Cancer Recurrence

A loco-regional recurrence would be to the breast, chest wall, axillary or supraclavicular lymph nodes. Distant disease means disease elsewhere in the body outside those areas, such as liver, lungs, bone or brain etc. These are the two types of recurrences.

Meditation has been shown to reduce stress, improve mood, and affect immune function, but studies have not yet established whether it prevents cancer recurrence. However, just because a study hasn’t been done yet to prove meditation prevents recurrence, does not mean it won’t be helpful. Stress and depression are often associated with higher morbidity and mortality rates among people with chronic disease in general, so anything you can do to manage your stress will be good for your health. In terms of the type of meditation, I suggest selecting the one you like the best and feels the most right to you. People vary a lot in their response to various forms of meditation and stress reduction. If you are in or around Massachusetts, for classes I highly recommend the UMass Center for Mindfulness http://www.umassmed.edu/Content.aspx?id=41252 originally founded by Jon Kabat-Zinn.

Melanoma is the 5th most common cancer (other than sqaumous and basal skin cancer) but is only the 12th most common fatal cancer. This is probably due to the massive public education campaign that has been ongoing since the rapid rise in melanoma in the 90's (doubling in incidence since then). Almost all melanomas are caused by UV A/B radiation from the sun (there are rare melanomas such as ocular and mucosal [anal, oral] that account for <2% of all melanomas) and more recently from tanning beds.

Melanoma typically spreads in an orderly fashion from the skin to the regional lymph nodes that drain that skin and then elsewhere in the body. Fortunately, spread to the lymph nodes is unusual with < 20% of patients having lymph node metastasis. Spread elsewhere in the body is even rarer < 12-14% of patients developing systemic spread. Death from melanoma is rare (<10%) if no lymph nodes are involved but survival does decrease if if lymph nodes are involved to ~70% at 5 years and beyond. If the melanoma has spread beyond the skin/lymph nodes, survival decreases further and depends on where it has spread - subcutaneous fat (70%), lung/liver (40%) and brain (10%).

The chance of recurrence/spread is based on the microscopic characteristics of the melanoma. Factors that make it more likely to return are ulceration, increasing thickness, mitoses (number of cells seen dividing under the microscope) >1/millimeter, and vertical growth phase. There are 4 main types of melanoma - nodular, sperficial spreading, acral and lentigo, with nodular and acral (palms of hands/soles of feet) tend to be a little worse but prognosis is really more related to the thickness than the type.

The answer to this question depends on many things, including the stage of disease. The more advanced the disease that was removed by surgery, the more likely it is to come back. There are several clinical trials in progress that are investigating ways to reduce the chance that melanoma will return once someone is declared N.E.D. It’s difficult to compare melanoma to other cancers in terms of likelihood of disease recurrence.

Both my Ovarian and Uterine Cancer were discovered at the same time. The wording on my pathology report is "the endometrial and left ovarian tumors appear to be independent primaries. The cul de sac and right ovary tumors likely represent metastasis from the left ovary" My gyn/oncologist refered to the Ovarian Cancer as primary and the Uterine Cancer as Secondary Primary. I did however have a Breast Cancer scare upon my mammogram almost a year after my Ovarian & Uterine diagnosis. Luckily for me all was fine but in the almost week that it took to find this out that all was OK I can say that I was more emeotional and scared about a possible second cancer diagnosis than when I was diagnosed.

Usually after mastectomy and reconstruction, imaging such as mammogram is not performed as all or almost all of the breast tissue is removed. MRI is sometimes performed every few years, but primarily to assess the integrity of silicone implants, if they were used for the reconstruction.

There are no standard recommendations for imaging in a patient that has undergone mastectomy and implant reconstruction - usually careful physical exam every 6 months is recommended as a recurrence will most often present as a palpable lump (able to be felt). In cases where it is difficult to differentiate scar tissue from recurrence, biopsy is usually performed.

If reconstruction is performed using a muscle flap, MRI or ultrasound are probably the most helpful tests to rule out recurrence, but again there are no standard recommendations for post-mastectomy imaging.

hi, my first diagnosis was stage 3 c, my first recurrence was to internal mammary nodes so still stage 3 c, second recurrence was metastatic to liver (stage 4) - because of the nature of Inflammatory Breast cancer we knew recurrence was likely so although we were upset and disappointed we also didnt get a complete shock with it either. After first recurrence they were scanning regualarly every 4-6 months because they were expecting it to come back again and because we knew that too it made it easier in a way when it did happen. We tend to have a 'it is what it is' attitude and try just to make the best of the time I have left - they are going for control not cure. doesnt mean I dont get down sometimes but I'm not going to waste too much time feeling sorry for myself. I actually think its harder for early stage people that have recurrences psychologically because there is a more definitive expectation of complete cure

Risk of recurrence will depend in staging (tumor size and presence or absence of nodal metastases).

Your chance of developing a new primary breast cancer has been greatly reduced by having a bilateral mastectomy.

A study by El-Tamer et al Ann Surg Oncol. 2004 Feb;11(2):157-64 found no difference in overall survival and breast-cancer specific survival between BRCA mutation carriers and non-carriers.

You choice to have bilateral mastectomy has certainly reduced the likelihood of a new cancer in the same breast and vastly reduced the chance of a cancer in the opposite breast. Adjuvant chemotherapy (and hormonal therapy when indicated) has reduced your chance of recurrence. Oophorectomy has diminished your chance of ovarian cancer.

It would be glib to say "don't worry". I just read an article by a survivor of endometrial cancer who thinks about her cancer 24/7. Thinking about cancer will be inevitable for someone who has undergone treatment. I advise my patients to reverse their thought process, think about the cancer not coming back, rather than it coming back.

I strongly recommend regular exercise, which has been shown to reduce recurrence rates.

When a patient misses a followup appointment with me, it means they are not dwelling on their cancer, and are off doing other things, and that's good.

I suggest you concentrate on the idea of surviving and living rather than the prospects of dying. Do positive things that make you happy, be with positive people and start enjoying life. Try meditation, healing drumming, anything to get your mind off of the negative vs. the positive. Visualize the cancer leaving your body for good and that your body will kill of the cancer cells if they return. Believe it! Believe in yourself and the ability to heal. Also take dietary steps to keep your immune system up and running-avoid sugars if possible, eat more greens, cut out dairy and eat meat only in moderation. Exercise the mind and the body and you will be on the road to healing and living out the rest of your days at peace.