Lung Cancer Recurrence: For Patients

Even after successful treatment and a period of complete remission, lung cancer can recur. Lung cancer recurrence is when the same type of cancer cells treated initially come back after at least one year without detectable symptoms of the disease. If this happens within a year, it is considered a progression of the disease rather than a recurrence.

The cancer cells can appear near the location of the original tumor or elsewhere in the body. With appropriate treatment, recurring lung cancer can, in some cases, be brought back into remission. In this article, we explain the different ways in which lung cancer can recur, the symptoms, and the possible treatments.

How often does lung cancer recur?

The chance that lung cancer comes back depends on different factors: the type of lung cancer, the stage of cancer at the time of diagnosis, and the treatment methods. Most often, lung cancer recurrence happens between two and five years after the original diagnosis.

Non-Small Cell Lung Cancer

Depending on the stage at the original diagnosis, people with non-small cell lung cancer (NSCLC) will have a bigger or smaller risk of recurrence. 3 in 10 people diagnosed with stage 1 lung cancer will see a recurrence typically within five years, while people diagnosed with stage 4 have a chance of relapse of 7 in 10.

Small Cell Lung Cancer

This less common and more aggressive type of lung cancer has a worse prognosis. 7 in 10 people with small cell lung cancer (SCLC) will experience a recurrence, in most cases within one to two years. The recurrence can be limited — on one side of the chest — or extensive, which means it has spread to both lungs, the lymph nodes or other parts of your body. However, after five years of cancer-free survival, the chance that SCLC comes back is less likely.

What causes lung cancer to recur?

Even after successful treatment, there may be lingering cells that are undetectable. The spread of these original cancer cells is the main cause of recurrence. They can cause the growth of a new tumor at the original location or in distant parts of the body. That is why lung cancer can recur in the form of, for example, a brain tumor. Less common than a recurrence is the emergence of a different type of cancer due to the damage done to the body by the treatment of the original lung cancer. The risk of recurrence also depends on the choices people make. Smoking alone can increase the risk of lung cancer recurrence more than seven-fold.

How does lung cancer return?

Lung cancer recurrence can take different forms. There are three possibilities:

Local recurrence. Cancer comes back in the lung near the location of the original tumor.

Regional recurrence. Cancer recurs in the lymph nodes near the location of the original tumor.

Distant recurrence. Lung cancer cells return to other body parts, such as the brain, bones, liver, or adrenal glands.

Symptoms of lung cancer recurrence

For both non-small cell and small cell lung cancer, recurrences are in most cases metastatic. That means that the cancer has spread to distant parts of the body. Therefore, the symptoms may vary, depending on where the tumors are located. Besides more general cancer symptoms, such as weight loss and tiredness, people can experience the following symptoms.

• When the recurrence is local or in lymph nodes, symptoms can include a persistent cough, shortness of breath and wheezing, pneumonia, and coughing up blood.
• In case of a recurrence in the liver, jaundice, abdominal pain, and confusion are common symptoms.
• If lung cancer has spread to the bones, a common symptom is pain in the chest, shoulders, arms, and legs.
• A metastatic tumor in the brain can lead to severe headaches, coordination loss, dizziness, and impaired or double vision.

What is the prognosis when lung cancer returns?

Once lung cancer recurs, it is often late-stage, and the disease has spread to other parts of the body, implying that the prognosis for a full recovery is rather dim.

For people with NSCLC recurrence, the median survival time is around 21 months. For people with SCLC, the prospect is worse, as many will die within six months. However, in both cases, numerous patients are cancer-free five years after the recurrence is treated. And as the treatment options keep evolving and improving, so do the chances of survival.

How is recurring lung cancer treated?

When lung cancer returns, the treatment options will depend on: where the cancer is located, any past treatments, and the patient’s general health. If there is no chance of a cure, the treatment will focus on increasing survival time and quality of life. Treatment options might be chemotherapy, radiation therapy surgery, targeted therapy, immunotherapy, or a combination of these.

Chemotherapy is the most common treatment for recurring lung cancer. It is the use of drugs to destroy cancer cells and works by keeping the cancer cells from growing and dividing. Because cancer cells usually grow and divide faster than normal cells, chemotherapy has a greater effect on them. However, the potent drugs used for chemotherapy can still cause damage to healthy cells and produce several unwanted side effects.

Often chemotherapy does not work as well as the first time because recurrent cancers have become resistant to previously used drugs. Therefore specialists are likely to use different chemotherapy drugs — so-called ‘second-line’ drugs — or a combination of them.

Radiation therapy is often used to treat lung cancer that has spread to the brain, bones, or liver. X-rays and other intense beams of energy destroy the genetic material that makes cells grow and divide. While high doses of radiation damage both healthy and cancerous cells, the aim is to destroy as few normal cells as possible. If radiation therapy has been part of previous treatment, it is used sparingly in case of a recurrence of the disease. Because the amount of radiation that a body part can safely receive is limited, radiation therapy is only an option if a patient’s lifetime dose is relatively low.

Targeted therapy is a treatment that uses drugs, just like chemotherapy, but differently. Targeted drugs affect specific genes and proteins that are essential for the growth and survival of cancer cells. While traditional chemotherapy is cytotoxic — can damage normal, healthy cells — targeted therapy only affects the cancer cells and mostly leaves healthy cells alone.

Another difference is that targeted drugs often work by blocking cancer cells from dividing and making new cancer cells. Traditional chemotherapy, on the other hand, kills cancer cells that have already been produced.

Targeted therapy is often used in combination with chemotherapy and other treatments, especially for people with recurrent lung cancer who have certain mutated strains. Genetic tests can determine if a patient who has gene mutations can undergo treatment with targeted therapy.

Immunotherapy is a biological therapy i.e. a treatment that uses substances made from living organisms. Immunotherapy drugs are made up of white blood cells and organs and tissues of the lymph system. The way they work is by stimulating the immune system to fight cancer. Though these drugs don’t work for everyone, they are effective in providing long-term control for some people with lung cancer recurrence.

Surgery is the preferred treatment when lung cancer occurs for the first time. Surgery can involve a wedge resection, where only a small piece of a lung is removed, a lobectomy — where one or more lobes of a lung are removed, or a pneumonectomy, in which case an entire lung is removed.

However, surgery is not a common treatment for lung cancer recurrence because the cancer cells usually spread to other body parts. However, it may be used to remove a localized tumor or larger isolated tumors in the brain or liver.

The choice of treatment center

All the above-mentioned treatment options are available in most hospitals, but choosing a treatment center does matter. Though the support of the family is often a reason to go to a local hospital, it can be advisable to consider other options. Treatment of lung cancer is evolving rapidly, and it is crucial to find the most up-to-date treatment. Lung cancer treatment is also complex. Many specialists are involved and attend to different aspects of the disease and related conditions.

While small hospitals that offer very personalized care have their benefits, big cancer centers that specialize in treating large numbers of cancer patients usually have more know-how and cutting-edge technology.

myTomorrows is dedicated to helping patients with lung cancer find and access potential treatment options, such as clinical trials. Click here to get started.