Survivorship

Monitoring for Recurrent and Second Cancers

Although active cancer treatment is behind you, it is possible the cancer may recur (come back) or that a new type of cancer (second cancer) may develop. Both of these possibilities make it critical for you to stay on top of your health by adhering to your follow-up plan.

Recurrent Cancer

When cancer that’s the same type as the original cancer comes back, it’s called recurrent cancer. If you are cancer-free after being treated for a specific type of lung cancer and, a few years later, you are again diagnosed with that same type of lung cancer, that it is recurrent cancer. It can happen weeks, months or even years after treatment stops, and cancer may come back in the same area of the body as the primary cancer (local recurrence), in an area of the body near the location of the primary cancer (regional recurrence), or in an altogether different area of the body (distant recurrence).

Cancer sometimes comes back because tiny cancer cells occasionally survive treatment and remain in the body undetected. These lingering cells grow and multiply until, eventually, tests can detect them.

Although doctors cannot know for sure who will experience cancer recurrence, they can sometimes make predictions based on the recurrence patterns of certain cancers. Be sure to ask your doctor for more information about your recurrence risk profile.

Second Cancer

Like recurrent cancer, a second cancer can develop after you’ve finished treatment for the first cancer. However, unlike recurrent cancer, a second cancer is a different or new type of cancer diagnosis. For example, you are cancer-free after being treated for ovarian cancer and then, a few years later, you are diagnosed with breast cancer. The breast cancer is considered a second cancer.

Many factors are linked to the development of a second cancer.

  • Cancer treatments. Leukemia and some solid tumors have been linked to past radiation exposure and past chemotherapy.
  • Cancer types. Although it’s not yet clear if second cancers are caused by the original cancer or its treatment (or a combination of the two), some primary cancer types are associated with certain second cancers (see Table 1).
  • Inherited and/or acquired gene mutations. When certain genes mutate due to inherited syndromes (passed down from generation to generation) or acquired circumstances (changes that arise throughout a person’s lifetime), the risk for various cancer types increases (see Genetic Testing).
  • Personal characteristics. Age (both current and at the time of primary treatment), gender, race, ethnicity and health status are among the personal characteristics that can play a role in your risk for developing a second cancer.
  • Lifestyle choices. Various unhealthy choices, including poor diet, physical inactivity, smoking and excessive alcohol use, might increase the chance of a second cancer.

The risk for developing a second cancer is small, but it’s still important to talk to your doctor about what to look for and what you can do to help minimize your risk.

Table 1. First and Second Cancers Among Adult Survivors

Primary Cancer Commonly Associated Second Cancers*
Bladder Bladder**, Colon, Lung, Prostate
Breast Breast (female, opposite side)**, Colon, Lung, Ovarian, Uterine
Colon Bladder, Breast (female), Colorectal**, Lung, Non-Hodgkin Lymphoma, Prostate
Hodgkin Lymphoma Acute Non-Lymphocytic Leukemia (ANLL), Breast (female), Colon, Lung, Non-Hodgkin Lymphoma, Prostate
Testicular Bladder, Lung, Prostate
*According to the American Society of Clinical Oncology: Standardized Incidence Ratio (SIR) and Excess Absolute Risk (EAR) for Selected Second Cancers among Adult Survivors .
**Second primary cancer diagnosis in the same organ or site.

Monitoring Your Health

As a part of your follow-up care plan, your doctor will watch for a potential recurrence or second cancer. Your plan might include physical examinations, blood tests, imaging tests and/or scheduled cancer screenings.

The National Comprehensive Cancer Network recommends certain screening guidelines for most adults by cancer type (see Table 2). However, variations and exceptions to these rules exist, so talk to your doctor about the schedule that’s right for you.

Along with getting screened at the recommended times, you can also be an active participant in monitoring your health. For example, most recurrences of melanoma develop within the first five years after treatment, so your follow-up visits will be more frequent within that time period. However, late recurrence, even after 10 years, is also possible. Your doctor will ask you to participate in your follow-up care with a monthly self-examination of your skin for potential melanoma. During these skin checks, you should also look for any abnormal lumps, especially where the surgery was done, if applicable, and in nearby lymph nodes. The “ABCDE” rule will help you know the difference between melanoma and a mole that is benign (noncancerous) (see Figure 1). Because family history plays an important role in melanoma and other skin cancers, your family members should also have regular skin screenings.

 

If cancer is detected, your doctor will run various diagnostic tests to learn as much as possible and will then talk with you about your treatment options.

Table 2. Recommended Cancer Screening Guidelines

Cancer Type Screening Test Age Frequency
Breast cancer Breast self-exam (BSE) 20+ (women) Regularly
Clinical breast exam (CBE) 40+ (women) Yearly
Mammogram 40+ (women) Yearly
Cervical cancer Pap test 21 to 29 (women) Every 3 years
Pap test + human papillomavirus (HPV) test 30 to 65 (women) Every 5 years
Colorectal cancer Colonoscopy 50+ (men and women) Every 10 years
Lung cancer Low-dose computed tomography (LDCT) of the chest 55 to 74 (men and women)* Yearly
Prostate cancer Prostate-specific antigen (PSA) blood test with or without a digital rectal exam (DRE) 50 to 70 (men)** Varies based on PSA level
*Lung cancer screening is not recommended in people who are at average risk of lung cancer, but people who meet all of the following criteria may be candidates for screening: in fairly good health; have at least a 30 pack-year smoking history (a pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked); and are either still smoking or have quit smoking within the past 15 years.
**Men who are African-American or who have a father or brother who was diagnosed with prostate cancer before age 65 should start talking to their doctors about prostate cancer screening at age 45.

Additional Resources

 

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