In 2002, cricket legend Geoffrey Boycott was treated for throat cancer. He endured chemotherapy and radiotherapy and for 20 years, everyone assumed he was cured. But last week he announced that the cancer had returned. Boycott, 83, told The Telegraph. “From past experience, I realise that to overcome cancer a second time, I will need excellent medical treatment and quite a bit of luck, and even if the operation is successful, every cancer patient knows they have to live with the possibility of it returning.”

Professor Richard Simcock, the chief medical officer for the charity Macmillan Cancer Support says, “The return of a cancer can be especially difficult. The optimism and effort that has gone into initial treatment has not been rewarded, which is emotionally very tough, and it comes with the knowledge of some of the difficulties that lie ahead.”

But why does cancer come back, even after apparently successful treatment? Dr Magnus Dillon, a clinician scientist at the Institute of Cancer Research, London and a consultant clinical oncologist at The Royal Marsden Hospital, says: “Cancer can come back either because a few cells have been left in the body after the initial treatment, either where the initial tumour was, or having spread to other parts of the body. Or it can come back as a ‘second primary’ where the same process, such as damage from smoking, that led to the first tumour leads to another one in the future.”

In general, recurrent cancer that comes back at or near the original cancer may be easier to treat than cancer that recurs in organs or tissues far away from the original tumour. At this point the cancer may be treatable, but incurable. It can be called secondary or metastatic cancer. 

If a cancer returns soon after treatment, it can indicate it is more aggressive.  

Some cancers are more likely to recur than others. Glioblastoma, an aggressive form of brain cancer, has an almost 100 per cent recurrence rate after treatment, partly because many cancer drugs cannot penetrate the brain. Epithelial ovarian cancer has around an 85 per cent recurrence rate according to a study published in Expert Review of Anticancer Therapy. Bladder cancer recurs locally 30 per cent to 54 per cent of the time, according to a study published in the World Journal of Urology. Breast cancer can come back in up to 30 per cent of patients. People treated for cancer in childhood also face an increased risk, as do people whose cancers were diagnosed at a more advanced stage. 

Nick Turner, a consultant medical oncologist at the Royal Marsden NHS Trust, and a professor of molecular oncology at the Institute of Cancer Research, says: “Early diagnosis is key to decreasing the risk of cancer spreading, as small cancers have an excellent chance of being cured. But sadly, even if you catch it early, that doesn’t mean it can’t spread. With most cancers, if you get to five years without relapsing you are cured, but the risk from breast cancer can last for at least 20 years.”

Jo Taylor, 55, from Saddleworth in Greater Manchester, knows all too well how it feels when cancer comes back. She was originally diagnosed with breast cancer in 2007, when she was 38. At the time she had a five-month-old baby daughter and a son who was just two-and-a-half years old. “I was told my treatment was curative,” she says. But in 2014, “I felt my neck one day and found a lump”. 

Scans revealed that the cancer was in lymph nodes in her neck and that there were two small cancerous lesions in her sternum. Today, Taylor is the founder of MetUp UK, a metastatic breast cancer patient advocacy group. She says: “It was devastating to hear my breast cancer had come back. After I’d got past five years, I hoped I was cured.”

So how can you manage if you have a second cancer diagnosis? 

Be a pushy patient

Recurrent cancer and its staging, prognosis, testing and treatment are complex subjects. Ask your oncologists questions to gain a better understanding about your cancer, its stage and available treatments. If you want to look for information online, stick to reputable websites such as Cancer Research UK. The charity also offers a free nurse helpline on 0808 800 4040.

Clinical trials can offer the opportunity to try drugs that aren’t otherwise available yet. Taylor says, “Consider getting on a trial early on. Don’t leave it until the last minute as you may not be eligible if you’ve had previous treatments.” Cancer Research UK maintains a list of ongoing trials. MetUp UK compiles a list of trials for metastatic breast cancer.  

She adds: “Don’t be afraid to ask for a second opinion. I have pushed for surgeries I wasn’t offered and believe that being a pushy patient is why I’m still here. My children are nearly 18 and 20. I never thought I’d see them finish primary school.” 

Seek support

Learning that your cancer has returned may be scary and depressing. You may worry about the implications for you, your family, job and finances. But you don’t have to go through it alone. Some people find it helpful to speak to a counsellor or psychologist; others prefer to join support groups to meet people in the same position either virtually or in person. Many charities offer support including free specialist counselling in person, over the phone or online. Maggie’s Centres are welcoming spaces attached to large hospitals that offer specialist cancer support. They help patients to explore challenging conversations about the impact of a diagnosis on their relationships and even how they want to die. 

Tony Collier, 67, is living with incurable prostate cancer. “The first 18 months of my diagnosis was a living hell. I forgot the joy of living through fear of dying and ended up having a breakdown. However, I had psychological support and since then have been generally okay.” Collier says that psychosexual counselling with his wife was “really helpful” in helping them navigate the changes in their relationship. This can be accessed privately or via the NHS. The charity Prostate Cancer UK has trained Relate counsellors in the specific challenges faced by prostate cancer patients. Studies showed that 80 per cent of men and their loved ones saw improvements in their relationships after attending the sessions.

Plan for the future 

It can be difficult to speak about dying with loved ones who may become upset or be in denial. However, you may want to plan for that eventuality in various ways and it can help to speak to someone who is less emotionally involved. 

Penny Morris was diagnosed with breast cancer in 2019 when she was 44 and six months pregnant. It returned in 2020, shortly after her treatment ended, when her daughter was five and her son not yet one. “It’s a weird limbo to be living but also preparing to die,” says Morris. “My mum is very much ‘That’s not going to happen’. My other half winces whenever I say it.” However, she says, “It was important to me to think about finances. At work I spoke to the benefits person and said, ‘Pretend I have died. Now tell me what will happen for my family’. I also spoke to a financial advisor.” 

Charities can help people with advance care planning. Advance directives are legal documents that provide written instructions about your end-of-life wishes before you may become too unwell to be able to communicate them. 

Think about living, not just dying

Even if your cancer isn’t curable, improvements in treatments mean that more people can live for years after a secondary diagnosis. That means it can be helpful to think about what you want that life to look like. Kerry Craig, who is head of Maggie’s centre Glasgow says, “We listen to people and empower them to think about what is important to them. Some people want to work or have to work and may need help to do that.” 

Exercise is important to many people living with cancer feel more in control. A 2022 review found that physical activity “decreases the severity of side effects of cancer treatment, reduces fatigue, improves quality of life, has a positive impact on mental health and improves aerobic fitness in cancer patients.”

Jacqueline Green, 54, was first diagnosed with ovarian cancer in 2017 and has experienced several recurrences since then. She’s now taking a type of drug called a PARP-inhibitor drug and her latest scans have shown no evidence of disease. “Going to a centre like Maggie’s has helped me in so many ways over the last few years,” she says. “The support is so helpful and they’re so knowledgeable about treatment pathways. Their various classes, their yoga and Tai Chi, Qigong and meditation classes have helped me and my family to relax at times when relaxing has not been easy.” 

Where to find help and information 

  • Macmillan
  • Maggies
  • MetUp UK
  • Future Dreams
  • Cancer Research UK
  • Prostate cancer UK
  • Working with Cancer
  • Penny Brohn UK

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