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When cancer returns after a period of remission, it is called a recurrence. Few mesothelioma patients will confront recurrence, simply because of the aggressive nature of this cancer. It is difficult to fully eliminate mesothelioma tumors in the first place. Because mesothelioma is almost always incurable, recurrence is usually irrelevant.
However, if mesothelioma is diagnosed early, some patients will beat this disease. These few patients must face the possibility that the cancer will return. Cancer survivors are often considered “in remission” rather than “cured.” This is because a recurrence is always a possibility, even years later. For mesothelioma, new treatments are reducing the recurrence rate.
A cancer recurrence means the same cancer has returned after a period of time when it wasn’t detected. If you are diagnosed with early stage mesothelioma that is treated aggressively until it can no longer be found in your body, that is called a complete remission. However, you may not be completely cured because the cancer could recur.
A recurrence does not have to appear in the same part of the body where the cancer began. For example, if you recover from pleural mesothelioma, cancer could recur in the abdominal cavity. Your cancer would still be referred to as pleural, but recurrent. Cancer recurrence may be local, meaning it is present in the same part of the body. It is considered regional if it returns to lymph nodes close to where it originated. A distant recurrence is when the cancer returns to a completely different part of the body.
Progression vs. Recurrence
Progression is another cancer care term which may be confused with recurrence. A return of cancer can only be called a recurrence after cancer cells were completely eliminated from the body. Progression describes cancer that has not been fully cured and gets worse.
Complete remission from mesothelioma is so rare that this can be confusing. Treatment may result in partial remission, meaning that half or more of a tumor has been eliminated. A partial remission may make you feel like you are healing. However, because the cancer has not been thoroughly eliminated, if it worsens it has progressed, not recurred.
Treatment and Recurrence
Aggressive, mutimodal treatment is the best way to prevent a mesothelioma recurrence. Several treatments can eliminate the cancer, including surgery, chemotherapy, and radiation. One study of mesothelioma patients found good survival rates after extrapleural pneumonectomy (EPP), the most aggressive (and dangerous) surgery for mesothelioma.
EPP removes nearly all the tissue from one side of the chest cavity, including the lung, pleura, and the diaphragm, which can be artificially reconstructed. Lymph nodes may also be removed during this procedure. Some patients in the study avoided recurrence for longer than patients unable to undergo the procedure with chemotherapy and radiation.
Stories of Survival
Although stories of survival are rare, some people have lived years after a diagnosis of mesothelioma, some with recurrences and others totally cancer free. One patient developed peritoneal mesothelioma, which normally reduces life expectancy to months. This patient survived for 19 years with no recurrences after initial treatment. This is practically unheard of with mesothelioma. There are also stories of patients going six and 12 years after diagnosis and treatment without a recurrence.
As treatments for this difficult cancer improve, more patients will face recurrence. As with many types of cancer, once a cure is found, recurrence becomes a common factor in long-term survival.
Mesothelioma specialists typically talk about controlling the disease rather than curing it. While a few people have been lucky, researchers don’t fully understand why.
However, advancements in mesothelioma treatment allow doctors to control the disease in their patients. They can help their patients live longer with the disease, which is a major improvement.
Coping with a Recurrence
As recurrences become more common in mesothelioma, patients must learn to cope with them. When your cancer is no longer detectable, it may feel like you are on top of the world. If you find out it has returned, you may feel like you are falling all over again. To catch recurrence early, it is important to stay on schedule with your surveillance scans and follow up visit with your medical team. Report and new or returning symptoms similar to your original diagnosis. Avoid smoking and try to maintain a healthy lifestyle.
If your cancer recurs, find a support network. Communicate with your medical team to make educated decisions about your treatment. It can be helpful to also care for your emotional health, with things like therapy, meditation, or stress relief techniques. Remember that recurrences may happen regardless of how well you took care of yourself. You may not cure your cancer again, but if you take the right steps, you may live longer with it under control.
Page Medically Reviewed and Edited by Anne Courtney, AOCNP, DNP
Anne Courtney has a Doctor of Nursing Practice degree and is an Advanced Oncology Certified Nurse Practitioner. She has years of oncology experience working with patients with malignant mesothelioma, as well as other types of cancer. Dr. Courtney currently works at University of Texas LIVESTRONG Cancer Institutes.