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When cancer strikes for the second time

Learning that cancer has returned is every survivor’s worst nightmare. Whether you’ve been in remission for a few weeks or for 20 years, the disease’s reappearance means fighting for your life all over again.

Having been through it before is little consolation. Still, you have advantages this time around that can make a real difference in your treatment’s outcome. The key, experts say, is to remember the lessons of surviving your first encounter with cancer and to apply them as vigorously and hopefully as you can.

Why tumors return

Even if chemotherapy, radiation or surgery obliterates the original tumor, a tiny number of cells can still manage to metastasize, or break away, and grow into new tumors elsewhere. However, not all cancer cells have this ability.

Metastatic cancers tend to show up in certain spots. For example, breast cancer can reappear in the same place (local), in the nearby lymph nodes (regional metastasized) or liver (distant metastasized). A biopsy of suspect tissue in the nodes or liver can confirm if the newfound cancer is from the original tumor. If so, doctors still consider it breast cancer—not lymphoma or liver cancer—and treat it as such.

Taking action

To fight back, doctors use X-rays, CT scans or ultrasound to pin down the nature and extent of the disease and decide what course of therapy is most likely to send the cancer back into remission.

Among the issues they consider:

  • What treatment was used originally—surgery, radiation, chemotherapy or a combined approach?
  • How did the patient respond?
  • How much time has passed between the final treatment and the recurrence?
  • What is the age and overall health of the patient now?

By weighing the patient’s current condition and previous history of cancer treatment, doctors will decide whether to retry surgery, radiation or chemotherapy, or whether a different approach—hormone therapy or biological agents like interferon or monoclonal antibodies—is more promising.

Knowledge is power

Summoning the willpower, energy and courage to defeat cancer again may seem overwhelming. But these strategies from the National Cancer Institute, plus your experience from round one, can help you come out swinging:

  • Get an education. Have your doctor thoroughly review your case with you. Ask as many questions as you can about your diagnosis, treatment options and outlook. Gather facts (not unsubstantiated claims) from the library, bookstores and respected medical and cancer sites on the Internet. Get a second opinion if you need independent advice about what you’ve been told.
  • Stay involved. Follow your doctor’s directions to the letter and keep him or her informed about how you’re feeling. At home, maintain your energy by eating nutritiously, getting your rest and being active. Stay connected with friends and loved ones.
  • Reach out. If you feel your spirits sinking, contact the hospital or the local American Cancer Society chapter for information on support groups. Or contact your counselor, clergy member or social worker for assistance. Don’t try to tough it out; instead, ask for the help you need.