“Cancer patients transitioning into survivorship are often left with a ‘what now?’ mentality and are wondering what to expect next,” says Jordan Henderson, BSN, RN, OCN, ONN-CG, a survivorship navigator at the Sarah Cannon Cancer Institute at Medical City Healthcare. Jordan offers these tips to help cancer survivors know when to call the doctor.
“Our survivorship care team always encourages patients to continue to follow up with their primary care physician and follow their recommendations for screening and long-term management of side effects,” Jordan says. “We also encourage patients to become familiar with signs and symptoms of recurrence to ensure that any indications of cancer are detected at the earliest stages. The signs and symptoms of recurrence can be specific to a patient’s disease site and should be discussed with the physician before transitioning into survivorship.”
Signs of possible cancer recurrence.
Signs of recurrence can be local, regional or distant. In the case of a breast cancer patient, recurrences could look like (but are not limited to) the examples below.
- Local recurrence appears in the same part of the body as the original cancer. Example: A local breast cancer recurrence may be a new breast lump in the same breast previously diagnosed.
- Regional recurrence happens when the cancer returns in the lymph nodes near the area of the original cancer. Example: A regional recurrence of breast cancer could involve the lymph nodes underneath the arm.
- Distant recurrence is when the cancer returns in a different part of the body, distant from the original cancer. Example: A distant recurrence could look like bone pain showing a bone mass.
Symptoms of possible cancer recurrence.
Some of the common symptoms of recurrence include:
Persistent cough. This is a nagging cough that doesn’t go away or worsens over time (unlike a common cough resulting from a cold). If there isn’t a reason for the cough (allergies, a cold, etc.) and it doesn’t improve with cough drops or medicine, patients should contact their physician.
Persistent and/or worsening pain, such as chest or bone pain. There are many types of chest pain with a number of different potential causes. Some chest pain can feel like an extreme pressure and warrants going to the ER. Other chest pain can be more manageable and expected, such as soreness after starting a new exercise. Chest pain that cannot be explained, including rib pain or pain when breathing, should be escalated to a doctor.
Bone pain. This isn’t pain or soreness that comes after raking leaves in the yard. This is unexplained bone pain that won’t go away. Achiness and joint pain can sometimes be affiliated with medications patients are taking for their cancer, such as hormone blockers for breast cancer. Bone pain associated with recurrence is more severe and specific to a certain area; for example, pain in the hip. Call the doctor for unexplained bone pain that won’t go away.
Difficulty breathing. Regardless of the reason or suspected condition, anyone having trouble breathing needs immediate medical attention. If you feel the condition is life-threatening, call 911. Head straight to the ER if it’s urgent but not life-threatening.
Loss of appetite. Not being hungry occasionally can be normal, but loss of appetite is concerning when it goes on for longer periods of time (weeks) and affects nutrition levels. Patients can look normal (normal BMI) and still be malnourished. Patients who lose their appetites should contact the physician to review strategies for improving appetite and ensuring health.
Unintentional weight loss. This is unintended weight loss of more than 15 to 20 pounds, which can frequently make people look gaunt. Often, there is a concern when patients eat normal amounts but continue to lose weight.
Severe headaches. Frequent and severe headaches with nausea and/or vomiting, as well as vision changes (such as spots, double or blurred vision) are all issues that should be reported immediately to a physician.
Seizures. Any seizure activity warrants an ER visit and should be reported to a physician. Loss of oxygen to the brain can be detrimental and medication may be used to stop the seizure. Additional scans will be needed to determine the cause of the seizure.
Loss of mobility (numbness/tingling/swelling). This could be loss of function of a body part, sudden paralysis or decreased function. All of these symptoms should be reported immediately. Numbness and tingling can sometimes be due to surgery or previous chemotherapy use. If this is a new symptom and not already being managed, report it to a physician for evaluation. Sudden numbness or tingling down one arm should be checked out at the ER.
Lymphedema (swelling in an arm or leg). Lymphedema can affect survivors of different types of cancers and can occur at any time during survivorship (lifetime risk). If patients notice any swelling, tightness, redness or warmth in any area where they had surgery and/or radiation, it should be evaluated by a physician.
Bowel changes/abdominal swelling. Patients with sudden bowel changes should talk to their physician. Symptoms can include a distended abdomen, which remains full even after having a bowel movement, as well as a bloody stool, increase or decrease in frequency, rigid abdomen (hard to the touch) or pain when having a bowel movement. Increase in constipation without relief from stool softeners should be reported. Abdominal swelling should always be reported.
Urinary changes. Symptoms such as the inability to urinate, painful urination, blood in the urine or changes in frequency and odor should be reported to physician
Additional issues to be aware of.
The above list of common cancer recurrence symptoms is by no means comprehensive. There are many other possible signs that something isn’t right. It’s always important to remember to listen to your body as you know it better than anyone. If anything feels off or you are unsure about anything, don’t hesitate to contact your doctor.
Additional issues to be aware of include:
- Decreased libido (lowered sex drive)
- Changes in menses (irregular bleeding related to menstruation/menopause)
- Unrelenting fatigue
- Medication side effects
- Mental health issues, including depression, PTSD or fear of recurrence
If you or someone you know needs help with getting back to daily life activities after cancer treatment, assistance is available. To find trusted and vetted local and national resources for patients and caregivers in one convenient place, free of charge, read Getting Back to life: Helping cancer survivors thrive.
Have a question? askSarah