When sarcoma cells can no longer be detected in the body, a patient is considered to be disease free or in remission. A recurrence is defined as the return of sarcoma after a period of remission.
Because doctors cannot guarantee a sarcoma will not return even if it appears the disease is completely gone, patients are given a plan for follow-up care and surveillance after successful treatment ends. This is done to help monitor recovery and check for the presence of recurrent disease, and usually involves periodic doctor’s visits and a schedule for tests or scans. The chance of recurrence is different for each person and depends on the type of sarcoma, the treatment received, and the length of time since treatment ended. For sarcomas that more commonly recur, the schedule for follow-up tends to be more rigorous.
Recurring disease is classified by its location and can be either a local recurrence (developing at or very close to the site of the original tumor) or a distant recurrence (also called metastatic disease, in which the tumor spreads to organs or tissues distant from the primary sarcoma, such as the lungs or liver). Soft tissue sarcomas have a somewhat predictable pattern of distant recurrence and most commonly spread to the lungs via the bloodstream. However, tumors arising in the abdominal cavity more commonly spread to the liver and peritoneum.
A recurrent sarcoma starts with malignant cells that treatment did not fully remove and were too small to be detected. Over time, these cells grow and multiply into tumors large enough to be detected as a recurrence.
After recurrence is detected, additional tests, scans, and blood work may be done to determine if it is the same type as what was there before. Even when sarcoma has spread to a new location, it is still named after the part of the body where it started. For example, if a GIST spreads from the stomach to the liver, it is still called GIST (with liver metastases).
The next step is to determine a plan for treatment. Many of the same factors considered when planning treatment for the primary cancer are also considered for the recurrent cancer. This includes your overall health status and the type, location, and size of the recurrence. In addition, past treatment history should be examined, including the medicines used, the method of delivery, how long ago they were administered, how the original sarcoma responded to the treatment, and any side effects you may have had. There will likely be several treatment options to choose from. Clinical trials may be an option.