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You or a loved one has endured rounds of chemo, possibly daily radiation therapy, side effects and other stresses of cancer treatment. You made it through the woods. Yet one persistent worry never leaves your mind: What if it comes back?
No other concern is more universally shared by patients and survivors. And hardly any cancer topic is equally more misunderstood. Can we as patients help prevent it? And what does being a cancer “survivor” really mean?
How cancer develops
Our bodies are made up of trillions of cells that divide to create new cells when old or damaged cells die. But sometimes, this process breaks down. “Cells may start dividing and multiplying out of control,” explains Dr. Matteo Trucco, a pediatric cancer expert at Sylvester Comprehensive Cancer Center, part of the University of Miami Health System. “If they cluster and create a growth of new tissue, it’s called a tumor.” Benign tumors are made of cells that can’t spread into nearby tissues or organs. But cancerous, or malignant, tumors are made of cells that can invade other areas, using the body’s blood vessels or lymph systems as superhighways.
Three ways cancer can come back
Cancer can return after treatment, spread to other parts of the body or arise months or years later. It can be either the original cancer, a secondary cancer or a second cancer.
- Recurring/ relapsing: Sometimes, an original cancer comes back after successful treatment. When this happens, the cells are either the same type as, or mutated versions of, the original cancer. Cancer that returns in the same location is a called a local relapse, while cancer that has spread (or metasticized) to a different part of the body is called a distant relapse. It will be given a new name: for example, If a prostate cancer patient develops a tumor in his lungs made of prostate cancer cells, the new cancer is defined as metastatic prostate cancer in the lung.
- Secondary cancer is related to the treatment of the original (primary) cancer. Radiation therapy to the neck and chest is the standard of care for young patients with Hodgkin’s disease, Dr. Trucco explains, “But as successful as many radiation, chemotherapy and even immunotherapy drugs are, they are still toxic therapies.” These patients could later develop thyroid cancer or other ailments and even when exposure of healthy cells is limited, he says, “Some risk remains.”
- Second cancer is a completely new cancer. Unlike primary or secondary cancers, second cancers are unlikely to be related to the original cancer or its treatment.
Cancer cells and treatment
Even before initial diagnosis, some cancer cells may have already moved to another location in the body, where they won’t be affected by the treatments aimed at the other cells. “We may have targeted the tumor cells perfectly. The cells were destroyed,” Dr. Trucco explains. But the cells that had traveled away before treatment may afterward start dividing, multiplying and creating new cells and tumors. It’s only then that your cancer care team can see them and plan a new treatment plan accordingly.
Another reason some primary cancer cells show up unexpectedly is that they can mutate to become resistant to treatments. “Cancer cells can learn how a therapy works,” says Dr. Trucco. “So if a cell has protected itself from an attack of chemo or radiation, and escapes, it can someday grow again.”
Be an informed, engaged survivor
While science and medicine may not be able to prevent the development of a secondary cancer or keep a primary cancer from recurring or spreading, there are steps you can take to help prevent a second cancer.
“Even after five years of being cancer-free, the journey is not over. It just shifts into long-term survivorship,” says Adrienne Vázquez, MSN, a nurse practitioner who leads cancer survivorship programs at Sylvester. “You still have a job to do, as do we.” Vigilance is crucial to catching cancers and other ailments, such as heart disease, diabetes and skin cancer, when they are still able to be treated successfully.
Initiatives like the UM Survivorship program can make all the difference. At Sylvester, Vázquez says, “We cater to each patient’s specific needs, interests and health history” with physical and emotional support that includes assistance with follow-up appointments, guidance on nutrition, exercise and stress reduction, referrals to genetic counselors and even discounted or free tickets to entertainment events. Says Vázquez, “We are here to support you throughout this journey.”
For questions or more information regarding the UM Survivorship program or Survivor events, please contact SCCCSURVIVORSHIP@miami.edu.