What is cancer recurrence?

Cancer recurrence refers to the return of cancer after completion of treatment. The same cancer may recur in the same place where it first started, or somewhere else in the body.

For example, breast cancer may return in the operated site or breast, or it may come back in the bones. In either case, it is considered as a breast cancer recurrence.

What are the types of cancer recurrence?

Recurrence can be categorised into three different types:

• Local recurrence - The cancer has returned in the same location it first started
• Regional recurrence - The cancer has returned in the lymph nodes near the location it started
• Distant recurrence - The cancer has returned in another part of the body, such as the bones, liver or lungs etc

If you encounter symptoms suspicious of a cancer recurrence, it is best to speak with your doctor as soon as possible for further evaluation.

What is the risk of recurrence?

The risk of recurrence varies between cancer survivors. This is dependent on many factors, such as the type of cancer, the treatment involved, and the duration of treatment.

You can discuss these questions with your doctor for a better understanding of recurrence:

• Where would it most likely return?
• How likely would it return?
• Is there anything that can be done to prevent it from returning?
• How to locate symptoms of recurrence

How can you prevent recurrence?

While there is no sure way to prevent recurrence from happening, you can still play your part to minimise the chances of a recurrence. This can be done via various methods below.

Diet

After completing cancer treatment, it is recommended to adopt a healthy and nutritious diet to aid in the rehabilitation process. While it has not been scientifically proven that nutrition can influence cancer recurrence, it is still wise to eat well in order to be as healthy as possible.

The recommended dietary intake for an adult comprises of 2 and a half cups of vegetables and fruits per day. Red meat such as beef, pork and lamb as well as processed meats such as sausages and luncheon meats should also be consumed in moderation. Opt for whole grains over refined grains and sugars.

Several types of cancer have been linked to alcohol consumption, so try to drink in moderation to reduce your cancer risk.

Vitamins & Supplements

Currently, there has been no conclusive evidence to suggest that consuming certain vitamins, herbs or dietary supplements will help to prevent recurrence.

Physical Activity

Although there has been insufficient research to link physical activity to a risk of cancer recurrence, studies have proven that regular physical activity can reduce anxiety and depression, improve the self-esteem and reduce symptoms of fatigue, nausea, pain and diarrhoea.

Try to engage in physical activities such as brisk walking, biking and swimming at least 150 minutes per week so as to see results of the benefits.

What are the possible symptoms of recurrence?

These are some common symptoms which may be related to a cancer recurrence. You may like to consult your doctor for further check-ups if you encounter one or more of the following symptoms:

• A lump or new growth where your cancer first started
• Unexplained weight loss
• New or unusual pain unrelated to an injury and does not go away
• Bleeding or unexplained bleeding
• Headaches
• Shortness of breath
• Bloody stools or blood in your urine
• Lumps, bumps, or swelling
• Nausea, vomiting, diarrhoea, appetite loss or difficulty swallowing
• A cough that doesn't go away

However, do not be too quick to assume your cancer has returned if you encounter any of these symptoms. They could very well just be common illnesses or medical problems so as with any illness, speak to your doctor about your situation.

 It is important that cancer patients obtain adequate nutrition during their treatment and recovery phase. Due to the disease and treatment process, cancer patients often have increase calorie and protein needs. It is sometimes difficult for patients to consume large quantities of food at a time due to the side effects of treatment. Therefore, it is advisable for patients to eat smaller meals more frequently and choose foods that are higher in energy and protein such as full cream dairy products, nuts and beans.

The disease and treatment process can result in an increase breakdown and use of protein and fat in the body. Cancer patients undergoing treatment often have increase calorie and protein needs. Thus, patients should focus on eating well and adequately in order to optimise their nutrition and prevent unintentional weight loss and muscle mass.

Consult your dietitian to help the patient set achievable lifelong goals in maintaining a physically active lifestyle, a healthy diet and keeping their weight within the healthy weight range.

Exercise for Cancer Patients & Survivors

*Before embarking on a moderate to vigorous exercise programme, it is best to seek your doctor or physiotherapist's opinion.

Below are some recommended exercise routines for cancer patients and survivors to keep healthy.
Generally, there are three types of exercises:

• Stretching / Flexibility Exercises (e.g. for arms, legs, chest, back) - Stretching is extremely important, and can help to stretch out scar tissues, lessen stiffness and improve posture. This is especially important if you had surgery or radiation therapy.
• Aerobic Exercise (e.g. brisk walking, jogging, swimming, cycling) - Aerobic exercise trains your heart, lungs, blood vessels and muscles to work more efficiently, thereby increasing your stamina and energy levels.
• Strengthening / Resistance Exercise (e.g. lifiting weights, isometric exercises, resistance bands) - Resistance exercise uses weights or resistance bands to strengthen your muscles. This builds lean muscle tissue which raises metabolism and reduces body fat. Strengthening muscles that were weakened during surgery or radiation therapy can help to prevent future pain and musculoskeletal complications.

Things to take note of during exercise

• Start slowly, think "a step at a time". a time”. Before you start, make sure you have clearance from your doctor. Start off with exercises that are easy and comfortable. Progress by increasing the number or duration of exercise sessions. Gradually increase exercise intensity only when you are ready. Consult a physiotherapist if you are unsure how to exercise appropriately.
• Always “warm up” and “cool down” to prevent injuries. “Warm up” at the start of the exercise helps to gradually increase heart rate and prepares the body for exercise. “Cool down” at the end of the exercise helps to gradually reduce heart rate and prepares the body to return to its resting state.
• Be aware of the proper technique of each exercise. Ask a physiotherapist to show you how to safely perform exercises that you are unfamiliar with.

Physical activity can also be increased without leaving the house. Here are some tips on how you can inculcate physical activity into your daily routine:

• Take the stairs instead of the elevator
• Take frequent breaks throughout the day to stand, stretch, and take short walks
• Check the kitchen for cans or bottles to perform light weight-lifting exercises

As a caregiver, it is important to provide your loved one with motivation and encouragement by accompanying them on walks or other exercise routines. Encourage them to do as much as possible for themselves.

What to watch out for

If you experience any of the following symptoms, stop exercising and rest:

• Extreme or unusual breathlessness or wheezing
• New or sharp pain
• Unusual sweating
• Headache, dizziness or light-headedness
• Nausea or vomiting
• Muscle cramps or pain

If the above symptoms do not go away with rest, consult a doctor.

If you experience any of the symptoms below during exercise, stop & consult a doctor.

• Tightness, pressure or pain in the chest, arm, neck or jaw
• Irregular heartbeat or palpitations

Blurred vision, new numbness, or tingling in the arms or legs

Active Living at NCIS

Here at the NCIS, we offer a series of programmes that are designed to help cancer patients, survivors and their caregivers stay active and healthy.

These are some of the fitness programmes that are currently offered:

• Relax Your Mind Yin Yoga Classes
• NPC oneHeart Support Group Nature Walks

To stay updated on new and upcoming programmes offered at the NCIS, check out our full events calendar here.

• Finding Support
• NCIS Stories of Hope
• Survivorship Videos