2023-10-26 21:03:00
The fear of recurrence consumes many patients who have won their first battle against cancer. Why do cancers recur and can we prevent these relapses? Answers.
Recidivism. It is because of her that the word cure is rarely used by oncologists when addressing their patients. They prefer the term complete remission. Because even if it fades over time, the risk of cancer recurring still exists.
According to the National Cancer Institute, recurrence is the “reappearance of cancer cells, in the same place or in another region of the body. A recurrence can occur very soon after the end of treatments, but also after a long period of remission. We also talk about relapse.” Thus, the recurrence can be a local recurrence of the cancer, where the initial tumor was located or in the surrounding tissues. It can also occur through metastases, cancer cells having spread to another organ or tissues distant from the initial area via lymph or blood.
Invisible cells
How can we explain a recurrence when a patient is in remission? “We can no longer detect disease. We then speak of complete remission, which means that there are no longer any disease cells detectable with the means at our disposal”, Professor Steven Le Gouill recently explained to us, hematologist, director of the Institut Curie hospital complex. That is to say, there may remain a residual cancer cell that current medical means are not capable of detecting. This cell is however very present and could be responsible for a recurrence in the more or less long term. The majority of recurrent cancers return within 2 to 3 years after treatment, the risk then decreases after 5 years.
Which cancers have the highest risk of recurrence?
Breast cancer, the leading cancer in women, is among those most at risk of recurrence. According to Dr. Paul Cottu, deputy head of the medical oncology department at the Institut Curie, “ten years after the first diagnosis, 15 to 20% of breast cancers recur.”
The greatest risk of relapse concerns so-called triple negative cancers with an average 20 to 30% relapse rate. “All types of cancer combined, we observe a peak in local recurrence or the appearance of metastases two years after treatments,” specifies the specialist on the Institute’s website.
The risks of recurrence of skin cancers, basal cell carcinoma and squamous cell carcinoma, are higher, respectively, during the first 3 and 2 years after treatment. Regular monitoring and special attention to skin changes are recommended.
Non-small cell lung cancer represents 84% of lung cancer diagnoses and is predominantly non-metastatic. However, between 30 to 55% of these cancers will recur, according to the Institut Curie.
Brain tumors also frequently recur. “The cause is the presence within them of cancer stem cells capable of perpetually renewing themselves, of disseminating, of reforming a complete tumor and of resisting treatments,” explains the foundation for medical research.
Recurrences of pancreatic cancer are also very common, metastatic and/or local. “It is important to detect a tumor recurrence before the appearance of symptoms to allow this recurrence to be treated more effectively and to improve long-term survival,” notes the National Cancer Institute.
Can we prevent recurrences?
To prevent the risk of local or metastatic recurrence, patients receive adjuvant treatment in addition to the main treatment. “Adjuvant treatment is a safety treatment. Surgery, chemotherapy, radiotherapy, hormonal therapy, immunotherapy can be adjuvant treatments,” notes the National Cancer Institute.
Furthermore, if we are talking about preventable cancers – caused by harmful behaviors such as tobacco or alcohol abuse – we are not talking about avoidable recurrences. However, a healthy lifestyle and regular activity would help prevent the risk of relapse.
Regular medical monitoring and vigilance when signs appear are also essential in order to treat recurrences at an early stage.
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