Introduction

Every cancer survivor knows the fear of a cancer recurrence. It is one of the most common worries that plague a cancer survivor, even when you hear the words cancer-free. Cancer recurrence is a common anxiety-inducing problem, filling survivors with uncertainty, and the dread and stress accompanying thoughts of recurrence can be disheartening and discouraging.

What is cancer recurrence?

Recurrence or relapse is defined as ‘the return of a disease or the signs and symptoms of a disease after a period of improvement.’ Cancer recurrences are more common than you think. Most cancers come back in the first two years or so after remission. The possibility of relapse reduces as more time passes. In rare instances, there is also a possibility of developing a new cancer drastically different to your initial type of cancer. This is called second primary cancer.

What causes cancer recurrence?

Some cancers recur due to one of two ways:

• The initial treatment didn’t eradicate all the cancer cells, and these cells now form a new tumour.
• Some of the malignant cells spread to other parts of the body and develop into a tumour in a new location.

Types of cancer recurrence:

Cancer recurrences can occur in the same part of the body or can also occur in a different body part. Cancer recurrence is divided into three categories:

• Local recurrence - This refers to cancer that occurs in the original location of the primary cancer cells.
• Regional recurrence - This refers to cancer occurring in the surrounding lymph nodes and tissues of the original cancerous mass.
• Distant recurrence - This refers to cancer that has spread to areas farther away from the original cancer location. This type of cancer is called metastatic cancer.

Some cancers are more likely to recur than others. It has been discovered that glioblastoma (cancer in the brain or spinal cord) has a 90% chance of recurrence. An estimated 85% of cases of ovarian cancers recur, even after successful treatments. Certain types of lymphomas also have a high recurrence rate. Cancers diagnosed at an advanced stage have a higher recurrence rate than cancers detected at the early stages.

What are the symptoms of cancer recurrence?

Each cancer has its own set of symptoms. But here is a list of symptoms that commonly point to recurrence of cancer:

• Unexplained weight loss.
• Return of cancer symptoms you had before your first diagnosis.
• A change in regular bowel or bladder function.
• Sores that do not heal.
• Unexplained lumps in parts of the body.
• Unusual bleeding or discharge.
• Unexplained pain.
• Fever.
• Skin changes.
• Frequent headaches.
• Shortness of breath.

How can we avoid cancer recurrence?

Cancer recurrence may be unavoidable in most cases. But here’s a list of things you can do to decrease your risk of relapse.

1. Keep up with your doctor’s appointments and checkups.

Even if you are cancer-free, it is always recommended to keep up with your doctor’s appointments and checkups to stay updated on your health. Your doctor will be able to keep an eye on your progress and be on the lookout for any new developments that may affect you.

2. Resume regular health screenings

In addition to mammograms, always be up-to-date with your flu shots and other such vaccinations, pap smears, blood tests, colonoscopies, and other screening tests recommended by your doctor.

3. Eat healthy

Include a lot of fruits, vegetables and whole grains in your everyday diet. Avoid processed food and excessive amounts of sugar. Add a lot of fish to your diet as fish is rich in protein and omega-3 fatty acids highly beneficial for you. Avoid trans fat and stick to a low-fat and low-calorie diet for a healthy life.

4. Limit consumption of red meat

Red meat is most commonly linked to colorectal, prostate and pancreatic cancer. Limit consumption of red meat and processed meat such as sausages, bacon, ham, etc.

5. Exercise regularly

Regular exercise, especially for cancer survivors, can aid a lot in general well-being. Start slow and work your way up. A brisk 30-45 minute walk can work wonders. Slowly start moving on to more strenuous exercises. Research shows that survivors of breast, prostate, ovarian and colorectal cancer who are physically active have shown a reduced risk of cancer recurrence.

6. Maintain a healthy weight

Try maintaining a body weight closer to your standard BMI as much as possible. Obesity is one of the primary risk factors for cancer. With a nutritious diet and regular exercise, you can maintain a healthy body weight.

7. Avoid smoking and drinking

Smoking and drinking vastly increase your risk of recurrence. A study shows an undeniable link between moderate and heavy drinkers and breast cancer. Smoking automatically increases your risk of cancer of the lung, mouth, throat, oesophageal, pancreatic and bladder. Quitting smoking is very beneficial and also reduces your chance of cancer recurrence.

8. Reduce stress

Try to reduce stress and endeavour to take care of your mental health in addition to your physical health. Pick up some hobbies that can help you alleviate stress like knitting, gardening, yoga, meditation, etc. Or go on a vacation!

9. Avoid dietary supplements

Some people are under the false impression that supplements reduce your risk of cancer recurrence. But there has been no research with solid evidence that proves this. In fact, some supplements do more harm than good. So it is best to avoid such supplements and get your nutrition from fresh and healthy food.

10. Take care of yourself mentally and emotionally

Cancer can be a mighty beast to conquer. The long and gruelling process would have drained you physically, emotionally and mentally. It’s time to put your needs first and recharge your batteries. Mental health is an unspoken element when it comes to recovering from a disease. You could try group therapy or one on one counselling. Don’t hesitate to talk to your doctors regarding any troubles that you have. A listening ear can sometimes make all the difference.

Coping with the fear of cancer recurrence:

When all is said and done, no one can predict a cancer recurrence. Studies show that anxiety over a cancer relapse is usually very strong within the first year of remission and slowly reduces over time. It is best to stay informed about your healthcare checkups and be open and honest about your fears and anxieties with your friends and family. Periodic counselling can also help quell the negative feelings that accompany you after recovery. It is important to remember that you are not alone, and imperative to establish a strong support system that can help you through this perilous time.

‘Scanxiety’is a particular fear that cancer survivors can face. It is the overwhelming stress you feel before and during a test, and while waiting for the results. There are a few things you can do to alleviate this stress. Devise a structured routine and stick to it. Follow meditation or other relaxing activities to help calm your mind and free yourself of anxieties. Distract yourself with menial tasks. And, as always, try to stay confident and cool-headed.

Cancer recovery is a long and arduous journey. The prospect of relapse is a very daunting thought that could affect your recovery. It is never easy to predict things, but at best you can be cautious and prepared to face any challenge that comes your way.