What is worse than being told you have cancer? I am certain that any cancer survivor will tell you that it is hearing their cancer has returned.

I had a period of time after my first all clear where I lived in blissful ignorance of the cell changes occurring inside me. I had barely processed my first diagnosis and its side effects, before hearing the news that my cancer had returned.

My initial response to recurrence, before shock and anger, was one of survival mode. I had been secretly preparing myself for this; I knew the odds were low, but preparing for the worst and hoping for the best helped me manage this uncertainty.

I felt oddly prepared in the moments of receiving my recurrence news because of the information I had gathered after my initial diagnosis. I already knew about potential treatment options and I felt that having that knowledge made me feel a little more in control at that moment. This ‘moment’ of calm only lasted a few hours before panic took over and I was bracing myself once more.

What is cancer recurrence?

Recurrence is cancer that goes away and comes back after a period of remission. The cell changes could develop in the same place they started or in a new part of your body.

There are three classifications for recurrent cancers:

• Local recurrence - The cancer returns in the same place / or very close to, where it first started.
• Regional recurrence - The tumor develops in the lymph nodes or tissues that are near the original cancer.
• Distant recurrence - The recurrent cancer has spread, or what doctors call "metastasized", to faraway organs or tissues in your body.

Most cancers that are going to come back will do so in the first 2 years or so after treatment. After 5 years, you are even less likely to experience a recurrence. Cancer survivors are advised of these milestones and this only goes towards heightening our anxiety around recurrence during this critical period of time.

Why do some cancers recur?

Part of a cancer diagnosis conversation with your oncologist will include the general statistics, odds and likelihood of recurrence for your cancer. Nobody knows with certainty what will happen, and this leaves anyone who has been through a cancer diagnosis living with some level of concern about recurrence.

Recurrence might occur because a small number of cancer cells were left behind after treatment (too small to detect or outside of the treatment area) or were lying dormant and over time have become active.

Whilst Doctors can't predict if your cancer will recur, they can advise which cancers are more likely to recur, especially if they were aggressive, advanced, your treatment is known to affect recurrence or you have a specific gene mutation.

6 points to remember if you experience cancer recurrence:

1. Make it known what is important to you now- Depending on the time since your original cancer diagnosis, your goals may have changed. Make your medical team aware of what you want ‘now’ if this differs from discussions you had during your original diagnosis. In my case, preserving fertility was high on my list at my initial diagnosis, but when cancer returned, my priority shifted to giving myself the best survival outcome.
2. Remember what you are capable of- “Where is the evidence to support this?” is what my therapist asked when I said I could not deal with cancer again. Evidence disproved this, I had found strength the first time and with support, I could do this again. Chances are, you will have learned a lot from your initial cancer diagnosis that will give you the strength you need during your recurrence treatment.
3. Familiar is reassuring- Walking into familiar surroundings and being cared for by people you know, can make the treatment of recurrence a bit less daunting. Having a team that you trust is key to feeling confident with your treatment plan and in helping you feel comfortable with the journey ahead.
4. You know how the system works- You are not starting from scratch with your medical knowledge. Having an understanding of cancer terminology, treatments and the complexities of the health insurance system will take a little of the stress out of understanding the diagnosis and treatment of a cancer recurrence.
5. You know what works for you - One benefit of recurrence is that you will be aware of what helped you cope after your first diagnosis. Whether it be exercise, meditation, or spending time with loved ones, you know best what helps manage your anxiety and stress.
6. You don’t have to do this alone- Don’t be afraid to reach out to friends and family for support, you might feel guilty for needing their help again, but they will not want you to go through this alone. You may also find that connecting with the cancer community allows you to speak to others who have been in a similar situation and can offer support.

Personal observations from experiencing cancer recurrence.

“I can be changed by what happens to me. But I refuse to be reduced by it.”- Maya Angelou

The biggest hurdle of my recurrence was getting my head around being a cancer patient once more, just as I was beginning to feel better.

Cancer was not a club I wanted to join, but having been a member before, I felt better equipped this time around. Research proves that I am not unusual in feeling this way. A study comparing breast cancer patients with initial diagnosis vs recurrence, found that those experiencing recurrence had significantly lower anxiety and confusion, and despite the physical burden, they exhibited considerable resilience in coping with recurrence.

I am now two years post recurrence and although feelings of uncertainty for the future are there, every critical milestone that I achieve sees my level of fear subside a little. You may find that scans and check-ups may always trigger you, after all we have been through it is understandable, but time can be a great healer.

I feel lucky (it is funny how we use the word ‘lucky’ with cancer) that my recurrence was in the original area, was found early and was a treatable grade. I know that not everyone is this fortunate and this does cause me survivor's guilt.

Remember to feel all the feels and allow yourself time to grieve for everything you have lost. Grief isn’t just experiencing physical loss, it can be the turmoil you experience in adjusting to a ‘new you’ and leaving behind the person you were before cancer. I am in awe of what my body and mind are capable of recovering from and I now advocate and support myself more than ever (except cancer cells, they do not get my support!).

Recurrence awakened courage and confidence in me that gave me a greater appreciation of what I am capable of and what I want from life. I encourage everyone to make bold choices in life and do the things that they might be putting off. Life is for living and experiencing a cancer recurrence really cements this mindset.