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Recurrence

If you have been successfully treated for cancer that is in remission, but it returns, you have what is called recurrent cancer. Approximately 50 percent of patients successfully treated for squamous cell head and neck cancer will develop recurrent disease within two years of successful treatment. 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. 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. The best way to handle the possibility of recurrence is to remain vigilant for several years following the end of your treatment. See your doctor regularly for follow-up visits and imaging to reassure yourself that you remain cancer-free or to detect a recurrence as early as possible. Just as it was with your initial diagnosis, the earlier you detect the cancer, the better your prognosis will be.

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It is not unusual for patients 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.

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 you develop recurrent disease.

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

If recurrent cancer is identified at an early stage, your prognosis is better than if it becomes advanced. Treatment options may be less effective for more advanced cancers. To improve the likelihood of identifying recurrent head and neck cancer as early as possible, your health care providers will advise you about the frequency and scheduling of your follow-up exams. In addition to advising you on the frequency of follow-up physical evaluations of the disease site, the health care provider may also recommend imaging of the previous site of the tumor and the chest. 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 and imaging of the former tumor sites within six months. Following your doctor’s recommendations for follow-up exams is extremely important.

You should 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. Stopping smoking and drinking should reduce your risk of cancer recurrence. If you still smoke or drink excessive amounts of alcohol, your health care providers should recommend counseling services to help you stop. There also are medications approved by the United States Food and Drug Administration (FDA) that can help you stop smoking. Consult a health care professional if you think you need support to help you stop smoking to minimize your chances of developing recurrent disease.

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 Whether you are diagnosed with locoregional or metastatic recurrent head and neck cancer determines your treatment options, treatment course and treatment goals.

Treatment options for head and neck cancer that returns but only in a small amount (eg, locoregional recurrence) include any of the following: surgery, radiation therapy, chemoradiation therapy or chemotherapy. However, whether or not your tumor was previously treated with radiation therapy will now guide current treatment decisions. The treatment goal for locoregional recurrent disease is usually to cure the disease; however, the recurrent disease is harder to treat if the tumor is large, inoperable and/or previously treated with radiation therapy and therefore excluded from additional radiation therapy.

Prognosis for recurrent widespread (ie, metastatic) head and neck cancer is unfortunately very poor. Treatment goals for recurrent metastatic disease are either to reduce disease symptoms (palliative care), such as pain, and/or to improve survival.If you are diagnosed with recurrent metastatic disease, a clinical trial may be the preferred treatment recommendation. 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 novel therapies will improve outcomes such as survival. If you do not qualify for and/or decide not to participate in a clinical trial, then your care team will assess your performance status and use this information to select the best treatment option. If you have recurrent metastatic head and neck cancer, you should begin discussing your treatment goals with your health care providers: Is your main priority to improve survival? Or is the reduction of disease symptoms the most important?

 

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

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