Patient Education

The journey through cancer is a deeply personal one, punctuated by triumphs and trials. A significant trial that some individuals encounter is the return of cancer, commonly referred to as cancer relapse. Tackling this formidable hurdle demands a harmony of effective medical care, emotional fortitude, and nurturing support, all of which are readily available at OncoCare.

Understanding Cancer Relapse

A cancer relapse or recurrence is the return of cancer after a period of improvement or remission. It means that, despite initial successful treatments, some cancer cells have survived and grown, manifesting themselves again.

The National Cancer Society of Singapore reported 84,002 cases of cancer between 2017 and 2021 alone. While this data doesn't differentiate between new diagnoses and recurrences, the rising number of overall cancer cases highlights the risk that a cancer relapse may happen to anyone.

Cancer relapse typically happens when some cancer cells resist the initial treatments and lie dormant in the body. They can eventually multiply, causing cancer to return. It can reappear in the same place as the original tumour, known as local recurrence. Alternatively, it can come back in different parts of the body, referred to as distant recurrence or metastasis.

Several factors contribute to the likelihood of a relapse. The type and stage of the original cancer, the extent of the initial treatment, individual health factors, and even genetic predisposition can all influence the chances of a recurrence.

What are the Symptoms of a Cancer Relapse?

As a cancer relapse occurs after your treatment, the symptoms of a relapse will likely mimic symptoms of the recurrent cancer. These can vary depending on the type and location of the original cancer, and may even resemble those experienced during the initial diagnosis. It's important to be aware of any new or persistent changes in your body.

Here are some common identifiable symptoms of a cancer relapse:

• New or unusual pain: This can be a sign that cancer has returned to the original location or spread to other parts of the body.
• Unexplained weight loss: This can occur if cancer cells are using up the body's nutrients.
• Persistent fatigue: Cancer and its treatments can cause fatigue, but unexplained and ongoing fatigue might indicate relapse.
• Changes in bowel or bladder habits: This could be a sign of recurrence in the digestive or urinary systems.
• Lumps or bumps: New lumps or bumps, especially near the original tumour site, warrant a doctor's evaluation.

What are the Chances of a Cancer Relapse?

It’s hard to say how long before cancer relapses. The timeframe for a cancer recurrence can vary greatly and depends on several factors, including the type of cancer, the stage at which it was initially diagnosed, the treatment received, and individual patient characteristics.

Some cancers may recur within a few months, while others may not recur for several years. While recurrence rates vary across cancer types, some cancers are more prone to relapse than others. Here are three of the most common cancer relapses in men and women:

• Breast Cancer: Approximately 30% to 40% of early-stage breast cancer cases face a high risk of recurrence according to a Straits Times report.
• Prostate Cancer: Up to 30% of men diagnosed with prostate cancer may experience a relapse, based on data from John Hopkins Medicine.
• Colon Cancer: A multicenter cohort study on Colon Cancer recurrence found that about 30% to 40% of who have completed colon cancer treatment have experienced a cancer recurrence.

Processing the News of a Cancer Relapse

Getting the news of a cancer recurrence is understandably gut-wrenching. A cancer relapse can be a difficult setback, but it's important to remember you're not alone. Once you've had time to absorb the initial shock, schedule a consultation with your healthcare team. This meeting will be crucial for understanding the nature of the recurrence.

Here are some critical questions to ask your healthcare team to get a clear picture of your situation:

• What type of recurrence is this?
• How advanced is the recurrence?
• What treatment options are available?
• What are the potential risks and benefits of each treatment option?
• What can I expect during treatment?
• How will this recurrence impact my prognosis?
• Are there any clinical trials I might be eligible for?

Where Can Cancer Relapse Occur?

Cancer relapse can manifest in various ways, depending on the type of cancer and its progression. It may recur locally, in the same area where it originally developed, or it may metastasise, spreading to other regions of the body.

In the context of localised recurrence, the cancer cells re-emerge at the original site. For example, if the initial cancer were in the breast, a local recurrence would mean the cancer cells are growing again in the same breast or the surrounding tissue, such as lymph nodes. On the other hand, metastatic recurrence indicates that the cancer cells have travelled through the lymphatic system or bloodstream and formed new tumours in other organs or tissues.

Additionally, it's important to note that the site of recurrence can also depend on the characteristics of the original cancer, including its type, stage, and the effectiveness of the initial treatment. Some cancers are more likely to recur locally, while others have a higher propensity to metastasise. For example, statistics show that breast cancer is more likely to metastasise than others due to their biological characteristics and the environment in which they grow. It can metastasise to several places in the body, most commonly to the bones, lungs, liver, and brain, as found by the National Cancer Institute.

How to Treat or Prevent A Cancer Relapse

If you experience symptoms that make you suspect a cancer relapse, it's crucial to reach out to your healthcare team promptly. Early detection is vital in managing cancer recurrence, and at OncoCare, we deliver comprehensive cancer care, offering a vast array of services.

Cancer Relapse Treatment Options

We provide rapid access to high-quality diagnostic scans to detect and confirm a cancer relapse, including MRI imaging and PET-CT scans, which ensure accurate and timely diagnosis. Our cancer relapse treatment is individualised, taking into account factors like cancer type, stage, location, patient's health, and prior treatments. Our range of services and treatment options include:

• Surgery: If the cancer recurrence is localised and the patient is in good overall health, surgery may be used to remove the recurrent tumour. Sometimes, surgery may be followed by radiation therapy or chemotherapy to eliminate any remaining cancer cells.
• Chemotherapy: This is a systemic treatment that uses drugs to destroy cancer cells throughout the body. Chemotherapy can be used if the cancer has spread to multiple locations.
• Radiation Therapy: This treatment uses high-energy radiation to kill cancer cells or prevent them from growing. Radiation therapy can be used for local recurrences.

Other therapies, such as targeted therapy or immunotherapy, can be employed based on the specific characteristics of the cancer. Hormone therapy may be used for hormone-sensitive cancers like certain breast and prostate cancers.

Follow-Up Care

In between treatments, it's important to ensure that you get the follow-up care you need. Regular check-ups, monitoring for new symptoms, managing treatment side effects, and psychological support are crucial to keeping the patient’s health stable and detecting any signs of recurrence at the earliest possible stage.

Relapses can be emotionally taxing, and it's crucial to have a strong support system during this time. Our oncology consultants based in Singapore are committed not only to providing medical care but also to supporting your emotional and psychological well-being.

Preventing a Cancer Relapse

While no one can guarantee the prevention of a cancer relapse, it's crucial to engage in practices that may reduce the risk of recurrence. Here are some tips to help lower the chances of a cancer coming back:

• Regular Physical Activity: Engaging in regular exercise helps to maintain a healthy weight, reduce inflammation, and improve immune function, all of which can help lower the risk of cancer recurrence. Aim for at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity each week.
• Healthy Diet: Focus on a diet rich in fruits, vegetables, and whole grains. Limit processed foods, red meat, and sugary drinks. A balanced diet provides your body with the nutrients it needs to stay strong and may help reduce the risk of cancer recurrence.
• Limit Alcohol: Reducing alcohol consumption minimises the risk of hormone-related cancers returning, such as breast and prostate cancer. According to the American Cancer Society, it's best to limit alcoholic drinks to no more than one per day for both men and women.
• Avoid Tobacco: Stopping smoking and avoiding tobacco products is essential for preventing the return of cancers, particularly those of the lungs, mouth, throat, and oesophagus.

OncoCare: Your Partner in Recurrence Management

Cancer relapse can be a difficult and challenging time, but remember that it's a setback, not the end. With advancements in oncology, many relapses can be treated effectively, and life can still be enjoyed to its fullest.

At OncoCare, our approach to cancer care goes beyond battling the disease. We aim for holistic care, addressing your physical, emotional and psychosocial needs. Our team of cancer specialists in Singapore are dedicated to helping you navigate this phase of your journey, and together, we'll face any challenges that come our way. Reach out to us today to learn how we can support you in your recovery journey.

“Expert knowledge means better care for cancer”

Written by:

Dr Kevin Tay

MBBS (Singapore)

ABIM Int Med (USA)

ABIM Med Onco (USA)

FAMS (Med Onco)

Senior Medical Oncologist