Cancer is a formidable challenge, but it is not always a death sentence. With advancing treatments like immunotherapy, even metastatic cancers (stage 4) have the potential for cure. However, understanding the recurrence of cancer and the importance of detecting it early remains paramount. We spoke to our experts Dr Abdeali Saif Arif Kaderi, MS General Surgery, MCh Surgical Oncology, Ad-hoc Assistant Professor, Surgical Oncology, Tata Memorial Hospital, Mumbai and Dr Arif Ehasanali Kaderi, MS Surgical Oncology, Professor and Head, General Surgery, ACPMMC, Dhule, ex alumni-Tata Memorial Hospital, Mumbai, who explained causes of recurrence of cancer and how to detect it early.
How and Why Does Cancer Recur?
“The recurrence of cancer is linked to the ability of cancer cells to spread to other organs. Early-stage cancers tend to recur less frequently than advanced ones because cancer cells can break through barriers and spread through the bloodstream to other organs, creating new growths”, said Dr Arif Kaderi.
Dr Ehasanali Kaderi added, “Additionally, cancer cells can evade the body's immune system. Cancer cells gain the ability to camouflage with normal body cells and get away without getting policed by the immune cells. While some cells remain locally near the tumour, others reach various organs.”
Sometimes, cancer cells remain dormant for years before re-emerging. Based on the location, cancer may recur in the original site (local recurrence) or a different organ (distant recurrence).
Indolent cancers recur late, in years or decades later, for example, hormone-positive breast cancers, while aggressive cancers recur early, within months. Sometimes, tumours recur in the same site after a large time gap. Such tumours are called ‘second primary’ and are biologically different from the first disease.
According to a 2008 study, 7-13% of breast cancer patients had recurrence within five years post-treatment, with higher stages posing greater risks. Radical prostatectomy led to a 25% recurrence rate in prostate cancer. Lung cancer recurrence rates vary from 30–75%. Adenomas linked to colorectal cancer recur in 40–50% of patients, while stage II and III colon cancer recur in about 33% of cases.
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Detecting Cancer Early
“We may not prevent it, but we may be able to catch it early. Even after complete treatment of cancer in the form of surgery, chemotherapy and radiotherapy, cancers recur. This connotes that treatment does not end with the disappearance of the tumour”, added Dr Arif Kaderi.
He added, “It is a continuous process. In the first three years, cancer survivors are surveyed three or four times a month, and in the next two years, they are surveyed six times a month. This surveillance includes blood tests of biomarkers and imaging to look for recurrence. Further, follow-up of the survivors is yearly or tailored to patients’ requirements.”
Chemotherapy is given after surgery, even after tumour removal. This chemotherapy works to eliminate micrometastasis (small clusters of cancer cells that have spread from a primary tumour to other parts of the body). Similarly, tumours that are slow-growing and depend on body growth factors like hormones respond to hormone therapy by having a reduced recurrence.
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What You Should Do
Dr Ehasanali Kaderi said, “Apart from systematic follow-up with an oncologist, one must adopt the habit of self-examination once a month. If one detects any abnormality like a lump, report it to the oncologist immediately. Limited recurrences are treatable and sometimes curable, especially if detected early.”
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What To Expect
The outcome of recurrence depends on where it occurs and whether it can be treated effectively.
For example, colon cancer with a small recurrence in the liver and the remnant colon may be treated by surgery and chemotherapy. If one of the sites is not addressable by any of the modalities, the disease is incurable.
The goal of treatment is to control the disease and improve the quality of life using chemotherapy and pain relief medicines, as surgery has a limited role in such cases. Apart from treating the disease or the scan, treating the patient is as important. Physical, social and spiritual aspects are equally important in patient care at this stage.
[Disclaimer: This article contains information provided by registered healthcare professionals and is for informational purposes only. Hence, we advise you to consult your expert for a treatment approach tailored to your needs and medical history.]