Perhaps the only thing more earth-shattering than hearing you have cancer is to hear that your cancer has recurred. Unfortunately, lung cancer recurrence -- even with tumors classified as “early stage” -- is far too common, despite treatments that are currently available. What do you need to know if your lung cancer comes back?
What is a Recurrence?Before talking about recurrence, it helps to make it clear what we are talking about. A cancer recurrence is defined as a cancer that returns (relapses) after treatment and following a period of time (remission) in which there is no evidence of cancer. On the other hand, cancers that are found within three months of the original diagnosis are usually considered a cancer progression.
A recurrence can be further defined by where it occurs:
- Local – This is when cancer comes back in the lung, near the original tumor.
- Regional – When cancer recurs in lymph nodes near the original tumor.
- Distant – When lung cancer recurs in sites such as the bones, brain, adrenal glands or liver.
How Often Does Lung Cancer Recur?The chance that lung cancer will recur depends on many factors, including the type of lung cancer, the stage at which it is diagnosed, and the treatments for the original cancer.
Most lung cancers that recur do so in the first five years following diagnosis. That said, the risk of lung cancer recurrence never returns to zero. One study that followed 5-year lung cancer survivors found that 87% made it another five years cancer-free.
Why Does Lung Cancer Sometimes Come Back?Treatments for lung cancer, such as surgery and radiation therapy, are considered local treatments -- that is, they treat cancer that is present near the site of the original tumor. Sometimes cells from the original tumor spread via the bloodstream or lymphatic channels to distant sites, but the cells are too small to be detected by radiological studies. Chemotherapy is designed to treat cancer cells that may have spread in this fashion. Sadly, even with chemotherapy cells may survive and begin to grow at a later date.
SymptomsSymptoms of a lung cancer recurrence will depend upon where the cancer recurs. If it is a local recurrence, or in lymph nodes near the original tumor, symptoms may include a cough, coughing up blood, shortness of breath, wheezing or pneumonia. Tumors that recur in the brain may cause dizziness, decreased or double vision, weakness on one side of the body, or loss of coordination. Tumors in the liver may result in abdominal pain, jaundice (a yellowish discoloration of the skin), itching or confusion. Recurrences in the bones most commonly present with deep pain in the chest, back, shoulders, or extremities. More generalized symptoms, such as fatigue and weight loss, may also signal a recurrence.
Treating Lung Cancer RecurrenceTreating a lung cancer recurrence will depend on the site where the cancer recurs. Once lung cancer recurs, there is little chance of the tumor being cured. That said, treatments are available that may both increase survival and improve quality of life. Possible treatments may include:
Surgery - Surgery is not commonly used to treat a lung cancer recurrence, but may be used in some cases to treat a local recurrence or to treat isolated tumors in the brain or liver.
Radiation Therapy - The use of radiation therapy may be limited if previous radiation therapy has been given. A simplistic way to think about this is that there is a “lifetime” dose of radiation therapy that can be delivered to a certain area. Yet even if you have had prior radiation therapy, this is sometimes used to treat a recurrence by using a lesser dose.
Chemotherapy - Chemotherapy is usually the mainstay of treatment for lung cancer recurrences. That said, the chemotherapy that is chosen is usually different than the chemotherapy initially used to treat the tumor. Genetic mutations often occur in tumors that recur, making them resistant to chemotherapy drugs that were used previously.
Clinical Trials – Once a lung cancer recurs, it is usually by definition stage 4. According to the National Cancer Institute, people with stage 4 lung cancer should consider clinical trials as a treatment for their cancer.
Prognosis After a Lung Cancer RecurrenceThe prognosis of recurrent lung cancer will depend on many factors, including the site of recurrence, the type of lung cancer, your general health, and the treatments that are chosen to treat the recurrence. Even though a recurrence certainly lowers the expected life expectancy with lung cancer, some people live with good quality of life for many years following a recurrence.
CopingCoping with a cancer recurrence is difficult, as all of the emotions that came with the original diagnosis of cancer resurface. Ask questions. Talk about options. Pull together your support network of loved ones and friends.
- Where Does Lung Cancer Spread?
- What Can I Expect in the Final Stages of Lung Cancer?
- Making Difficult Decisions: Goals of Care
Bogot, N., and L. Quint. Imaging of recurrent lung cancer. Cancer Imaging. 2004. 4(2):61-67.
Maeda, R. et al. Long-term outcome and late recurrence in patients with completely resected stage 1A non-small cell lung cancer. Journal of Thoracic Oncology. 2010. 5(8):1246-50.
National Cancer Institute. Non-Small Cell Lung Cancer Treatment (PDQ). Recurrent NSCLC Treatment. Health Professional Version. Updated 02/10/12. http://www.cancer.gov/cancertopics/pdq/treatment/non-small-cell-lung/healthprofessional/page12