returns, it’s called a recurrence or a relapse. The likelihood of this happening depends on several factors, including the type and stage of cancer that was first diagnosed.

“For some cancers, the chances of a recurrence are very low. For others, the chances can be much higher. Patients should discuss with their doctor what the estimated probabilities are for them,” said Ignacio Durán, MD, PhD, an American Society of Clinical Oncology (ASCO) expert and medical oncologist at Hospital Universitario Marqués de Valdecilla in Santander, Spain.

Finding out that cancer has recurred can cause uncertainty and raise new concerns. But knowing what to ask your doctor can help you feel better equipped to make decisions and navigate the next phase of care.

1. Where is the cancer located?

Understanding the location and extent of the recurrence helps your doctor decide which treatment options to recommend. Your doctor will likely order tests to determine where and how much the cancer has spread.

“Even if a patient has a successful initial treatment, like surgery, there can already be microscopic cancer cells that we cannot see,” said Dr. Durán. “Months or years later, those microscopic cells can grow and become larger, representing a recurrence.”

Keep in mind that a recurrence is different from a second cancer. A recurrence means the primary tumor, or same original cancer, has come back. It is not renamed and is not staged again. Depending on where the cancer has recurred, it may be referred to as metastatic or advanced cancer. This is different from a second cancer that is a new, different type of cancer and starts somewhere else in the body.

Cancer that comes back in the same place is called a local recurrence. If the cancer comes back near the original area, it’s called a regional recurrence. And if the cancer comes back in a different part of the body, it’s called a distant recurrence.

If your cancer has come back, your doctor might suggest a biopsy to verify that it’s a recurrence instead of a second cancer. “By analyzing those cells through a biopsy, we can confirm whether they are different cells and represent a new tumor,” said Dr. Durán.

2. What are my treatment options?

Your doctor may recommend a similar or different type of treatment plan for a recurring cancer than you had with your initial cancer diagnosis. Either way, you’ll want to understand all your treatment options.

Ask your doctor:

• How these treatment options differ from previous treatment options
• Possible side effects of each treatment
• The expected length of each treatment
• Overall success rates for each treatment

You can also ask whether a clinical trial might be an option for you. Clinical trials are often the best way to get access to new treatments, including for people whose cancer has returned. Your doctor can help you weigh the pros and cons of participating in a clinical trial if one is available to you.

3. What is my prognosis?

Your prognosis describes your outlook and chances of recovering from the cancer. The prognosis received when you were first diagnosed with cancer could change if your cancer returns, especially if it’s a distant recurrence.

“A recurrence normally has a different prognosis than a primary tumor, so patients should ask their doctors about this. Talking openly about it will help you understand how to approach the situation,” said Dr. Durán.

Even though your prognosis may be different if your cancer returns, many recurrent cancers respond well to treatment. The type of treatment recommended for a cancer recurrence can also have an impact on your prognosis.

4. What is the goal of treatment?

To decide which treatment is right for you, you and your doctor will consider your overall treatment goals. For example, treatment can be given to cure the cancer, control the growth of the cancer, or relieve symptoms of the cancer. “If the recurrence is local, it can normally be treated with the intent to cure the disease. If the recurrence is distant, in many cases the goal is more controlling the disease rather than curing it,” said Dr. Durán.

Let your doctor know what matters most to you about getting treatment again. Your personal preferences can help them recommend the best treatment options for your situation. For example, you may have experienced certain side effects with your last treatment that you’d like to avoid this time. Your doctor will consider your wishes when making recommendations.

5. Where can I find support to help me cope?

A cancer recurrence can bring up different feelings and support needs for different people. You may feel lonely or isolated, angry, or withdrawn. You may need more support or different kinds of support than you did with your initial diagnosis. Everything you’re feeling is normal, and there are people and resources that can help.

Ask your doctor or nurse about support groups. If your treatment center doesn’t have support groups, ask about other ones in your area. Some communities or treatment centers may even have support groups for people with specific types of cancer.

“A recurrence can be very stressful and concerning for patients,” said Dr. Durán. “But receiving support from your community and your care team can help make it easier.” 

Dr. Durán is a member of ASCO’s Patient Information Advisory Committee.