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How to avoid relapse


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  • SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.

    Also visit the online treatment locator.

SAMHSA’s National Helpline, 1-800-662-HELP (4357) (also known as the Treatment Referral Routing Service), or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations.

Also visit the online treatment locator, or send your zip code via text message: 435748 (HELP4U) to find help near you. Read more about the HELP4U text messaging service.

The service is open 24/7, 365 days a year.

English and Spanish are available if you select the option to speak with a national representative. Currently, the 435748 (HELP4U) text messaging service is only available in English.

In 2020, the Helpline received 833,598 calls. This is a 27 percent increase from 2019, when the Helpline received a total of 656,953 calls for the year.

The referral service is free of charge. If you have no insurance or are underinsured, we will refer you to your state office, which is responsible for state-funded treatment programs. In addition, we can often refer you to facilities that charge on a sliding fee scale or accept Medicare or Medicaid. If you have health insurance, you are encouraged to contact your insurer for a list of participating health care providers and facilities.

The service is confidential. We will not ask you for any personal information. We may ask for your zip code or other pertinent geographic information in order to track calls being routed to other offices or to accurately identify the local resources appropriate to your needs.

No, we do not provide counseling. Trained information specialists answer calls, transfer callers to state services or other appropriate intake centers in their states, and connect them with local assistance and support.

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Last Updated: 08/30/2022

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The Locator is authorized by the 21st Century Cures Act (Public Law 114-255, Section 9006; 42 U.S.C. 290bb-36d). SAMHSA endeavors to keep the Locator current. All information in the Locator is updated annually from facility responses to SAMHSA’s National Substance Use and Mental Health Services Survey (N-SUMHSS). New facilities that have completed an abbreviated survey and met all the qualifications are added monthly. Updates to facility names, addresses, telephone numbers, and services are made weekly for facilities informing SAMHSA of changes. Facilities may request additions or changes to their information by sending an e-mail to [email protected], by calling the BHSIS Project Office at 1-833-888-1553 (Mon-Fri 8-6 ET), or by electronic form submission using the Locator online application form (intended for additions of new facilities).

prognosis, treatment, symptoms in the international clinic Medica24

If cancer is diagnosed in the early stages, timely treatment can lead to remission. This term refers to the state when all existing diagnostic methods show that there are no signs of the presence of a malignant tumor in the human body. Oncologists usually do not use the word "recovery", but if a remission is stated, it can be said that the patient has recovered. He managed to overcome the disease.

Unfortunately, after remission, the cancer may return. In such cases, it is said that a relapse has occurred. This can happen in weeks, months or years. It is impossible to accurately predict whether a malignant tumor will recur in a particular patient. There is always such a possibility.

Generally, in oncology, the term "relapse" is used when a malignant tumor reappears after a patient has been in remission for at least one year. If earlier, they talk about the progression of the disease.

This is not a reason to constantly live in tension and be afraid that the cancer will return. But after the successful completion of the treatment, it is important to be attentive to your health, follow the doctor's recommendations and regularly undergo the necessary examinations.

Statistics show that in 7% of people who have overcome cancer, the fear of recurrence turns into a serious phobia and greatly reduces the quality of life. If you or your loved one is faced with such a problem, you should contact a psychotherapist.

What is the likelihood of cancer recurrence?

There is no single answer to this question. The percentage of cancer recurrence depends on a number of factors, primarily the type, stage, histological and molecular genetic characteristics of a malignant tumor, the individual characteristics of the patient, and methods of treatment.

Some cancers are very difficult to treat and have a high recurrence rate. For example, glioblastoma, an aggressive brain tumor, returns in all patients despite treatment. Other types of cancer that often recur:

  • Ovarian cancer - in 85% of cases.
  • Soft tissue sarcomas after adjuvant chemotherapy - 50%, in advanced stages - 100%.
  • Bladder cancer after organ removal (cystectomy) - 50%.
  • Pancreatic cancer after surgical treatment - up to 46%.
  • Diffuse large B-cell lymphoma - up to 40%.
  • Peripheral T-cell lymphoma - 75%.

Other types of malignant tumors return after remission relatively rarely:

  • Hodgkin's lymphoma - up to 13% after the first course of treatment, up to 50% after the second course of treatment.
  • Breast cancer - up to 30%, depending on the molecular genetic characteristics of the tumor and the treatment regimen.
  • Colon and rectal cancer - 17% if a negative resection margin is obtained after removal of the affected area of ​​the intestine. According to other data, about half of patients who undergo surgery, the tumor will return within the first three years.
  • Non-small cell lung cancer - 26% after radical surgery, 27% after chemoradiotherapy for locally advanced disease.

Of course, the earlier the cancer is diagnosed and treated, the higher the chance of remission and the lower the chance of a relapse in the future.

If the malignant tumor does not return for a sufficiently long time, the patient can be considered cured. Here the timing is also individual. For some malignant tumors, waiting five years is sufficient. If, for example, small cell lung cancer has not returned within three years, it is unlikely to recur. But some types of hormone-sensitive breast cancer can return after 20 years, moreover, in the form of distant metastases.

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Why do malignant tumors recur?

Cancer may return due to the fact that after treatment, small tumor foci remain in the patient's body. They are dormant, microscopic in size, do not cause symptoms, and cannot be detected using modern diagnostic methods. Over time, the remaining "wrong" cells multiply, and the new tumor reaches a large size.

Recurrences after surgical removal of cancer usually occur because the tumor was not completely removed during the operation, or the patient already had micrometastases that were not detected during the examination.

Many mechanisms play a role in the recurrence of malignant tumors, and they are quite complex. Scientists continue to study them. Considered important are:

  • Tumor stem cells. Due to the peculiarities of metabolic processes, they are resistant to anticancer drugs, and it is because of them that resistance (resistance) of malignant tumors to treatment often develops.
  • Neoz is a special type of abnormal division of tumor cells.
  • Rise of the Phoenix is a molecular mechanism by which dead cells stimulate the proliferation of stem and progenitor cells.

Perhaps further study of these and other mechanisms will help to better understand the process of cancer recurrence and develop treatments that will help prevent the return of malignant tumors.

What are the symptoms of a recurrence of a malignant tumor?

The symptoms of cancer recurrence are different, they are about the same as in the case of a primary malignant tumor. It is important to understand that the disease can return in different parts of the body. Depending on this, three types of relapses are distinguished:

  • Local: the tumor occurs in the same place where it was previously.
  • Regional: Tumor occurs in regional lymph nodes or adjacent tissues near the site of the primary tumor.
  • Recurrence in the form of distant metastases.

Relapses from the third group can be especially difficult to diagnose because their symptoms are nonspecific and do not suggest a malignant tumor. For example, a person may suffer from pain in a joint, believe that he has osteoarthritis, but in fact it is a bone metastasis.

It is important to pay attention to any unusual, new, persistent symptoms. If they appear, you need to visit a doctor and get checked. It is likely that these are not signs of cancer recurrence, but manifestations of other diseases. But there is always a risk.

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Are there effective preventive measures?

There are no specific methods of prevention. No one can be 100% protected from cancer recurrence. It is important to lead a healthy lifestyle in general and follow the basic recommendations:

  • Eat right. Most of a healthy diet should be vegetables and fruits. The body must receive all the necessary nutrients, vitamins, trace elements. It is recommended to limit the consumption of red, processed meat.
  • Regular physical activity is essential, especially if you have a sedentary job.
  • Maintain normal weight.
  • Give up bad habits.
  • Avoid exposure to harmful substances. If at work you have to constantly contact with chemicals, use all the protective equipment provided.

How to diagnose a relapse in time?

After the onset of remission, the patient's communication with the doctor does not end. The oncologist prescribes regular examinations, examinations - their volume depends on the type of malignant tumor. It is important to follow these recommendations and arrive at the clinic on time. In case of recurrence, this will help to detect the return of a malignant tumor in a timely manner and conduct effective treatment.

Treatment

Treatment depends on the type of cancer, the location of the recurrence, and the degree of disease progression.

If only one tumor is found, it can often be removed surgically, with radiation therapy or stereotactic radiosurgery. After that, remission may occur again.

If the patient has many metastases in different parts of the body, they cannot be removed. In fact, the disease becomes incurable. But such patients can still be helped. In such situations, chemotherapy, targeted therapy, immunotherapy, and radiation therapy become the main methods of treatment. They will not destroy all tumor cells in the body, but they will help slow down the progression of the disease, reduce the size of foci, prolong the life of the patient and relieve him of painful symptoms.

Often after a relapse, cancer cells have new mutations that make them resistant to previous treatments. In such cases, the doctor will prescribe a different treatment regimen.

It is often difficult to fight cancer after a relapse. If the doctor said that the treatment would be ineffective, and he could do little to help if the prescribed therapy did not help, you should get a second opinion from another specialist.

In the international clinic Medica24, you can undergo a molecular genetic analysis that will help determine which mutations have occurred in cancer cells, which molecules in them do not work correctly, and which drugs could be most effective in this case.

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If none of the existing treatments help, the patient may consider participating in clinical trials. During them, new anticancer drugs and therapy regimens are tested.

The prognosis after cancer recurrence is always individual. Some patients manage to achieve remission, in others the disease continues to progress, and doctors can only slow down this process. The chances of successful treatment should be discussed with the doctor in each case individually.

The Medica24 international clinic uses the most modern methods of treating recurrent cancer. Our doctors perform surgical interventions of any complexity, use the latest generation of anticancer drugs in accordance with modern international recommendations. Come to an appointment with our specialist, he will assess your situation, prescribe the necessary examination and recommend the optimal treatment regimen.

The material was prepared by the Deputy Chief Physician for Medical Work of the Medica24 International Clinic, Candidate of Medical Sciences Petr Sergeyevich Sergeev.

Sources:

  1. Kit O. I., Gevorkyan Yu. Relapses of rectal cancer and methods of their prevention // Scientific Bulletin of the BelSU. Series: Medicine. Pharmacy. 2012. No. 22 (141).
  2. Dzhuraev M. D., Khudaiberdieva M. Sh., Egamberdiev D. M. Relapse of gastric cancer: the current state of the problem // Siberian journal of oncology. 2009. №3.
  3. AK Al-Yahiri Patterns of development of recurrence of locally advanced gastric cancer // Problems of health and ecology. 2008. No. 4 (18).

Prevention of recurrence

Urolithiasis has a high recurrence rate. In 50-75% of patients after surgery, a second stone forms in the interval of 5-10 years. In patients with "infectious" and "uric acid" stones, relapses occur much faster, including as early as 3-6 months after surgery.

The fact is that the surgical operation removes the stone, but does not eliminate the causes of its formation.

The causes of stone formation are diseases and external factors that change the properties of urine. In healthy people, urine is a highly concentrated saline solution, in which, thanks to special protective systems, the salts are in a dissolved state and do not precipitate.

When the balance is disturbed, crystallization of salts and stone formation occur. Stones can form not only in the renal pelvis and calyces where urine collects, but also under the mucous membrane (Randall's plaques). To prevent relapse, it is necessary to identify and eliminate these violations.

Diagnosis of the causes of stone formation:

The scope of the examination to identify the causes of stone formation includes:

  • Determination of the chemical composition of the stone by any available method (infrared spectroscopy, X-ray phase analysis, etc.).
  • Biochemical blood test: uric acid, ionized calcium, vitamin D, parathormone
  • Biochemical analysis of daily urine for stone-forming agents
  • Exclusion of causes leading to obstruction of urine outflow

The reality is that only a small number of patients perform these studies and the majority of patients remain unexamined.

Medicines to prevent relapse

Medicines prescribed to prevent relapse must correct the identified violations of the biochemical composition of the urine.

When evaluating metabolic disorders, we most often encounter the following situations:

  • Increased levels of uric acid in the urine (hyperuricuria)
  • Increased urinary calcium (hypercalciuria)
  • Increased urinary calcium levels (hyperoxaluria)
  • Decreased level of citrate justifications (hypocitraturia)
  • Change in urine acidity.

Diet for urolithiasis

Diet is a powerful but not the only factor influencing the properties of urine.

When choosing a therapeutic diet, the doctor first of all takes into account the chemical composition of the stone and the existing biochemical abnormalities in the urine. Therefore, to prescribe a therapeutic diet, it is necessary to perform a biochemical analysis of daily urine.

Please note that most of the advice available on the Internet is from outdated sources and is incorrect. Thus, restricting dietary intake of calcium in most cases will be harmful and increase the risk of stone formation, and limiting oxalate-rich foods will be useless.

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