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Living With Cancer - Recurring Cancer

Living With Cancer: What is it, diagnosing cancer recurrence, treatment and palliative care. | KKH

Living With Cancer - Recurring Cancer - What it is

The Challenge Of Living With Cancer

To be diagnosed with cancer can be very frightening. There is the fear that the cancer treatment will not be successful. There is the fear that the cancer will return. There is the fear of pain. And there is the fear that you may not survive this disease. All these feelings are normal and very understandable.

The information below gives some suggestions for coping with these feelings.

Fear That Cancer Will Recur

After the completion of the treatment, there is always fear that the cancer will return. Any new symptom makes you worry that the cancer has come back. These feelings are more likely to occur just before your next follow-up visit with your doctor and especially if you know that x-rays, scans or blood tests may be ordered to check your progress.

It can also be very worrying if you hear about other cancer patients who are not doing well. Stories told by friends and family members, even television programmes, can increase your anxiety about what is happening to your body. It is important for you to realise that these fears are normal and are to be expected.

Family members also worry about these things. They will suggest foods, herbs or medicines to build up your immunity. This can be very confusing especially if your family's advice conflicts with your doctor's instructions. If you are planning to try a special diet or herbal medicines, discuss these with your doctor so that you can make a decision based on as much accurate information as possible.

If you do have symptoms which are troubling you, you should seek medical attention early so that your doctor can examine you and reassure you if nothing is wrong. It is also important to remember that, even if cancer does recur, the treatment can be successful. Many patients survive following further treatment.

Assisting Your Own Recovery

It will assist your recovery if you have a positive attitude towards your diagnosis and treatment. Some people find that prayer or meditation is helpful. Others enjoy the company of others with whom they can share their feelings and explore the meaning underlying the experience of illness. All agree that what matters most is love, laughter and taking pleasure in the simple things of life.

Why And Where Does Cancer Recur?

Your treatment is meant to destroy the original cancer cells. However, a small number of cancer cells sometimes survive and continue to multiply. If the body's natural defences do not detect and destroy these cells, tumours may develop from these cancer cells. These tumours are made up of the same type of cells as the original cancer, no matter where the new tumours are found. For example, if cancer of the ovary recurs in the lung, this is not lung cancer, but cancer of the ovary that has spread to the lung.

Cancer can recur in 3 places -- local, regional or distant. Local recurrence means that the cancer has come back in the same place as the original cancer. Regional recurrence means that the cancer cells have spread to the lymph nodes or tissues near the site of the original cancer.

Distant spread, also called metastases, means that the cancer cells have spread to organs or tissues some distance from the original cancer site. For example, if cancer of the cervix has spread to the bones, the tumours in the bone are called bone metastases.

Living With Cancer - Recurring Cancer - Symptoms

Living With Cancer - Recurring Cancer - How to prevent?

Living With Cancer - Recurring Cancer - Causes and Risk Factors

Living With Cancer - Recurring Cancer - Diagnosis

Diagnosing Cancer Recurrence

If your cancer has recurred you may have noticed unusual symptoms such as weight loss, bleeding, a new lump or a persistent pain. Sometimes there are no obvious signs or symptoms and your doctor may find evidence of illness only when examining you.

The doctor will then want to have answers to some of these questions:

  • Are these signs and symptoms caused by cancer or by some other medical problem?
  • If this is cancer, has the original cancer recurred or is this a new type of cancer?
  • If this is the original cancer, has it spread beyond the original site? Physical examination and tests such as X-rays, scans, blood tests, ultrasound, endoscopy and biopsy will help provide the answers to these questions.

Living With Cancer - Recurring Cancer - Treatments

Treatment Of Cancer Recurrence

The treatment that is recommended by your doctor for cancer recurrence depends on the type of cancer, its size and location, your general health, and other treatments you have already had for the original cancer.

It is very important that you ask your doctor about the treatment. You need to understand why one treatment is being recommended over others. You need to understand the benefits, risks, side effects, cost of treatment, and the possible impact of the recommended treatment on your quality of life.

These are some of the questions you may wish to ask your doctor about treatment.If you obtain answers to these questions, you and your doctor will be able to make the best possible decision about which treatment is best for you.

  • What are you hoping that this treatment will do for me? Will it cure me, will it shrink the tumour or will it just relieve my symptoms?
  • Why do you think that this treatment is the best for me? Are there other possible treatments? What are they?
  • What are the side effects of this treatment? Are they temporary or are they permanent?
  • How will I know that this treatment is working?
  • Will I need to stay in hospital?
  • How much will this treatment cost?
  • How long will I be on this treatment?
  • What will happen if I do not have this treatment?

What If I Have Pain?

Not everyone with cancer has pain. However, pain can occur at any stage of the disease. It is important to remember that, if there is pain, there are many ways to relieve it.

Cancer pain usually occurs because the growing tumour presses on the surrounding tissues. Therefore, if the cancer is causing your pain, your doctor may recommend surgery, radiotherapy or chemotherapy to remove or shrink the tumour.

You may also need pain medication to relieve the pain. There are many different types of pain medication. Different pains require different types of medicine. This is why your doctor will often prescribe a combination of medicines for your pain.

Most pain can be controlled with medicines that are taken by mouth. Medications like paracetamol (Panadol), non steroidal anti-inflammatory drugs such as naproxen (Synflex) and opioids such as codeine or morphine are commonly used.

However it is not always necessary to take pain medications by mouth or by injection. Fentanyl, a strong pain medicine which should only be used if prescribed by your doctor, is available in a small adhesive patch, which is placed on the skin. The medicine is absorbed through the skin. The patch is replaced every third day.

Sometimes medications that are normally used for other conditions, are used to treat pain. For example, anti-depressant medications or anti-epileptic medications can also help nerve pain that has tingling, burning or shooting quality. If your doctor prescribes these medications, it does not mean that you are depressed or likely to have epileptic fits.

Pain medicine works best if taken before the pain becomes severe. This is why your doctor will recommend that you take your medicine at regular intervals, not just when the pain returns.

Your doctor needs to know as much about your pain as possible. These are some of the questions you will be asked about your pain:

  • Where exactly is your pain? Does it move from one place to another? Have you more than one pain?
  • How does the pain feel? Is it dull, sharp, aching, burning? Try to describe the pain as clearly as possible.
  • How often does the pain occur? What seems to make the pain start? Is the pain related to specific activities such as eating, walking, passing motion?
  • How long does the pain last?
  • Does anything seem to make the pain better?
  • What medication have you already used for this pain? Did it help?

Living With Cancer - Recurring Cancer - Preparing for surgery

Living With Cancer - Recurring Cancer - Post-surgery care

Living With Cancer - Recurring Cancer - Other Information

What About Morphine?

Morphine is made from the sap of the poppy plant and is a very effective pain medicine for severe pain. Morphine belongs to a group of medicines called opioids that work on nerve cells in the spinal cord and in the brain to decreased the sensation of pain.

Morphine is available in two oral forms -- short acting mixture and long acting tablets. The effect of short acting morphine mixture lasts only 4 hours and therefore it must be taken every 4 hours.

Long acting morphine tablets (also called slow release morphine tables or MST) are made so that the effect of the tablet will last up to 12 hours. Therefore long acting tables are usually taken every 12 hours. This means that the effect of the medicine will last throughout the night.

If you are taking long acting tablets and you have an episode of severe pain, you should not take additional long acting tablets. Instead you should take a dose of short acting morphine mixture which will relieve your pain very quickly. However, if you need many doses of short acting morphine mixture each day, your doctor may decide to increase your dose of long acting morphine tablets.

Long acting morphine tablets must not be crushed or chewed but should be swallowed whole.

Morphine can also be given by injection. Sometimes the morphine is given by a portable pump called syringe driver. The syringe driver injects a small dose of morphine continuously via a fine needle which is inserted under the skin and secured with adhesive plastic.

Concerns About Morphine

People are sometimes concerned about taking morphine. The fear of addiction is one of the main reasons why people either refuse to take morphine or take less than the amount prescribed. However, morphine is a safe and effective pain medication when used as prescribed by the doctor.

  • There is no evidence that taking morphine for pain control will lead to drug addiction. Many people who have been taking morphine for prolonged periods can gradually discontinue morphine when other methods of pain control have been successful.
  • Morphine does not make people drowsy if used correctly. When a person first starts taking morphine there may be some feelings of drowsiness. However, this effect wears off after a couple of days. If the drowsiness persists, this may mean that a lower dose of morphine would control your pain adequately.
  • Morphine is not used as a last resort and will not hasten death. Instead, morphine can be used safely at any stage of the disease if pain is not controlled by other pain medications. When prescribed correctly, morphine can give a new lease of life by making it possible to sleep well at night and to live a more normal active life during the day.
  • Some people fear that the effectiveness of morphine will wear off and that the dose will need to be continually increased. This is not so. Many patients need only the same dose of morphine over many months.
  • Morphine can cause constipation and therefore regular laxatives (bowel medicines) are usually needed to prevent this. Senna, a laxative made from the pod of the senna plant, is commonly prescribed. Senna tablets can be purchased from the Chinese medicine shop or from the local pharmacy. It is also helpful to have an adequate intake of fluid to prevent constipation while you are taking morphine.

Palliative Care

Palliative care, also called hospice care, is offered to people with advanced disease when the focus is on control of symptoms and emotional support. If your disease has progressed and you require additional support, your doctor can refer you to the palliative care physician or to one of the hospice home care programs.

Hospice staff will come to your home to assess your medical, nursing and emotional needs and will work with you and our family to develop a plan of care. They will arrange to visit you regularly. If there is an emergency, there will always be someone from the hospice on-call to assist you and your family.

If the family is no longer able to provide care at home, there are also in-patient hospices that provide short-term admission.

For others who are well enough to enjoy creative activities and outings, there are hospice day care centres that provide a supportive environment for people who attend the centre for the day.

Families who experience hospice care feel that it offers great comfort and support for them when they are caring for someone with advanced cancer.

Conclusion

If cancer recurs, it is sometimes difficult to recover physical and psychological strength. You may face prejudice and discrimination as you attempt to resume an active life.

However, this is an opportunity for you to re-evaluate what life is about, who you are, and what you value most. You may find that, when you have faced the challenge of living with cancer, you have a greater appreciation of life are better able to respond to your own needs and to the needs of others.

Hospice Care Services in Singapore

  • Assisi Home and Hospice
    820 Thomson Road, Singapore 574623
    Tel: +65 6347 6446 Fax: +65 6253 5312
    Email: assisi@assisihospice.org.sg
    Services provided: In-patient care, home care, day care
  • Bright Vision Hospital
    5 Lor Napiri, Singapore 547530
    Tel: +65 6248 5755 Fax: +65 6881 0702
    Email: caremail@singnet.com.sg
    Services provided: In-patient care
  • Dover Park Hospice
    10 Jalan Tan Tock Seng, Singapore 308436
    Tel: +65 6355 8200 Fax: +65 6258 9007
    Email: dover_park_hospice@doverpark.org.sg
    Services provided: In-patient care
  • Hospice Care Association
    12 Jalan Tan Tock Seng, Singapore 308437
    Tel: +65 6251 2561 Fax: +65 6352 2030
    Email: info@hca.org.sg
    Services provided: Home care, day care
  • Methodist Hospice Fellowship
    c/o Bethany Methodist Nursing Home
    9 Choa Chu Kang Ave 4, Singapore 689815
    Tel: +65 6314 1580 Fax: +65 6314 1576
    Email: mhf@bethany.mws.org.sg
    Services provided: Home care
  • Metta Hospice Care
    32 Simei St 1 Metta Building 5th Floor, Singapore 529950
    Tel: +65 6580 4695 Fax: +65 6787 7542
    Email: hhospice@metta.org.sg
    Services provided: Home care
  • St Joseph's Home
    921 Jurong Road, Singapore 649694
    Tel: +65 6268 0482 Fax: +65 6268 4787
    Email: stjoseph@stjh.org.sg
    Services provided: In-patient care
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