Back in 2014, a study on cancer recurrence, published in Science Direct, estimated that 7-13 percent of breast cancer patients develop recurrent cancer within five years.
The same study went on to say that the recurrence rate of prostate cancer was 25 percent, that of lung cancer was 30-75 percent, and that of colon cancer was 33 percent.
These are BIG NUMBERS.
Especially considering that over 14 lakh people were diagnosed with cancer in India in 2022. According to the National Institutes of Health, that is one in every nine people.
This burden is only set to increase. In 2023, while speaking in the Rajya Sabha, the junior health minister had mentioned that the incidence of cancer cases is likely to rise to 15.7 lakh by 2025.
Ahead of World Cancer Day on 4 February, FIT spoke to doctors to understand better why cancer can relapse in some survivors.
The Big Question About Cancer Recurrence: WHY?
Dr Pakhee Agarwal, Senior Consultant, Gynaecological Oncology and Robotic Surgeon, Indraprastha Apollo Hospital, explains to FIT,
“Cancer is an uncontrolled growth of cells. When a patient undergoes surgery, chemotherapy, or radiation, we destroy the cells that we can see. But there are millions of cells that are microscopic and spread to the body, and might not be treated during surgery.”
Dr Mitu Shrikhande, Director, Haematology & BMT at Fortis Cancer Institute, Vasant Kunj, agrees.
She adds that there can be other reasons too for cancer recurrence – cells that are resistant to surgery, cells that were dormant and remained in the body, and cells that spread to other organs.
But, the biggest reason, Dr Shrikhande says is – “Cancers have a tendency to relapse. It’s just in their biology.”
Cancer recurrence is divided into three categories based on where the cancer is appearing.
The first is local recurrence, where the cancer returns in the same organ where it had first been diagnosed.
The second is regional recurrence where the cancer is diagnosed in the tissues or organs close to where it was diagnosed the first time.
The third recurrence is called metastatic cancer when it is identified in organs or tissues that are distant from that of the first cancer.
‘Regular Follow Ups & Keeping an Eye Out for Symptoms’: Identifying Cancer Recurrence
A very basic reason that cancer often relapses is due to the very nature of the disease, says Dr Agarwal.
Dr Shrikhande explains that this is why once a patient’s cancer is in remission, their oncologist draws up a detailed follow up plan for them.
She adds that cancer survivors are asked to undergo blood tests and complete body check-ups at regular intervals.
More specific tests are also advised to patients depending on the cancer they were diagnosed with. For instance, breast cancer survivors are advised to undergo regular breast scans.
Regular follow ups and biomarkers are one way that cancer recurrence can be detected early on and treated. Another thing that doctors ask patients to keep a close eye on is the symptoms of cancer.
Some symptoms, Dr Agarwal says, can include:
Extreme fluctuation in weight
Fatigue and weakness
Swelling in the body
Fever, jaundice, or nausea
Abdominal pain
But it’s not that the recurrence rate of every cancer is high. Dr Agarwal explains that doctors usually take preventive measures to avoid a relapse.
In genetically high-risk women who are diagnosed with uterine, ovarian, or breast cancer, these organs are removed after the cancer is treated.
Dr Agarwal says, "In these genetically high-risk women, there is role of prophylactic surgery before cancer develops in these organs."
To reduce the chances of recurrence, many times doctors also advise that the patient undergo chemotherapy after their tumour is surgically removed.
“For certain cancers, we have adjuvant treatment where we give suppressive treatment or endocrine therapy that prevents the cancer from recurring.”Dr Pakhee Agarwal
According to Cancer Research UK, some patients are also advised to undergo hormone therapy or prescribed drugs that can eliminate any remaining cancer cells in the body.
However, that said, certain types of cancers do have high recurrence rates. According to the Journal of Neuro-Oncology, glioblastoma, which is a type of brain cancer, has a “near 100 percent recurrence rate.”
The recurrence rate of epithelial ovarian cancer is 85 percent. On the other hand, according to research published in the World Journal of Urology, bladder cancer has a relapse rate of 30-54 percent.
Coping With Cancer Recurrence Can Be Difficult
Again, regular follow ups can help detect the cancer recurrence early and treat it as far as possible. But, “it can be devastating even if the survivor knows that that is just how the disease works,” says Dr Agarwal.
Dr Shrikhande agrees. She says that while cancer survivors are sensitised to the process and the treatment journey both, it can be even more difficult if the relapse is aggressive.
“Many patients go through the five stages of grief while coming to terms with it – there’s denial, anger, bargaining, depression, and acceptance.”Dr Pakhee Agarwal
Research done by the American Cancer Society has found the same thing too. When cancer relapses in a survivor, it’s often accompanied with anger, depression, and anxiety.
The research goes on to suggest that it’s always a good idea to seek therapy, while also seeking treatment for the cancer.
Dr Agarwal nods in agreement as she adds, “We are now studying more and more about cancer recurrence and the molecular structures of cancer to understand it better and hopefully prevent it in most survivors.”
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