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Cancer recurrence. METASTATIC CANCER, 

When cancer comes back after treatment, doctors call it a relapse or recurrent cancer.  

Finding a cancer recurrence can cause feelings of shock, anger, sadness, and fear. But now you have something that was not there before - experience. You are already a cancer survivor and you know what to expect. Also remember that treatment may have improved since you were first diagnosed. New medications or methods can help you heal or treat side effects. In some cases, improved treatments have helped turn cancer into a chronic disease that people can cope with and live with for years.


Якорь 1
Рецидив рака.

1.1. Why does cancer return?

Cancer recurrence begins with cancer cells that were not completely removed or destroyed in the first treatment. This does not mean that you received the wrong treatment. It simply means that a small number of cancer cells survived the treatment and were too small to be detected in subsequent tests. Over time, these cells have developed into tumors or cancers that your doctor can now detect.

Sometimes a new type of cancer occurs in people who have had cancer. When this happens, the new cancer is called the second primary cancer. The second primary cancer is different from recurrent cancer.

1.2. Recurrent cancer types


Doctors describe cancer recurrence by where it develops and how far it has spread. Different types of relapses:

  • Local recurrence means that the cancer is in the same place as or very close to the original cancer.

  • Regional recurrence means that the tumor has grown into lymph nodes or tissues near the original cancer.

  • Distant relapse means that the cancer has spread to organs or tissues that are far from the original cancer. When cancer spreads to distant parts of the body, it is called metastasis.  or metastatic cancer . When cancer spreads, it is still the same type of cancer. For example, if you have had colon cancer, it may return to your liver. But cancer is still called colon cancer.

1.3. Cancer recurrence stage

To find out what kind of relapse you have, you will need to go through many of the same tests you did when you first diagnosed your cancer, such as laboratory tests and imaging procedures. These tests help determine where the cancer has returned to your body, whether it has spread, and how far. Your doctor may refer to this new assessment of your cancer as "restyling."

After these tests, the doctor may prescribe a new stage for the cancer. The letter "r" will be added​​ to the beginning of a new stage to reflect the re-staging. The initial stage in the diagnosis does not change.

Check out our diagnostic information.  to learn more about tests that can be used to assess recurrent cancer.

1.4. Recurrent cancer treatment

The type of treatment for recurrent cancer will depend on your type of cancer and how far it has spread. To find out about the methods of treatment that can be used to treat your recurrent cancer, you can order a consultation / second opinion from the best international oncologists in Turkey on our website.


Cancer that spreads from where it originated to a distant part of the body is called metastatic cancer. Many cancers are also called stage IV cancers (4). The process by which cancer cells spread to other parts of the body is called metastasis.

When observed under  microscope and other studies, metastatic cancer cells have features similar to those of the primary cancer and are not similar to the cells where metastatic cancer is found. This way, doctors can determine that it is cancer that has spread from another part of the body.

Metastatic cancer has the same name as primary cancer. For example, breast cancer that spreads to the lungs is called metastatic breast cancer, not lung cancer. It is treated as stage IV breast cancer, not lung cancer.

Sometimes when people are diagnosed with metastatic cancer, doctors cannot tell where it started. This type of cancer is called cancer of unknown primary origin or CUP. 


Якорь 2

During metastasis, cancer cells break away from where they first formed (primary cancer), travel through the circulatory or lymphatic system, and form new tumors (metastatic tumors) elsewhere in the body. A metastatic tumor is the same type of cancer as the primary tumor.

2.1. How cancer spreads

Cancer cells spread throughout the body in several stages. These steps include:

  1. grows into or invades adjacent normal tissue

  2. movement through the walls of nearby lymph nodes or blood vessels

  3. travel through the lymphatic system and bloodstream to other parts of the body

  4. stopping in small blood vessels at a distant location, invading blood vessel walls and moving into surrounding tissues

  5. grows in this tissue until a tiny tumor forms

  6. causes the growth of new blood vessels, which creates a blood supply that allows the metastatic tumor to continue to grow


In most cases, cancer cells die at some point. But as long as conditions are favorable for cancer cells at each stage, some of them can form new tumors in other parts of the body. Metastatic cancer cells can also remain inactive in a distant location for years before they start growing again, if ever.

2.2. Where does cancer spread?

Cancer can spread to almost any part of the body, although different types of cancer are more likely to spread to certain areas than others. The most common sites for cancer to spread are bones, liver and lungs. The following list shows the most common metastatic sites, excluding lymph nodes, for some common cancers:

  • Bladder: Bone, liver, lung

  • Chest: Bone, brain, liver, lung

  • Large intestine: Liver, lung, peritoneum

  • Kidney: Adrenal gland, bone, brain, liver, lung

  • Lung:  Adrenal gland, bone, brain, liver, other lung

  • Melanoma: Bone, brain, liver, lungs, skin, muscles

  • Ovary: Liver, lung, peritoneum

  • Pancreas: Liver, lung, peritoneum

  • Prostate: Adrenal gland, bone, liver, lung

  • Rectal: Liver, lung, peritoneum

  • Stomach: Liver, lung, peritoneum

  • Thyroid: Bone, liver, lung

  • Uterus: Bone, liver, lung, peritoneum, vagina

2.3. Symptoms of metastatic cancer

Metastatic cancer does not always cause symptoms. When symptoms do occur, what they are and how often they occur will depend on the size and location of the metastatic tumors. Some common signs of metastatic cancer include:

  • pain and fractures when the cancer has spread to the bones

  • headache, cramps, or dizziness when cancer has spread to the brain

  • shortness of breath when the cancer has spread to the lungs

  • jaundice or swelling in the abdomen when cancer has spread to the liver


2.4. Metastatic cancer treatment

There are treatments for most types of metastatic cancer. Often, the goal of treatment for metastatic cancer is to control it by stopping or slowing its growth. Some people can live for years with metastatic cancer that is well controlled. Other treatments can improve quality of life by relieving symptoms. This type of care is called palliative care. It can be administered at any stage of cancer treatment.

The treatment you can get depends on your type of primary cancer, where it has spread, treatment you have received in the past, and your overall health.  


2.5. When metastatic cancer can no longer be controlled. Palliative care

If you've been told that your cancer is no longer controllable, you and your loved ones may want to discuss end-of-life patient care. Regardless of whether you decide to continue treatment to reduce cancer or control its growth, you can always get palliative care to control cancer symptoms and  side effects  treatment.  

Palliative care is care that helps patients feel better, but does not cure the disease itself. Palliative care should be started when cancer is diagnosed. This continues during and after treatment. Research shows that palliative care improves the quality of life for patients and their families. All patients are entitled to comfort and quality of life throughout the entire treatment period.

Palliative care is especially important if you decide to stop cancer treatment. It includes:

  • treating or preventing symptoms and side effects caused by cancer treatments

  • receiving emotional and spiritual support

  • solving practical problems of patients and their families

Palliative care:  many of the same methods that are used to treat cancer, such as medications and certain therapies, can also be used to reduce pain or other symptoms and help the patient feel more comfortable. For advanced cancer, palliative treatment may be prescribed to help the person feel better, even if it is not intended to treat cancer. For example, doctors may prescribe chemotherapy or radiation therapy to slow the growth of a tumor that is causing pain. Or, surgery may be done to remove a mass that is pressing on certain nerves and causing pain.

Your healthcare team can help you to get palliative care. However, sometimes a palliative care professional may be the best person to treat the problem. Ask your doctor or nurse if you have access to a specialist.

2.6. Hospice care for cancer patients

Hospice is a special type of care that provides medical, psychological and spiritual support to cancer patients and their loved ones when treatment no longer helps control the disease. At the hospice, a team of healthcare professionals works with patients and their families to provide the comfort and care they need towards the end of their lives.

Hospice care is not the same as palliative care. Although both hospice and  palliative care  provide patients with comfort and support, palliative care is available throughout the patient's experience with cancer. Cancer treatment continues while the person is receiving palliative care, but hospice care shifts the focus to symptom relief and end-of-life support.  


Hospice care is care, not treatment. The goal of hospice is to help you live every day to the fullest by controlling pain and other symptoms and making you as comfortable as possible. It is neither designed to hasten nor to delay death.


Choosing a hospice does not mean that you have given up hope. Instead, hospice care means changing what you hope for. It can be the hope for a good quality of the rest of your life, including more time with family and friends.


Hospice care is available in various locations. Hospice care is most often provided at home, but it can also be provided in specialized inpatient facilities, hospitals and nursing homes. It can also be done in conjunction with professional home care if needed. Hospice services will differ depending on where you live and the hospice's philosophy, but will generally include:

  • medical and nursing services

  • medical supplies and equipment

  • medicines to treat cancer-related symptoms and pain

  • short term inpatient treatment

  • volunteers to give caregivers a break

  • counseling and spiritual assistance

  • social work services

  • prompt consultation and support


Hospice specialists and volunteers undergo special training. They are committed to supporting the emotional needs of both patients and their families and are trained to cope with medical symptoms. A hospice team typically includes doctors, nurses, home care aides, social workers, clergy or other counselors, and trained volunteers. The team may also include speech therapists, physical therapists and therapists, if needed. The hospice team will focus on your end-of-life care goals, creating a treatment plan tailored to your needs and desires.

Hospice can provide support for several months. Although many people unfortunately believe that hospice is only available in the last days or weeks of life, it can provide support for several months. Many people said they would like hospice care to start earlier. They were surprised by the attentiveness and understanding of the hospice specialists.

Your doctor must confirm that you are eligible for hospice care. Most insurance plans cover hospice care after receiving a statement from your PCP and hospice medical director that your life expectancy is 6 months or less. You must also sign a statement that you are choosing a hospice. Hospice care can be continued if you live longer than 6 months if the hospice doctor re-confirms your condition.

You always have the option to discontinue hospice treatment if you want. Sometimes patients change their minds, decide to switch to another hospice provider, or their situation changes in some way. Less often, but not uncommon, patients may be discharged from hospice if their condition improves or if they resume cancer treatment. Although hospice care focuses on end-of-life care, it can be difficult to predict with certainty what will happen to a person, and sometimes unforeseen circumstances occur or the person's situation improves.  

For information on the types of costs covered by private health policies, contact your hospital office, your hospice social worker, or your insurance company.

Local community, charitable or faith-based organizations can also help patients and their families with hospice costs.

Choosing a hospice.  If you decide to use hospice services, talk to the organizations as soon as possible. The choice of hospice will depend on what services are available in your area. Not all hospices provide the same services. It will also depend on which one you like. Talk to family and friends who have used hospice services. Ask your healthcare team for advice.

2.7. Questions about advanced cancer to ask your doctor

Communication is important when providing cancer care. If you find out that you have advanced cancer, you will have a choice of treatment and steps to take. Many people find it difficult to ask questions about what these steps should be. Some people with advanced cancer benefit from new treatments, while others do not.  

Whether you've just been diagnosed or the standard treatment isn't working, it's important to ask your healthcare team what to expect in the future. Research shows that patients who discuss these issues with their doctor have a better quality of life than those who do not.

You can hope for the best while still being informed of your choice. The more information you have, the better decisions you and your loved ones can make about how you want to move forward with your concern. When you meet with your doctor, consider asking some of the following questions:

Questions about your cancer:

  • What does advanced cancer mean to me?

  • How Long Can I Live With Advanced Cancer?

  • Are there any tests I need to take now to better understand the extent of my cancer?


Questions about treatment options:

  • What can we hope for by trying another treatment? What is the purpose?

  • What are my treatment options? What do you recommend me and why?

  • Is this treatment plan for treating side effects, slowing cancer growth, or both?

  • Is there a chance that a new treatment will be found while we try the old one?

  • Is a clinical trial right for me?

  • What help will I get to feel comfortable if I choose not to actively get treatment for my cancer?


Questions about symptoms and side effects:

  • What are the possible side effects and other disadvantages of this treatment? How likely are they?

  • How can I manage the symptoms of advanced cancer or the side effects of cancer treatment?

  • Can you refer me to a palliative care specialist to help me manage my side effects?


Questions about moving from cancer treatment to hospice:

  • How do I decide whether to continue or stop my cancer treatment?

  • When should I consider hospice treatment?

  • How can I be sure that I have the best quality of life - that I am comfortable and that I am not in pain?

  • Can I get help with hospice at home or do I have to go to a special institution?

  • How can I get help with financial and legal issues (such as paying for hospice care or preparing a will or advance directive)?

  • How can I get help for my spiritual needs?


Discussing these issues can help you decide whether to continue or begin active treatment. Tell your healthcare team exactly what you want to know and how much you can take. If possible, it is best to involve your loved ones in this process. This will help you understand your needs and the needs of those close to you.


Need help?

Doctors-coordinators will advise you and help you with the choice. Services  Medikal & Estetik Group  are free for you and do not affect the clinic bill.

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