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If cancer comes back it can be shocking for you and the people closest to you. The medical work-up is difficult and all of the emotions you had when you were first diagnosed can return – and might be even stronger this time. You might feel more cautious, guarded, and less hopeful than ever before. Many issues and questions come with cancer recurrence. Here are some of the more common ones.

Could I have prevented the recurrence?

Many people blame themselves for missing a medical appointment, not eating right, or putting off blood work or imaging test. But even if you do everything just right, cancer may come back. Even with our current knowledge of how cancer develops and grows, it’s still a mystery in many ways.

Why me?

For some people, looking for an answer to “Why me?” can cause sleepless nights and incredible soul searching. Others find that it doesn’t really matter why something has happened – how best to deal with it is more important.

Worry can drain people of energy they need to help cope with the illness. If you find yourself unable to move beyond this question, talk with your cancer care team. You may need a referral to a mental health professional who can help you work through these feelings.

On treating cancer recurrence

If 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. Is it to control the cancer? Is it to cure the cancer? Is it 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.

Please remember: It’s very important to check on your insurance coverage along with the medical care options you are thinking about.

Why won’t I get the same treatment for the recurrence as I did the first time?

 Some people may end up having some of the same types of treatment that they had for their first time with cancer. For instance, a woman with breast cancer that recurs in the breast may have surgery again to remove the tumor. She may also get radiation therapy, especially if it had not been given before. Next, she and her doctor may consider chemotherapy and/or hormone therapy.

Treatment decisions are based on:

• Type of cancer
• When it recurs
• Where it recurs
• How much it has spread
• Your overall health
• Your personal values and wishes

Another thing to think about is that cancer cells can become resistant to chemo. Tumors that come back often do not respond to treatment as well as the first tumors did.

Another reason your doctor may use a different treatment is because of the risk of its side effects. For example, certain chemo drugs can cause heart problems or nerve damage in your hands and feet. To keep giving you that same drug might risk making those problems worse or lead to long-term side effects.

Ask your cancer care team why a certain treatment is recommended for the cancer recurrence. Discuss your options with your team, with members of your support group, and especially with members of your family.

If surgery is needed for a cancer recurrence, how long is too long to wait? Will the cancer spread while I wait?

For most cancers there is time before you must decide on a treatment for recurrence. Remember that cancer cells multiply until they grow enough to form a tumor or something that can be seen in a blood test or on a scan. This takes time. Usually there’s some time to make a thoughtful decision about the right treatment option for you.

You might take time to get a second opinion. And be sure to discuss all the options with your cancer care team and your family. You need to feel like you’ve made the best decision for you. Talk to your doctor if you are worried about waiting to start treatment.

What are the chances of recurrence after this treatment?

 This question is very hard to answer. There’s no way to answer with exact numbers. The answers depend on your situation and many different factors including:

• Type of cancer you have
• Length of time between the original diagnosis and recurrence
• Aggressiveness of the cancer cell type
• Your age
• Your overall health status
• Your treatment regimen
• How well you tolerate treatment
• The length of time you are able to take treatment

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. Even with using methods to estimate There may be risk of cancer recurrence.

How do I know if I should keep getting treatment?

There’s no one answer to this question. It depends on the type of cancer, how it’s affecting you, what your cancer care team is telling you, and what you and your family are thinking and feeling about the situation. For some, getting cancer treatment helps them feel better and stronger, because they’re doing something to fight the cancer. For others, being in treatment works the opposite way – it might make them feel more tired or less free. Only you can decide how you want to live your life. Of course, you will want to hear how your family feels about it, too. Their feelings are important since they are living through the cancer with you. But keep in mind, the final decision is up to you.

It is important for you to voice your concerns and what you want to your family and cancer care team. This will help you make a decision on whether you continue treatment or not.

Whether or not you want cancer treatment, you should ask to get supportive or palliative care. Palliative care focuses on treating symptoms and  making your life the best it can be.

For many people, cancer can be controlled with treatment this way for years. Treatment can be used to shrink the cancer, help relieve symptoms, and help you live longer. Even though it can be hard to do, many families adjust to this kind of treatment schedule.

On emotions when cancer recurs

Everyone does not have the same feelings and thoughts when cancer comes back. And everyone does not have the same responses shared here, but many have these concerns.

Placing blame

It’s understandable to be very upset when you expect one thing to happen and the opposite does. The last thing anyone expects is to have to go through more treatment for a cancer that they thought was gone. It’s normal to want to blame someone. No one is to blame. Talk to your cancer care team to help you through your feelings.

Whatever your feelings are, they should be talked about with your family and cancer care team..

Anger

Feeling angry and upset about a cancer recurrence is completely normal, and you might need support and someone to talk to about these feelings. There are different places to find support. For some, their support community is their place of worship. For others, a formal support group or online support group can be helpful. Other cancer survivors who have faced recurrence can understand and offer support. Still, some people prefer the privacy of one-on-one counseling. Ask your friends, family, or a trusted doctor for a referral. Just make sure that you find ways to release your feelings. You deserve to be heard.

Depression and anxiety

Some degree of depression and anxiety is common in people who are coping with cancer recurrence. But when a person is emotionally upset for a long time or is having trouble with their day-to-day activities, they may have  depression or worry a lot and need medical attention. These problems can cause you to feel sad make it harder for you to follow a treatment schedule.

Even if you are clinically depressed or anxious, you have some things going for you.

• Depression can be treated and treatment usually works well.
• Improving your physical symptoms and taking action may help make your mood better.
• You’ve learned a lot when you had cancer the first time. Try the things that helped you then. Those same coping skills may help you now.

Family and friends should watch for symptoms of distress. If they notice symptoms of depression or anxiety, they should encourage the person to seek the help of a health care professional. Anxiety and clinical depression can be treated many ways, including medicine, psychotherapy, or both. These treatments can help a person feel better and improve the quality of their life.

Fear of death

Cancer is hard at any age, but it’s especially hard to cope with when you are young and believe you have a full, long life ahead of you. Cancer recurrence may seem even more unfair then.

The thought of death may be difficult , but talk  with your cancer care team to get an idea of how realistic your fears and concerns are. You need to get support that works for you so you can talk about and express your feelings about recurrence. You can also learn more about yourself and explore the meaning of your life. Sometimes our lives have a purpose and meaning we cannot see clearly. It can be very helpful to discover that purpose and take pleasure from it when it seems there’s no hope.

Hopelessness

There are different ways to look at and talk about cancer that has come back. If cancer comes back, you may find that your hopes are very different from those you had when you were first diagnosed.

If the cancer comes back, this means that treatment will be different and maybe stronger than it was at first. It’s important for you to talk to your cancer care team. They can give you a good idea of what you can expect to happen. There are things that can be done to keep the cancer from growing. You and your family should be clear about the goal of any treatment.