How to deal with cancer recurrence

In February 2017, the Uganda Cancer Institute (UCI) celebrated a major milestone after declaring five children cancer-free, meaning that the cancer cells are no longer active after treatment.
The children suffered deadly cancers including Leukemia, lymph node, Hodgkin’s lymphoma had been followed up for a period of five years before being declared free of cancer.
However, the celebrations were cut short after one of the children passed on nearly a year after, causing public doubt about the earlier declaration by the institute.
Similarly, Dr Sheila Ndyanabangi, 52, the principal medical officer in charge of mental health and substance abuse at the Ministry of Health was declared cancer-free towards the end of 2016 in India.
She had started feeling weak at the beginning of the same year when she was diagnosed with cancer of uterus and operated on to remove it.
However, after almost a year of routine monitoring and checks a blood test indicated that the cancer had spread to other organs in the lower abdomen, and she was operated on again to remove a swelling that had grown bigger.

When cancer recurs
Cases of the same kind are common in Uganda and worldwide, casting doubt and anxiety among patients whenever they are declared cancer-free. They are always frightened by the fact that they may have to repeat the hectic treatment or even risk death.
Dr Henry Ddungu, a consultant oncologist at UCI, explains that someone with cancer is evaluated to see the extent of the disease and come up with a treatment plan after which if the there are no cancer cells remaining, the patient is said to be in remission(what is referred as cancer free).
“For us as doctors we don’t declare people cancer-free because we know diseases come back,” Dr Ddungu says.
He further explains that the patient continues to be followed up for more than five years during which they are still in remission. After that time the patient is regarded to be free from cancer but not declared as such, Dr Ddungu.
“If we start seeing cancer signs recurring, we say one has relapsed. There are those who relapse after one year while others can relapse after a long time,”Dr Ddungu adds.

When recurrence happens
The chances of the cancer recurring also depends on the stage and type of cancer. For instance, adult acute myeloid leukemia (AML), a cancer of the blood and bone marrow, is likely to recur if one is not given bone marrow transplant.
“Early stage cancers also have less chances of recurring compared to late stage cancers,” says the consultant.
According to Mayo Clinic, a nonprofit academic medical centre in Rochester, Minnesota, USA, when cancer returns after a period of remission, it’s considered a recurrence. It happens because, in spite of the best efforts to rid you of your cancer, some cells from your cancer remained.
“These cells could be in the same place where your cancer first originated, or they could be in another part of your body. These cancer cells may have been dormant for some period, but eventually they continued to multiply, resulting in the reappearance of the cancer,” the Mayo Clinic website reads in part.
They further explain that cancer recurrence means it is the same cancer coming back after some time. In rare cases, though, one may be diagnosed with a new cancer that is unrelated to your first cancer. This is referred to as a second primary cancer.

Area of recurrence
Cancer can recur in the same place it was originally located, or it can migrate to other parts of your body. Recurrence is divided into three categories, according to the Mayo clinic website.
• Local recurrence. This means the cancer reappears in the same place it was first found or very close by. The cancer has not spread to the lymph nodes or other parts of the body.
• Regional recurrence. A regional recurrence occurs in the lymph nodes and tissue located in the vicinity of your original cancer.
• Distant recurrence. This refers to cancer that has spread (metastasized) to areas farther away from where your cancer was first located.
Where your cancer recurs depends on your original cancer type and stage. Some cancer types commonly recur in specific areas.

Recurrence versus progression
According to the American Cancer Society(ACS), when cancer spreads or gets worse, it is called progression. Sometimes it is hard to tell the difference between recurrence and progression. For instance, if cancer has been gone for only three months before it comes back, was it ever gone? Is this a recurrence or progression? Chances are this is not really a recurrence. In this case, it is likely one of two things happened:
The surgery done to take out the cancer did not get all of it. Tiny clusters of cancer cells that could not be seen or found on scans or other tests were left behind. Over time they grow large enough to show on scans or cause symptoms. These cancers tend to be aggressive (fast-growing and quick to spread).
The cancer has become resistant to treatment. Cancer cells can become resistant to treatment just like germs can become resistant to antibiotics. This means chemotherapy or radiation may have killed most of the cancer cells, but some of them were either not affected or changed enough to survive the treatment. These cancer cells can then grow and show up again.
According to cancer.org, the less time between when the cancer was thought to be gone and the time it came back, the more serious the situation. There’s no standard length of time to decide if it’s recurrence or progression. But most doctors consider recurrence to be cancer that comes back after you have had no signs of it for at least a year.

Difference between cancer response and remission
In case of complete remission, a treatment completely gets rid of all tumors that were seen on a test or were measured in some way, it’s called a complete response or complete remission. A complete response or complete remission does not mean the cancer has been cured, only that it can no longer be seen on tests.
On the other hand, partial remission means the cancer responded to treatment, but still has not gone away. A partial response is most often defined as at least a 50 per cent reduction in measurable tumor. (If you’re in a clinical trial, response is usually defined very precisely.)
The reduction in tumour size must last for at least a month to qualify as a response. You can ask for details about the kind of response to treatment the doctor sees, and how long it lasts.

Where to get tested

UMC Victoria Hospital: Free breast cancer screening at the hospital and UMC Entebbe clinic, free specialist/ doctor consultation and discount on extra investigations such as ultra-sound /biopsy if required.
Nakasero Hospital: Breast cancer awareness presentation twice every week for October, free clinical breast examination following the presentation, free mammography services following the breast exam for those that require it and all the above will require booking to ensure good planning for each day.
AAR: All AAR clinics (Makerere Health Centre, Bweyogerere Health Centre, Bweyogerere Health Centre – annex, Kabalagala Health Centre, Bugolobi Health Centre, City Health Centre, Entebbe clinic, Ntinda Health Centre, Acacia Health Centre, Mukono Health Centre, Natete Health Centre and Gulu Health Centre) will provide free breast cancer examination and V/A screening at a subsidised price of Shs10,000.