When cancer returns, you may feel some of the same emotions you felt with your first diagnosis. The uncertainties may be back, too, and you might be wondering about more cancer treatment and about your future.

Some people report that a second cancer diagnosis can be more upsetting than the first, but there are strategies that can help.

When cancer returns after a period of remission, it's considered a recurrence. A cancer recurrence happens because, in spite of the best efforts to rid you of your cancer, some cells from your cancer remained. These cells can grow and may cause symptoms.

These cells could be in the same place where your cancer first originated, or they could be in another part of your body. These cancer cells may have been dormant for a period of time. But for reasons that aren't understood, eventually they continued to multiply, resulting in the reappearance of the cancer.

In rare instances, you may be diagnosed with a new cancer that's completely unrelated to your first cancer. This is referred to as a second primary cancer.

Your cancer can recur in the same place it was originally located, or it can move to other parts of your body. Recurrence is divided into three categories:

• Local recurrence. This means the cancer reappears in the same place it was first found or very close by. The cancer hasn't spread to the lymph nodes or other parts of the body.
• Regional recurrence. A regional recurrence occurs in the lymph nodes and tissue located in the vicinity of your original cancer.
• Distant recurrence. This refers to cancer that has spread to areas farther away from where your cancer was first located. This is called metastatic cancer.

Where your cancer recurs depends on your original cancer type and stage. Some cancer types commonly recur in specific areas.

Cancer recurrences are diagnosed just like any other cancer. Your health care provider might suspect a cancer recurrence based on certain tests, or you might suspect a recurrence based on your signs and symptoms.

After your last round of treatment, your health care provider probably gave you a schedule of follow-up exams to check for cancer recurrences. You were probably told what signs and symptoms to be alert for that might signal a recurrence.

All cancers are different, so talk with your health care provider about what's best for your type of cancer. The particulars of your diagnosis can guide what tests you'll have during routine checkups after your initial treatment.

Many local and regional recurrences can be cured. Even when a cure isn't possible, treatment may shrink your cancer to slow the cancer's growth. This can relieve pain and other symptoms, and it may help you live longer.

Which treatment you choose, if any, will be based on many of the same factors you considered when deciding on your treatment the first time. Consider what you hope to accomplish, your goals for treatment and what side effects you're willing to accept. Your provider will also take into account what types of treatment you had previously and how your body responded to those treatments.

You might also consider joining a clinical trial, where you may have access to the latest treatments or experimental medications. Talk to your health care provider about clinical trials that are available to you.

A cancer recurrence can bring back many of the same emotions you felt when you were first diagnosed with cancer. Here are some ideas that may help you cope with the emotions of a cancer recurrence.

• Remember that you know more now. Knowing more about cancer and your treatment options can help reduce your anxiety. Think about how much you knew about cancer at your first diagnosis. Compare this to what you know now, such as what treatment involves and what side effects to expect.
• Treatments may have improved. There may be newer drugs or newer methods for treating your cancer or managing side effects since your first diagnosis. Rapid developments in cancer treatment may open up possibilities that had not been available to you previously.
• You've built relationships. You've worked closely with members of your health care team, and you know your way around the hospital or clinic. This can help you feel more comfortable. You've been there before, and you know what to expect.
• You've done this before. Based on your first experience with cancer, you know what's best for you during this time. Whether you needed some time alone or preferred having someone nearby, you can draw on your experience to plan ahead. Take heart in the fact that you were able to do it the first time.
• You can turn to strategies that help. Meditation, yoga, physical activity, journaling and finding support from friends and family members can all be helpful coping tools during this time.
• You can get additional help if you need it. If you're struggling with a cancer recurrence, it might help to reach out to a therapist or counselor who works with people who have cancer.

Some people say that a cancer recurrence can be especially devastating because the strong support system they had after their first cancer diagnosis sometimes evaporates when the cancer recurs. Don't be afraid to reach out to friends and family again and communicate how they can support you.

Also, express your feelings to your health care provider. The conversation that results can give you a better understanding of your situation, and it can help you make treatment decisions.