Sally had a lumpectomy plus radiation therapy six years ago for two small cancers in her breast. As a cancer survivor, she has never stopped worrying about recurrence. And with good reason.
Even a patient who has been in remission for several years may still harbor malignant cells that remain dormant for an extended period before showing up again like an unwanted house guest. Moreover, cancer treatment itself–whether radiation or chemotherapy–increases the risk of future cancers as well as other medical problems.
The cancer frequently recurs in the same local area where it was before. Although doctors try very hard to remove all of the cancer along with a margin of healthy tissue, some cells may be resistant to treatment and remain dormant for an extended period.
The cancer may also occur in lymph nodes and tissue in the vicinity of the original cancer. Or it may have metastasized and spread to distant areas.
The risk of recurrence and where it appears varies with the individual, the type of cancer and the stage of the cancer when it was diagnosed. For Sally’s cancer, which was detected early and localized to the breast, the risk of recurrence is 20 to 30 percent. If it had spread to the lymph nodes or to distant parts of the body, the risk would have been 30 to 60 percent.
Aggressive cancers are more likely to recur early–during the first four years. Slower growing cancrs may remain dormant and could come back at almost any time.
Although Sally was by now an official “survivor,” her doctor monitored her regularly, with appointments every six months. And Sally was given information about signs and symptoms that could mean a recurrence. For a recurring localized cancer, early detection is even more important than it was for the original cancer.
Guidelines for Prevention
The American Institute for Cancer Research (AICR) has developed a set of specific guidelines for cancer survivors to reduce their risk of recurrence.
• Stay lean but not to the point of being underweight.
• Engage in some physical activity for at least 30 minutes every day. Preferably, at least some of this activity should be at least moderately intense.
• Avoid sugar-sweetened drinks such as soda pop and processed foods, particularly foods that are high in sugar or fat and low in fiber.
• Eat a variety of fruits, vegetables, beans and whole grains.
• Limit your intake of red meats and avoid processed meats.
• Limit your alcoholic drinks to two a day for a man and one for a woman.
• Cut back on foods and processed foods.
• Don’t rely on supplements to protect you against cancer.
• Don’t smoke or chew tobacco.
• New mothers, unless they are receiving chemotherapy, should breast feed exclusively for the first six months before adding other liquids and foods.
Most of these simple recommendations are the same as those advised to prevent cancer, and they also help protect against heart disease, stroke, diabetes and other serious illnesses. They were, however, developed specifically for cancer survivors, based on a study of available research.
Expanding on the need for healthy eating, the AICR called for a low-fat, plant-based diet. To get the vitamins, minerals and phytochemicals needed to protect against cancer recurrence, you should try to get about two thirds of your diet from fruits, vegetables, whole grains and legumes. Focus on brightly colored, highly flavored produce such as dark green leafy vegetables, tomatoes, strawberries, blueberries, carrots and cantaloupe.
For the remaining one third of your diet, look to fish, poultry and cheese. Red meat promotes inflammation in body tissues, and inflammation is believed to promote the growth of cancer cells. Even more dangerous are processed meats like cold cuts, bacon, sausage and ham–not just because they are high in sodium but also because they may contain cancer-causing substances.
Consumption of high-fat foods should be limited. The growth and development of both breast and prostate cancers are affected by the amount of saturated fats in the diet.
Regular physical activity is also important for cancer survivors. An expert panel of the American College of Sports medicine has strongly endorsed exercise as safe and beneficial for cancer survivors and even for those currently in treatment. The nature of the exercise and the intensity depends on the patient’s physical condition.
Many cancer drugs can damage the heart and the cardiovascular system. That’s one reason for the strong emphasis on heart-healthy habits for cancer survivors.
Other possible long-term effects of cancer treatment include weight gain, high blood pressure, high cholesterol and an increased risk of type 2 diabetes.
Excess weight increases inflammation and cardiovascular risk. And body fat, particularly around the waist, promotes the release of hormones and substances that are associated with the growth of cancer cells.
Moderate alcohol use is good for heart health, but no protective effect against cancer has been found. In fact, alcohol use is associated with a higher risk of breast cancer. The AICR recommends avoiding alcohol. For those who choose to drink, the advice is no more than one drink a day for a woman, two for a man.
In addition to its negative effects on the cardiovascular system, tobacco, in any form, is a major cancer-causing substance and should be strictly avoided by anyone who is at risk of cancer or cancer recurrence.
Cancer survivors are usually acutely aware of the possibility of recurrence. They should not allow that possibility to cause them distress, however. Stress affects the immune system, and a healthy immune system is crucial to fighting off cancer as well as other diseases. For the same reason, if cancer does return, it’s even more important to deal effectively with the distress, anger and self doubt that is likely to follow.
Survivors should remember that the same coping mechanisms that brought them through cancer the first time are still available to them. They know more now about cancer and their own bodies than they did at that time, and they have built a successful support network. If the initial cancer treatment was several years ago, they should understand that advances in treatment have probably occurred since that time.
REFERENCES:
American Institute for Cancer Research, “AICR’s guidelines for cancer survivors,” 2012.
American Institute for Cancer Research, “Recommendations for cancer prevention,” 2012.
Laura Bell, “A breast cancer cure?” Prevention, November, 2011, updated September, 2012.
“Breast cancer overview: prevention and lifestyle factors,” New York Times Health Guide.
Breast Cancer Partner, “Preventing cancer recurrence,” LiveStrong.com.
Denice Economou, RN, MN, CNS, CHPN, et al, “Integrating a cancer-specific geriatric assessment into survivorship care,” Clinical Journal of Oncology Nursing,, June 29, 2012.
Zhemming Fu, et al, “Lifestyle factors and their combined impact on the risk of colorectal polyps,” American Journal of Epidemiology, November 12, 2012.
Cesare Hassan, et al, “Primary prevention of colorectal cancer with low-dose aspirin in combination with endoscopy,” Gut, July 17, 2012.
Mayo Clinic Staff, “When cancer returns: how to cope with cancer recurrences,” MayoClinic.com, February 19, 2011.
National Comprehensive Cancer Network, “Nutrition for cancer survivors,” 2012.
01/08/2013
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