Dr Wong Siew Wei
Cancer remission is a term used to describe a time when cancer is either under full or partial control. There are 2 contexts of cancer returning after remission.
The first is when cancer returns despite surgery, radiation, or additional medical treatment with the intention of curing it.
The second scenario occurs when a patient diagnosed with stage 4 cancer undergoes treatment that causes the cancer to reduce in size or disappear on scans, only to reappear on a subsequent scan.
Cancer remission can take 2 forms, depending on the patient's initial prognosis.
Patients treated with curative intent, such as with surgery or radiation, have a significantly higher chance of being cured, with some estimates placing the likelihood as high as 90%. If complete remission is maintained for 3 – 5 years in this scenario, the chance of it becoming lifelong is more likely. Unfortunately, late relapses might occur for certain cancers, such as testicular and kidney cancer.
When it comes to a patient with stage 4 cancer, they would be considered to have gone into remission when all signs and symptoms of cancer have disappeared, and examination and tests detect no trace of cancer – also called no evidence of disease (NED). In this setting, doctors will hope that the cancer has been cured but cannot be sure until there have been follow-up scans for a number of years.
This differs according to the situation a patient is in.
For stage 4 cancer, remission is not the same as cancer-free. Medical professionals can only conclude that a patient’s stage 4 cancer is under control, and not "cured" when it comes to the disease.
In stage 4 kidney cancer, for example, a proportion of patients may have a very good response to immunotherapy-based treatment, with as high as 10% – 15% of patients having a complete response on scans, meaning that doctors see nothing that can point to a cancerous spot. These people may remain well, even after treatment has been stopped. However, doctors can’t claim that they are cured because the cancer had already reached a late stage.
In the other scenario, where cancer is being treated with curative intent, the chance of a cure is a lot higher, and it could be even up to 90%. In this context, doctors would be able to say the patient is cancer-free after no recurrence has occurred for 3 – 5 years.
Cancer recurrence is the return of cancer in patients who have achieved remission and is caused by the incomplete elimination of cancer cells during the initial treatment. Some cancer cells may survive therapy and be undetected by tests. Over time, these cancer cells may continue to grow and eventually become large enough to be detected. In general, recurrent cancers are more aggressive and often require a different treatment plan.
There are 3 types of cancer recurrences based on location and spread:
Sometimes, a new type of cancer can develop in people with a previous history of cancer. This is called a second primary cancer.
A second primary cancer is a distinct cancer that develops in a person who has previously been diagnosed and treated for another cancer, and it can occur in the same or a different part of the body. The increased risk of second primary cancer is associated with a history of cancer, certain genetic mutations, exposure to environmental factors, and lifestyle habits.
When cancer returns after remission, it can be a distressing and emotional experience. Here are some steps to help cope with the situation:
It is important to be honest with yourself and your loved ones about your feelings and emotions. Talk to them about how you feel and what you are going through. You can also consider joining support groups for people who have experienced cancer recurrence.
It is crucial to follow up with your medical team and attend all scheduled appointments. They will be able to provide you with the necessary treatment and care. They can also help you manage any symptoms and side effects that you may experience during treatment.
There are various treatment options available for cancer recurrence, including surgery, radiation therapy, chemotherapy, and immunotherapy. Your medical team can discuss the options with you and help determine the best course of treatment. It is important to be informed and ask questions about the treatment options available to you.
Coping with cancer recurrence can be emotionally and mentally taxing. It is essential to take care of your emotional and mental well-being during this time. Consider seeing a therapist or counsellor to help manage your emotions and mental health. If you’re looking for support, Parkway Cancer Centre in Singapore provides a non-profit cancer counselling and support service called CanHOPE.
Taking care of your physical health is equally important during cancer recurrence. Make sure to maintain a healthy diet, engage in regular exercise, and get enough rest. These actions can help boost your physical and emotional well-being during treatment.
Coping with cancer recurrence is not easy, but can be manageable with the right support system and practices in place. Do not hesitate to speak to an oncologist to get the help and treatment you need.