One goal of follow-up care is to check for a recurrence of cancer. A recurrence is when the cancer comes back after treatment. Cancer may recur because some cancer cells remain in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. Depending on the type of cancer, this can happen weeks, months, or even many years after the original cancer was treated. 

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Types of Recurrence

• Cancer recurrence is generally classified as local, regional, or distant.

• A local recurrence means the cancer has returned in the same area as the original cancer. For example, cancer may reappear in the same organ or near the original tumour site.

• A regional recurrence occurs when cancer returns in tissues or lymph nodes close to where it first developed.

• A distant recurrence occurs when cancer spreads to another part of the body, such as the bones, lungs, liver, or brain. This is also known as metastatic cancer or stage 4 cancer.

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Signs and Symptoms to Watch For

Many symptoms of recurrence are similar regardless of the type of cancer. It is important to report any new, persistent, or worsening symptoms to your healthcare team, particularly if they last more than a few weeks or cannot be explained by another condition.

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Some general symptoms that may require further evaluation include persistent pain, unexplained weight loss, unusual fatigue, new lumps or swelling, changes in bowel or bladder habits, persistent coughing, shortness of breath, or unexplained bleeding.

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The symptoms of recurrence often depend on where the cancer has returned. Cancer that has spread to the bones may cause ongoing bone, back, or joint pain. If it has spread to the lungs, symptoms may include a persistent cough, shortness of breath, or chest discomfort. Cancer involving the liver may cause abdominal pain or bloating, loss of appetite, nausea, weight loss, or jaundice. If cancer spreads to the brain, symptoms may include headaches, vision changes, seizures, balance problems, weakness, or confusion.

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Breast Cancer 

A recurrence may be local, which means cancer has come back in the same breast or chest area as the original cancer. It may also be regional, which means it has returned in an area near the original location, in lymph nodes in the armpit (axillary lymph nodes) or collarbone area. It may also be distant where the breast cancer spreads away from the original tumour to the lungs, bones, brain or other parts of the body. This is metastatic cancer often referred to as stage 4 breast cancer.

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​​​​​​​​​​​​​​​​​​​​Symptoms of a local recurrence you should watch for include, a new lump in the breast or the chest wall an area of the breast that feels unnaturally firm; swelling of all or part of the breast; skin irritation or redness in the breast area; flattening or other nipple changes; skin pulling or swelling near the original breast cancer surgery site; and, thickening of surgery scars. The symptoms of a regional recurrence are a lump or swelling in the lymph nodes under the arm, above the collarbone or near the breastbone; pain, swelling, or numbness in one arm or shoulder; and, constant chest pain.

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It’s important to mention that, after breast cancer surgery and radiation therapy, the breast area may be swollen and red for a few months after those treatments are completed. Also, you may feel lumps caused by a build-up of scar tissue. These lumps usually aren’t cancer, but tell your doctor about any lumps you feel in your breast so they can be monitored. 

Breast cancer can spread to other parts of the body including bones, lungs, liver, brain, and chest. Symptoms you should watch for and report to your doctor include, back, bone, or joint pain that does not go away; constant dry cough or shortness of breath; chest pain; loss of appetite; abdominal bloating; pain or tenderness; constant nausea, vomiting, or weight loss; jaundice; severe headaches; vision problems; seizures loss of balance; and confusion.
 

Colorectal Cancer

Colorectal cancer most commonly recurs in the bowel, liver, lungs, or nearby lymph nodes.

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Symptoms that should be reported include persistent abdominal pain, changes in bowel habits such as ongoing diarrhea or constipation, blood in the stool, unexplained weight loss, loss of appetite, abdominal bloating, or increasing fatigue. If the cancer has spread to the liver, symptoms may include abdominal discomfort, jaundice, or swelling in the abdomen. Lung involvement may cause a persistent cough or shortness of breath.

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Prostate Cancer

Many prostate cancer recurrences are first detected through rising prostate specific antigen (PSA) levels before symptoms develop. However, some individuals may experience symptoms if the cancer returns or spreads.

 

Potential symptoms include difficulty urinating, changes in urinary frequency, blood in the urine, pelvic discomfort, or erectile dysfunction. If the cancer spreads to the bones, persistent back, hip, or bone pain may occur. Bone pain that does not improve should be discussed with your healthcare team.

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Lung Cancer

Lung cancer recurrence may occur in the lungs, lymph nodes, brain, bones, liver, or other organs.

Symptoms can include a persistent or worsening cough, shortness of breath, chest pain, coughing up blood, unexplained weight loss, or increasing fatigue. If the cancer spreads to the brain, symptoms such as headaches, vision changes, weakness, balance problems, or confusion may develop.

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Gynecologic Cancers

For survivors of ovarian, uterine, cervical, or other gynecologic cancers, recurrence may present with abdominal or pelvic symptoms.

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Symptoms may include persistent abdominal bloating, pelvic pain or pressure, changes in bowel or bladder habits, abnormal vaginal bleeding or discharge, unexplained weight loss, or ongoing fatigue. Because these symptoms can develop gradually, it is important to discuss persistent changes with your healthcare team.

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A NOTE ABOUT SYMPTOMS

Many of the symptoms listed above can be caused by conditions other than cancer recurrence. However, new, persistent, or worsening symptoms should not be ignored. Early reporting allows your healthcare team to determine whether further testing is needed and, if necessary, begin treatment as soon as possible.

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To help find signs of a potential recurrence, your doctor will ask specific questions about your health and usually do a physical examination during your follow-up visits. If a recurrence is suspected, your doctor may order additional diagnostic imaging tests and/or biopsies.