What Is Cancer Recurrence?

Sometimes, cancer comes back after treatment. When it does, it's called cancer recurrence. The cancer might come back in the same place it first started, or it might come back somewhere else in the body.

Understanding cancer recurrence can help survivors take better care of their health. Learn about different types of recurrence, possible signs and symptoms, lowering the risk, and strategies to cope emotionally.

What are the types of recurrence?

There are different types of cancer recurrence:

• Local recurrence means the cancer has come back in the same place it first started.
• Regional recurrence means the cancer has come back in the lymph nodes near the place it first started.
• Distant recurrence means the cancer has come back in another part of the body.

Even if the cancer comes back in a new part of the body, it’s still named after the part of the body where it started.

If your cancer recurs, your cancer care team can give you the best information about what type of recurrence you have and what it means, if you'd like to know. They can also talk with you about different options for treatment and your outlook (prognosis). If your cancer care team thinks this could be a second cancer (a different type of cancer), they can talk with you about testing to find out what is happening.

Why does recurrence happen?

Cancer recurrence may happen because:

• The surgery done to take out the cancer didn’t get all of it. Tiny clusters of cancer cells that couldn’t be seen or found on scans or other tests were left behind. They may lay dormant in the body for a period of time. Most of the time, your immune system can find and destroy these leftover cells. But sometimes, the remaining cells keep growing and dividing until there are enough to be found during follow-up exams and tests. These cancers tend to be very aggressive (fast-growing and quick to spread).
• The cancer has become hard to treat or resistant to treatment. Cancer cells can become resistant to treatment just like germs can become resistant to antibiotics. In this case, chemo or radiation may not have killed all the cancer cells. These cancer cells can then grow and cause problems again.

What’s the difference between recurrence and progression?

Sometimes it’s hard to tell the difference between recurrence and progression. Recurrence means the cancer has come back. Progression means the cancer is growing or spreading without ever having gone away completely. 

For example, if cancer has not been found for a short time before it comes back, it was probably not completely gone and is likely not really a recurrence. In this case, it’s important to talk about a care plan with your cancer care team.

There’s no standard length of time to decide if it’s recurrence or progression. But most doctors consider recurrence to be cancer that comes back after you’ve had no signs of it for at least a year.

How likely is cancer recurrence?

It’s usually not possible to say exactly how likely it is that a cancer will recur. It depends on the type of cancer, its stage, how aggressive it is, and how effective the initial treatment was. Cancer recurrence rates can help give you an idea of what to expect based on the cancer type.

Scientists are studying genetic tests that may predict how likely it is that cancers such as breast, colon, and melanoma will come back. There are methods that can help estimate the chance of recurrence for a few types of cancer.

Recurrence is more likely and harder to treat if a cancer is:

• Fast-growing
• More advanced or widespread

Cancer recurrence can happen months to years after you finish treatment. Most often, it happens within the first 5 years after diagnosis and treatment.

Signs and symptoms of a recurrence

Whenever you have a symptom, your first thought might be that your cancer has come back. Remember that there are illnesses and medical problems that have nothing to do with your previous cancer. You can still get colds, infections, arthritis, heart problems, and so on – just like anyone else.

Symptoms of recurrence can vary and often depend on the type of cancer you had. Check with your cancer care team for a list of common signs of recurrence for your type of cancer.

There are a few symptoms that could mean serious problems. If you have any of the problems listed below, tell your cancer care team:

• Return of previous cancer symptoms (like a lump or new growth at the original site)
• New lumps, bumps, or swelling with no known causes
• Unexplained pain that doesn’t go away
• Weight loss without trying
• Easy bleeding or bruising
• Rashes or allergic reactions (swelling, severe itching, wheezing)
• Chills, fevers, or frequent headaches
• Shortness of breath or cough that doesn’t go away
• Blood in stool or urine
• Nausea, vomiting, diarrhea, loss of appetite, or trouble swallowing
• Any other unusual symptoms your cancer care team has talked to you about or that you can’t explain

What can be done to prevent cancer recurrence?

There’s no sure way to prevent cancer from coming back after treatment, but you can lower your risk.

Managing fear of cancer recurrence

Fear and anxiety are normal parts of survivorship. Worrying about cancer coming back is common and usually most intense the first year after treatment. This worry usually gets better over time, and you should let your cancer care team know if it does not. 

How is a cancer recurrence diagnosed?

After finishing your original cancer treatment, you will receive a follow-up care plan, also called a survivorship care plan. The goal of follow-up care is to make sure you are healthy and to watch for a recurrence. Often, a careful exam and conversation will be the focus of follow-up care.

Depending on the type of cancer you had, you may need blood tests or imaging scans. Your doctor may tell you to watch for specific signs or symptoms of recurrence.

If your doctor suspects the cancer is coming back, you will likely need other tests to learn more. These may include lab tests such as blood and urine tests, imaging scans, or a biopsy.

How is cancer recurrence treated?

If your cancer comes back, your doctor will talk with you about treatment options and how helpful each one is likely to be.

Be sure you understand the goal of each treatment you are considering. Goals may include:

• To control the cancer
• To cure the cancer
• To make you more comfortable

You might also decide to get a second opinion or get treated at a cancer center that has more experience with your type of cancer.

Clinical trials usually are offered for patients with cancer recurrence, too. If you’re thinking about a clinical trial, you’ll want to know the goal of the clinical trial and its chances of helping you.