Understanding Cancer Recurrence: Surgical Misses vs. Metastasis

Cancer recurrence after surgery can be a complex issue, often leaving patients and their physicians questioning the efficacy and timing of the surgical procedure. It is essential to understand the potential reasons for recurrence, whether it is due to an incomplete surgical removal or the spread of pre-existing metastatic cells. While it may be challenging to determine the exact cause, identifying the source of the recurrence is crucial for devising the appropriate treatment plan.

Factors Contributing to Cancer Recurrence

It is not always straightforward to determine if the recurrence is due to the surgery itself or if the cancer cells had already metastasized (cancer recurrence), as both scenarios may lead to similar outcomes.

During the surgical procedure, it is possible that some cancerous tissue may be missed, leading to a recurrence. Similarly, dislodged cancer cells that enter the bloodstream can potentially grow and form new tumors at distant sites. However, in my personal experience, recurrences often occur due to pre-existing metastatic cells, which have already spread before the initial surgery (metastasis).

Personal Experience with Liver Cancer

When I was diagnosed with bowel cancer in 2014, I already had visible tumors on my liver and a lymph node. The lymph node was successfully removed at the same time as the primary tumor, and I have not experienced a recurrence there. However, the liver story is different.

Initially, two liver tumors were surgically removed in 2014 but more tumors appeared the following year. A year later, I was put on palliative care, and despite chemotherapy, the tumors resurfaced in 2018. The recent recurrence provided some interesting insights:

The lung tumor is the same one that was shrunk by the chemotherapy and has regrown. A previously hidden liver tumor from 2014 has reappeared in a new location. Some of the tumors that disappeared after the most recent chemotherapy are still present elsewhere. There may be other small clusters of cancer cells elsewhere in the body.

This experience highlighted the fact that even after successful surgical removal and chemotherapy, cancer cells can remain dormant or too small to be detected on imaging scans. As my liver surgeon explained, PET/CT scans can only detect tumors once they reach a certain size, and some cells can take a long time to grow large enough to be visible.

Expectations and Treatment

The recurrent cancer is now expected to be a ongoing 'cherry picking' process, where each time a tumor recurs, it will be surgically removed. However, even after successful resection, the cancer cells can resurface, necessitating ongoing monitoring and treatment. This experience has reinforced the importance of having hope in the face of medical challenges.

Conclusion

While it can be challenging to determine the exact cause of cancer recurrence, it is often more critical to understand that the recurrence is likely due to pre-existing metastatic cells. This knowledge can guide treatment decisions and help patients and their physicians prepare for ongoing challenges.