At What Rate Does Each Cancer RECUR (RETURN)?

For cancer returning, different terms are used. Although often used interchangeably, these terms have some small differences.

• Recurrence: the most commonly used term for cancer returning.
• Relapse: return after disease signs and symptoms have disappeared (early recurrence). It is mostly used for hematological cancers (originating in blood and bone marrow).
• Recurrence: return after complete recovery (cure) from disease (late recurrence). Mostly in hematological cancers.
• Return

Cancer recurrence is the foremost concern of patients and their caregivers (source no 1). This fear may negatively affect quality of life and approximately % 7 of patients develop severe, prolonged fear, including misinterpreting even mild symptoms and complaints unrelated to cancer.

- Related topic: 6 Tips for Coping with Fear of Cancer Recurrence

It is important for doctors to discuss recurrence risk with patients, because this information can reduce fear of recurrence among patients. Doctors should discuss cancer recurrence rates, the types of cancer that recur, signs of recurrence, measures that may reduce recurrence risk, and the rationale behind follow-up plans with patients and their families.

Cancer Recurrence Rates - General Principles

Two points should always be remembered when discussing recurrence rates:

1. The likelihood of cancer recurring varies greatly according to stage, cancer type and subtype, genetic factors, patient-related factors and different treatment options.
2. Most estimates of recurrence rates are based on past data and do not specifically account for new anticancer treatment options. For example, entering cancer medicine after 2011 and being widely used in many cancers after 2015, immunotherapies have not yet yielded current, long-term recurrence rates for many cancers. Recurrence rates should therefore be viewed as estimates that may vary between individuals.

Which Cancers Have a HIGH Likelihood of Recurrence?

Some cancers are difficult to treat and have high recurrence rates. For example, despite combined treatment (surgery + radiotherapy + chemotherapy), GBM brain tumorpatients almost all experience recurrence (source no 2). Ovarian cancer (cancer of the female ovaries) patients also have a recurrence rate of around % 85 (3). Soft tissue sarcomas, adjuvant (postoperative protective) chemotherapy is followed by recurrence in approximately % 50 of patients, and for most patients with sarcoma diagnosed at an advanced stage, the recurrence rate approaches % 100 (4). Similarly, bladder cancer patients have recurrence in approximately % 50 after cystectomy (surgical removal of the bladder). Another example is patients with early-stage disease undergoing surgery with curative intent, with pancreatic cancer , in whom % 36 - % 46 develop recurrence despite adjuvant chemotherapy (5-7).

Among hematological malignancies (cancers originating in blood and bone marrow), cancer recurs in % 60 - % 70 of patients with diffuse large B-cell lymphoma, a subtype of non-Hodgkin lymphoma, and after primary treatment in % 75 of patients with peripheral T-cell lymphoma (8-9).

Which Cancers Have a LOW Likelihood of Recurrence?

Some cancers have low recurrence rates, particularly when treated at early stages. Estrogen receptor -positive, non-advanced breast cancer patients have a recurrence rate of only % 5 to % 9. Kidney cancer recurrence develops after surgery in approximately % 13 of patients, and local (regional) recurrence of early-stage osteosarcoma is around % 11 - % 12 (11-12).

Hodgkin lymphoma can usually be completely treated with combination chemotherapy, and its recurrence rate is low: between % 10 and % 13 (13). If this patient group experiences recurrence, the recurrence rate after second-line treatment is % 20 to % 50 (14). For low-risk childhood acute myeloid leukemia, a recurrence rate of around % 9 has been reported (15).

- You may be interested: What Is the Difference Between Leukemia and Lymphoma?

"Approximate" Recurrence Rates for Specific Cancers

• Bladder cancer: % 50 after cystectomy (source no 5).
• Breast cancer: % 30 for all stages and subtypes. 
  % 5 - % 9 in hormone-positive breast cancer over a median of 10.6 years (10, 16). 
• Colorectal cancers: % 17 after complete surgery with negative surgical margins (17).
• Glioblastoma brain tumor (GBM): Close to % 100 (2).
• Stage 4 Head and neck cancer: %17 local recurrence.
  % 22 distant metastasis (18).
• Hodgkin lymphoma: % 10 - % 13 after first-line treatment.
  % 20 - % 50 after second-line treatment (13, 14).
• Kidney cancer: %13 after early-stage surgery.
  %49 in advanced disease after tyrosine kinase inhibitor drugs produce a complete response (11, 19).
• Childhood leukemia acute lymphoblastic lymphoma (ALL): % 9 - % 29 according to risk status (20).
• Diffuse large B-cell lymphoma: % 60 - % 70 (8).
• Peripheral T-cell lymphoma: % 75 (9). 
• Malignant melanoma skin cancer: % 15 - % 41, varying by stage.
  % 87 in metastatic disease (stage 4) (21).
• Non-small cell lung cancer: % 26 after curative surgery (complete tumor removal).
  % 27 after chemoradiotherapy for locally advanced disease (22, 23).
• Orteosarcoma (bone cancer): % 11 - % 12 local recurrence.
  % 5 - % 45 metastasis (12).
• Ovarian cancer (female ovary): % 85 (3).
• Pancreatic cancer: % 36 within 1 year after curative pancreatic cancer surgery (complete tumor removal).
  % 38 risk of local recurrence after postoperative adjuvant chemotherapy, and % 46 risk of distant metastasis (6, 7).
• Prostate cancer: After prostatectomy (prostate cancer surgery), 10-year recurrence risks: % 24 for low-risk disease; % 40 for intermediate-risk disease; % 48 for high-risk disease (24).
  - Related topic: Staging and Risk Groups in Prostate Cancer
• Soft tissue sarcoma: % 50 after postoperative protective chemotherapy. In advanced disease, close to % 100 (4).
• Thyroid cancer: Up to % 30 in differentiated thyroid cancer.
  % 8 - % 14 after surgery for medullary thyroid cancer (25, 26).

Are There Tests to Calculate Cancer Recurrence Risk?

The likelihood of cancer recurrence, until recently, was estimated only from clinical characteristics (age, tumor diameter) and tumor pathology (grade, Ki67, etc.), whereas today genomic tests have begun producing more precise results. These tests have so far been developed for breast, colon and prostate cancer; however, they have entered clinical use most extensively in breast cancer. The best-known genomic test measuring recurrence risk is Oncotype Dx , a tumor recurrence score. By examining activity of 21 genes in a breast tumor, this test calculates recurrence risk in early-stage breast cancer and predicts whether the patient will benefit from chemotherapy.

Finally, when considering the likelihood of a cancer recurring;

• Recurrence rates vary greatly according to cancer stage, type and subtype, genetic factors, patient-related factors and treatments, and
• It should be remembered that most of these estimates are based on past data and that contributions from new treatment options in particular are not yet included in these calculations.

Cancer, with its subtypes reaching 1000 varieties, is a vast disease groupformed through highly complex biological and genetic processes. Although all cancers still cannot be completely cured , in oncology advances contribute more to patients' lives every day. However, as long as life exists, cancer and its recurrences will also exist. It is therefore important to inform patients and their families about recurrence, because this awareness can reduce fear of recurrence among patients.

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- Why Does Treated Cancer Return? Dormant Cancer Cells