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Recurrence

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Though the doctor might tell your loved one after completing treatment that there is no evidence of disease or that the cancer appears to be gone, there is never a guarantee that the cancer will not return. 1When cancer comes back: cancer recurrence. American Cancer Society web site. Available at http://www.cancer.org/treatment/survivorshipduringandaftertreatment/understandingrecurrence/whenyourcancercomesback/when-cancer-comes-back-common-questions-about-recurrence, Accessed May 1, 2012. As much as you don’t want to consider the possibility, your loved one will always be at risk of the cancer returning or a new cancer occurring. The patient must therefore remain vigilant for several years after completing treatment. Make sure your loved one sees his or her doctor regularly for follow-up visits and imaging to remain cancer-free or to detect a recurrence as early as possible. Just like the initial cancer, the earlier the recurrent cancer is detected, the better the prognosis.

Recurrent cancer can occur near the original site of the tumor, known as recurrent locoregional cancer, or at distant sites in the body, known as recurrent metastatic cancer.2Marur S, Forastiere AA. Head and neck cancer: changing epidemiology, diagnosis, and treatment. Mayo Clin Proc. 2008;83(4):489-501. Approximately 30 to 40 percent of patients successfully treated for head and neck cancer will develop recurrent locoregional cancer, whereas between 20 to 30 percent of patients successfully treated for head and neck cancer will develop recurrent metastatic disease.2Marur S, Forastiere AA. Head and neck cancer: changing epidemiology, diagnosis, and treatment. Mayo Clin Proc. 2008;83(4):489-501.

It is not unusual for people who were successfully treated and remain disease-free to continue to be concerned about the possibility of recurrent head and neck cancer several years later; in a survey of successfully treated, long-term head and neck cancer survivors, approximately half of these patients continued to be concerned about the possibility of recurrent disease.3Campbell BH, Marbella A, Layde PM. Quality of life and recurrence concern in survivors of head and neck cancer. Laryngoscope. 2000;110(6):895-906.

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This section will describe what you can do to discover disease recurrence as early as possible, lessen the risk for disease recurrence and understand what will happen if your loved one does develop recurrent disease.

Optimizing outcomes: follow-up visits and reducing risk of recurrence

If a clinician identifies recurrent cancer at an early stage, the prognosis is better than if it discovered at an advanced stage. More advanced cancers may not respond (or only slightly respond) to treatment. To improve the likelihood of identifying recurrent head and neck cancer as early as possible, the cancer care team will give recommendations for the frequency and scheduling of follow-up exams. In addition to a recommendation for follow-up physical evaluations of the disease site, the health care provider may also give recommendations for imaging of the previous site of the tumor and the chest.4, Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed December 9, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.5, Abgral R, Querellou S, Potard G, et al. Does 18F-FDG PET/CT improve the detection of posttreatment recurrence of head and neck squamous cell carcinoma in patients negative for disease on clinical follow-up? J Nucl Med. 2009;50(1):24-9.6Lowe VJ, Boyd JH, Dunphy FR, et al. Surveillance for recurrent head and neck cancer using positron emission tomography. J Clin Oncol. 2000;18(3):651-8. For example, during the first year after successful disease treatment for head and neck cancer, a patient should have a physical every one to three months; imaging of the former tumor sites may be recommended within six months.4Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed December 9, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org. Following the cancer care team’s recommendations for follow-up surveillance is extremely important.

Encourage your loved one to take all possible steps to reduce the risk of cancer recurrence.

Smoking and/or excessive alcohol consumption are known risk factors for developing many types of head and neck cancer in addition to several other types of cancer., 7American Cancer Society (ACS). Cancer Facts and Figures 2012. Atlanta, GA: American Cancer Society, Inc. 2012. Smoking and drinking cessation can reduce a person’s risk of cancer recurrence. If your loved one continues to smoke or drink to excess, ask his or her health care providers to recommend counseling services.4Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed December 9, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org. There also are medications approved by the U.S. Food and Drug Administration (FDA) that can help your loved one quit smoking.8, Henningfield JE. Nicotine medications for smoking cessation. N Engl J Med. 1995;333(18):1196-203.9Hughes JR, Stead LF, Lancaster T. Antidepressants for smoking cessation. Cochrane Database Syst Rev. 2007;(1):CD000031.

Managing recurrent head and neck cancer

Patients with recurrent head and neck cancer are likely to have an even more challenging path to achieving a cancer-free state than the first time around.10Vermorken JB, Specenier P. Optimal treatment for recurrent/metastatic head and neck cancer. Ann Oncol. 2010;21 Suppl 7:vii252-61. Whether your loved one is diagnosed with locoregional or metastatic recurrent head and neck cancer determines the treatment options, treatment course and treatment goals.

The cancer care team will use the same treatment options for newly diagnosed disease and for locoregional recurrent head and neck cancer. As a reminder, these treatments include any of the following: surgery, radiation therapy, chemoradiation therapy or chemotherapy.The treatment goal for locoregional recurrent disease is usually to cure the disease; however, the recurrent disease may not be treatable if the tumor is large, inoperable and/or previously treated with radiation therapy and therefore excluded from additional radiation therapy.

Prognosis for recurrent metastatic head and neck cancer is not as hopeful as it was the first time around. Treatment goals for recurrent metastatic disease are either to reduce disease symptoms (palliative care), such as pain, and/or to improve survival.4Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed December 9, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org. If your loved one is diagnosed with recurrent metastatic disease, according to NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Head and Neck Cancer, a clinical trial is the recommended treatment course.4Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed December 9, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org. Clinical trials can provide access to new therapies not available to most health care providers or patients, even if it has not yet been determined whether the new therapies will improve outcomes such as survival.11Clinicaltrials.gov website. Accessed at clinicaltrials.gov on January 10, 2013. If the patient does not qualify for and/or decides not to participate in a clinical trial, then the cancer care team will assess the patient’s performance status and use this information to select the best treatment option.4Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed December 9, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org. If your loved one develops recurrent metastatic head and neck cancer, then you should both begin discussing treatment goals with the cancer care team: Is the main priority to improve the chances of survival or to reduce the discomfort that comes with certain symptoms and side effects?

When the cancer recurred, it wasn’t as bad as the first time since I knew what to expect.Tony L. (oral cancer survivor)

References

1 When cancer comes back: cancer recurrence. American Cancer Society web site. Available at http://www.cancer.org/treatment/survivorshipduringandaftertreatment/understandingrecurrence/whenyourcancercomesback/when-cancer-comes-back-common-questions-about-recurrence, Accessed May 1, 2012.

2 Marur S, Forastiere AA. Head and neck cancer: changing epidemiology, diagnosis, and treatment. Mayo Clin Proc. 2008;83(4):489-501.

3 Campbell BH, Marbella A, Layde PM. Quality of life and recurrence concern in survivors of head and neck cancer. Laryngoscope. 2000;110(6):895-906.

4 Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed December 9, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.

5 Abgral R, Querellou S, Potard G, et al. Does 18F-FDG PET/CT improve the detection of posttreatment recurrence of head and neck squamous cell carcinoma in patients negative for disease on clinical follow-up? J Nucl Med. 2009;50(1):24-9.

6 Lowe VJ, Boyd JH, Dunphy FR, et al. Surveillance for recurrent head and neck cancer using positron emission tomography. J Clin Oncol. 2000;18(3):651-8.

7 American Cancer Society (ACS). Cancer Facts and Figures 2012. Atlanta, GA: American Cancer Society, Inc. 2012.

8 Henningfield JE. Nicotine medications for smoking cessation. N Engl J Med. 1995;333(18):1196-203.

9 Hughes JR, Stead LF, Lancaster T. Antidepressants for smoking cessation. Cochrane Database Syst Rev. 2007;(1):CD000031.

10 Vermorken JB, Specenier P. Optimal treatment for recurrent/metastatic head and neck cancer. Ann Oncol. 2010;21 Suppl 7:vii252-61.

11 Clinicaltrials.gov website. Accessed at clinicaltrials.gov on January 10, 2013.