Also referred to as relapse, lung cancer recurrence can occur even in those who had early-stage tumors and despite modern cancer therapies.
Lung cancer recurrences can sometimes be brought back into remission—undetectable on tests or decreased in size—with appropriate treatment. But those that develop rapidly or are more advanced and widespread are generally hard to treat.
This article will explain the different types of lung cancer recurrence and common symptoms, treatment options, and prognosis.
Types of Lung Cancer Recurrence
A lung cancer recurrence is defined by where it occurs:
Local recurrence is when cancer comes back in the lung near the site of the original tumor. Regional recurrence is when cancer recurs in the lymph nodes near the site of the original tumor. Distant recurrence is when lung cancer cells reappear far away from the original tumor, such as in the bones, brain, adrenal glands, or liver.
It’s also possible that someone who had lung cancer develops a different cancer entirely after having been in remission. This is not a recurrence, but a secondary primary cancer.
This new cancer can be distinguished from a recurrence of lung cancer when cells are examined under a microscope. Cells of lung cancer that recurs look the same whether they reappear in the lung, liver, or elsewhere. Other cancer cells have a unique appearance.
How Often Does Lung Cancer Recur?
The chance that lung cancer will recur depends on many factors, including the type of lung cancer involved, the stage of cancer at the time of diagnosis, and how the original cancer was treated.
Most lung cancers that recur tend to do so between two and five years of the original diagnosis.
Non-Small Cell Lung Cancer
Between 30% and 55% of people with non-small cell lung cancer (NSCLC), the most common form of the disease, will experience recurrence.
The risk of recurrence varies by the stage of cancer, of which NSCLC has five (stage 0 through stage 4):
Who: Around 3 in 10 people will experience a relapse with stage 1 NSCLC, increasing to roughly 7 in 10 by stage 4. When: Recurrence typically occurs within five years with earlier stages of NSCLC, decreasing to two years by stage 4.
Small Cell Lung Cancer
By contrast, around 7 in 10 people with small cell lung cancers (SCLC) will experience recurrence, usually within one to two years.
As a disease with only two stages—limited and extensive—SCLC generally has worse outcomes than NSCLC and a greater risk of recurrence. Not surprisingly, people with extensive SCLC (in which cancer has spread beyond one lung) are more like to relapse.
Interestingly, the recurrence of small cell lung cancer after five years of disease-free survival is rare.
Small cell lung cancers are further classified: Refractory cases are those that return within 60 days of chemotherapy, while sensitive ones have a longer sustained period of remission.
As a general rule, sensitive cases tend to respond better to second-line treatment than refractory ones.
Symptoms of Lung Cancer Recurrence
Symptoms of a lung cancer recurrence depend on where it occurs.
Local or in lymph nodes near the original tumor:
Persistent cough Coughing up blood Shortness of breath Wheezing Pneumonia
Bones:
Deep pain in the chest, back, shoulders, or extremities
Brain:
Dizziness Impaired vision Double vision Weakness on one side of the body Loss of coordination
Liver:
Abdominal pain Jaundice (yellowing of the skin and eyes) Itching Confusion
The more general symptoms of cancer, such as fatigue and unintentional weight loss, may also signal a recurrence.
With NSCLC, around 83% of recurrences will be metastatic—meaning cancer has spread to distant parts of the body instead of near the site of the original tumor. Because of this, the symptoms can vary depending on where the metastatic tumor is located (most commonly the liver, brain, or bones).
Similarly, the majority of SCLC cases are extensive rather than limited stage disease.
Where symptoms can differ is in the development of paraneoplastic syndromes—a set of conditions in which the immune system responds abnormally and attacks healthy central nervous system cells. This can cause the loss of fine motor skills, slurred speech, difficulty walking or swallowing, memory loss, and seizures.
These disorders are far more common with SCLC than NSCLC.
Causes
Most lung cancer recurrences are caused by the spread of the original cancer. Even after the initial curative treatment, there may be lingering cells that survive and fall below the detection levels of imaging tests.
These cells can potentially “seed” a new tumor at the original site or be transported via the bloodstream or lymphatic system to distant parts of the body. This is why lung cancer cells can be found in brain tumors, for example.
The risk of recurrence can increase if you don’t change the modifiable risk factors that contributed to lung cancer in the first place. For example, moderate to heavy smoking alone can increase the risk of recurrence more than seven-fold compared to survivors who quit cigarettes.
Although it is less common than a recurrence, the treatments used to kill cancer may increase your risk of an entirely new and different cancer.
A typical example involves radiation therapy in which exposure to high-dose radiation may cause you to develop an entirely new type of cancer in the irradiated tissues.
Referred to as radiation-induced secondary malignancies (RISM), these new tumors tend to develop within five years of exposure and may require different forms of treatment.
Treatment
Treating a lung cancer recurrence depends largely on where the cancer recurs and the type of cancer involved. Unfortunately, once lung cancer recurs, it is often late stage and there is little chance of a cure.
With that said, treatments are available that may increase both survival time and potentially quality of life. Among them:
Chemotherapy is usually the mainstay of treatment for lung cancer recurrence. Second-line drugs will be used, in large part because recurrent cancers tend to change (mutate) and become resistant to previously used medications. Radiation therapy, which uses strong beams of energy to kill cancer cells, is generally used sparingly if previously used as treatment. This is because there is a limit to the amount of radiation an area of the body can safely receive. If your lifetime dose is relatively low or the benefits of treatment outweigh the risks, it may still have a place in treatment. Stereotactic body radiotherapy (SBRT) is a form of radiation used to ablate (remove) small secondary tumors in places like the brain or liver. Targeted therapies may be useful for people with advanced or recurrent lung cancer who have certain mutated strains. Genetic tests can help determine if you have at treatable gene mutations, such as the EGFR mutation, ALK-positive lung cancer, or ROS1-positive lung cancer. Immunotherapy involves the use of medications that stimulate the immune system to fight the disease. These drugs don’t work for everyone but have provided long-term control for some people with lung cancer recurrence. Surgery is not commonly used to treat lung cancer recurrence but may occasionally be used to remove a localized tumor or larger isolated tumors in the brain or liver.
The National Cancer Institute recommends that people with stage 4 lung cancer consider clinical trials to gain access to experimental treatments that may extend life.
Prognosis
The prospect of recovery from recurrent lung cancer depends on many factors. These include the site of the recurrence, the cancer type, your general health, and the treatments you previously received.
A recurrence is unlikely to be cured, but treatments, such as chemotherapy or targeted therapies, can increase survival time.
When NSCLC recurs, the majority of cases involve spread beyond the original tumor site. According to a 2014 study in Translational Lung Cancer Research, 44% will occur in distant sites, while 39% will involve both local and distant sites.
The median survival time for people with NSCLC recurrence is around 21 months, with some people living for eight years.
The outcomes with SCLC, on the other hand, tend to be poor. Most people with SCLC recurrence live two to three months if untreated; many others will die within six months even with treatment, according to a 2016 article in the Journal of Thoracic Disease.
However, as much as 87% of people with NSCLC and SCLC who do not experience another recurrence within five years are likely to remain cancer-free for another five.
Unfortunately, the risk of recurrence never completely returns to zero.
Even though recurrence lowers a person’s expected life expectancy, some people have been known to enjoy a good quality of life for many years.
Coping
Coping with a cancer recurrence can be difficult, as all of the emotions of the original diagnosis can not only return but be amplified. For some people, the disappointment can be overwhelming and lead to depression and anxiety over a battle they thought they had won.
While these emotions are entirely normal, try not to let them overwhelm you to the extent that you just give up.
It is important to remember that survival times are based on studies involving all sorts of people, each of whom have different health concerns.
Try to focus less on how you long you may live. Instead, work with your healthcare provider so that your goals are clearly understood—whether it be to fight the disease with all available options or to forego lung cancer treatment so you can maintain the highest quality of life with the time that is left. There is no wrong or right answer.
Ask questions. Talk about your options. Pull together a support network of loved ones and friends. Join a support group or seek counseling if you have difficulty coping.
Summary
A lung cancer recurrence is when the same type of cancer you had previously comes back after treatment, particularly if you’ve had no signs of it for at least a year.
Recurrence of lung cancer usually happens within five years of the original cancer and it is often metastatic, which means it has spread.
Lung cancer recurrence is hard to treat and lowers life expectancy, but survival rates and quality of life vary widely from person to person.
