Cancer Recurrence: Insights After Chemotherapy and Radiation

Two weeks after chemotherapy, cancer cells were found again?

Oral cancer was diagnosed on December 7, 2021.
Surgery was performed on the left mandible, and from January 1, 2022, I began chemotherapy and radiation therapy.
By February 25, I completed a total of 7 chemotherapy sessions and 35 radiation treatments.
On March 9, I discovered a small, swollen lump near my clavicle.
By March 15, it had grown slightly larger compared to the previous week.
On March 22, the lump was approximately 6 centimeters in diameter and felt soft to the touch.
On March 23, the doctor performed a biopsy, and the results indicated the presence of malignant cancer cells.
Further tests, including a whole-body PET scan and CT scan, will be conducted.

Initially, I thought the discomfort in my voice and swallowing was a normal side effect of radiation therapy, especially since it has been four weeks since the treatment ended.
However, I am now wondering if the ongoing swallowing difficulties are related to the tumor.
There is also a small, red protrusion in the middle of my neck, just below the clavicle, measuring about 6 centimeters in diameter.
The doctor mentioned that surgery could be performed on the swollen area, and the purpose of the examination is to determine if there is any metastasis.

I would like to ask the doctor: Given that I just completed my treatment two weeks ago, does the presence of cancer cells in my neck indicate a recurrence or metastasis? During the treatment, there were no indications of dead cancer cells, etc.
Thank you.

Rou, 40~49 year old female. Ask Date: 2022/03/30

Dr. Hu Ziren reply Oncology

If the pathology report indicates malignancy, it suggests local lymphatic metastasis.
Note: If lymphatic metastasis occurs shortly after the completion of chemotherapy and radiation therapy, it indicates that the primary cancer cells have a high degree of malignancy and are likely more resistant to treatment.
It is recommended to conduct a comprehensive examination (whole-body PET scan) to rule out the possibility of distant metastasis (such as to the lungs or liver) before discussing further treatment options (such as additional surgery, localized radiation therapy, or systemic chemotherapy) with the physician.

Reply Date: 2022/03/30

More Info

Understanding cancer recurrence, especially after chemotherapy and radiation, is a complex and nuanced topic. In your case, it appears that you have undergone significant treatment for oral cancer, including surgery, chemotherapy, and radiation therapy. Unfortunately, the recent findings of a lump near your clavicle and the subsequent biopsy indicating the presence of cancer cells raise important questions about the nature of this new development.

Firstly, it is essential to differentiate between cancer recurrence and metastasis. Recurrence refers to the return of cancer after treatment, which can occur in the same location (local recurrence) or in a different part of the body (distant recurrence). Metastasis, on the other hand, involves the spread of cancer cells from the original tumor to other organs or tissues. The distinction can be critical for determining the appropriate course of action.

In your situation, the lump that has developed post-treatment could potentially be a sign of recurrence or metastasis. Given that it has grown in size and the biopsy results indicate the presence of cancer cells, it is crucial to conduct further imaging studies, such as a PET scan and CT scan, to assess the extent of the disease. These imaging modalities can help determine whether the cancer has spread to nearby lymph nodes or other areas of the body.

The timing of your symptoms is also significant. You mentioned that the lump appeared approximately two weeks after completing your radiation therapy. While it is not uncommon for patients to experience swelling or discomfort in the treatment area due to radiation effects, the rapid growth of a new lump raises concerns. It is essential to communicate openly with your healthcare team about your symptoms, as they can provide insights into whether these changes are typical post-treatment effects or indicative of a more serious issue.

In terms of managing your symptoms, it is important to address any discomfort you are experiencing with swallowing and voice changes. These issues can be common after radiation therapy, but they can also be exacerbated by the presence of a new tumor. Your healthcare team may recommend supportive care measures, such as speech therapy or dietary modifications, to help manage these symptoms.

As you await further evaluation and potential treatment options, it is crucial to remain proactive in your care. Keep a detailed record of your symptoms, including any changes in size or discomfort of the lump, and share this information with your oncologist. They may consider additional treatment options, such as targeted therapy or immunotherapy, depending on the characteristics of the cancer cells identified in your biopsy.

In conclusion, while the emergence of new cancer cells shortly after completing treatment is concerning, it is essential to undergo further evaluation to determine the nature of this development. Understanding whether this represents a recurrence or metastasis will guide your treatment plan moving forward. Stay engaged with your healthcare team, and do not hesitate to ask questions or express concerns about your treatment and recovery process. Your health and well-being are paramount, and your medical team is there to support you through this challenging time.

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