Cancer Recurrence: What exactly it is and how it should be dealt with

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Experts from Parkway Cancer Centre (Singapore) share insights on how to approach cancer recurrence

Dr. Ang Peng Tiam

Upon treatment of cancer, patients are likely to be told that the cancer is “under control.” While this can give great comfort to patients, they should nonetheless be continuously monitored in case their cancer recurs.

In a webinar on cancer recurrence organized by Parkway Cancer Centre (PCC) and Channel NewsAsia last Aug. 1, Dr. Ang Peng Tiam, PCC’s medical director and senior consultant for medical oncology, notes that while not all cancers relapse, some might due to failure in surgery or resistance to treatment by cancer cells.

“The aim of surgery is always to try to clear the entire tumor, and remove everything as much as possible. But the problem is that sometimes there are tiny clusters of microscopic cells which cannot be detected,” Dr. Ang explained. “It’s only over the course of time that these cells have grown in number and they gathered together, and they start causing problems.”

Cancer cells can also become resistant to treatment, as much as germs can become resistant to antibiotics, the medical director added.

There are three main factors that can contribute to a patient’s risk of cancer recurrence. According to Dr. Ang, these are the type of cancer, the stage of cancer, and the treatment given along with the consequent response to such treatment.

To prevent cancer from recurring, Dr. Ang stressed that aside from avoiding cancer in the first place through living a healthy lifestyle, detecting cancer earlier and getting the best treatment are the best things to do. The earlier the stage of cancer detected, the better the chances of cure.

“Getting the first treatment right offers the best chance of cure. There are many advances in cancer treatment and all these have led to better treatment and better results,” he added.

The increased understanding of the molecular genetics of cancer and the advances in imaging and surgical management and therapy, among other developments, make it more possible to get the best treatment for cancer.

More importantly, medical experts are collaborating for selecting the best treatment for an individual’s cancer. “It’s very important nowadays that oncologists don’t work alone,” the medical director said. “I work with my surgeons, my radiation oncologists. We all work together to provide what we call patient-centric care.”

Whenever patients feel that their cancer might be occurring, Dr. Ang advised them to have their trusted doctor confirm whether it is a recurrence or otherwise.

While he noted that most recurrences can be controlled rather than cured, advances in treatment — immunotherapy in particular — can greatly help in dealing with cancer recurrence.

Staying strong amid cancer recurrence is as much important as it is in cancer itself. “When you deal with cancer, we all need a warrior instinct to fight the disease and not lose hope,” Dr. Ang said.

Blood cancer relapses

Cancer recurrence does not only concern solid tumors like breast cancer, colon cancer, etc. Recurrence can also happen with blood cancers, which are classified into acute leukemia, chronic leukemia, lymphoma, and multiple myeloma.

Dr. Colin Phipps Diong

Also speaking at PCC’s online forum, Dr. Colin Phipps Diong, senior consultant for hematology at PCC, shared that the recurrence of blood cancers need more detailed and targeted approaches. He pointed out some considerations that must be taken in dealing with blood cancer recurrences.

First, apparent recurrences should be confirmed through biopsies, since treatment could differ if the diagnosis is an infection instead of a recurrence.

It should also be figured out whether mutations can be targeted through medications, or as Dr. Colin puts it, “getting to know the enemy from the outside in.”

Whether the patient is also fit for what kind of treatment should also be carefully considered. “Fitness to receive treatment, especially in relapse patients, is something we have to assess properly,” Dr. Colin said. “The decisions on the treatment must be tailored to a lot of things, including how fit the patient is.” Lastly, it should be determined whether bone marrow transplant is feasible, and whether it should be autologous (stem cells coming from the patient) or allogeneic transplant (stem cells coming from anyone but the patient).

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HealthNews is an online health and wellness resource developed by Parkway Cancer Centre Singapore.

In the Philippines, Parkway Cancer Centre Singapore is represented by CanHOPE Manila. They act as a link with direct access to the Singapore team providing integrated care throughout a patient’s journey.