Your cancer is back, and so is the shock and fear that came with your first diagnosis. The uncertainties are back, too, and you wonder about treatment and about your future. The distress you feel is normal — some say the second cancer diagnosis can be more distressful than the first.

So what can you do? Find out what makes a cancer recurrence different from a first diagnosis and why it's common to feel angry or afraid. Use this information and everything you learned during your initial treatment to give you confidence and strength as you cope with the return of your cancer.

When cancer returns after a period of remission, it's considered a recurrence. This happens because some cells from your initial cancer were left behind after treatment. It can also happen when cancerous cells leave the original site where your cancer was found and hide in another place in your body. These cancer cells continued to multiply, resulting in the reappearance of the cancer you thought had been removed during your previous treatment.

Most often it's the same cancer, but in some cases you can be diagnosed with a new cancer that isn't related to your first cancer. That's referred to as a second primary cancer.

Your cancer can recur in the same place it was originally located, or it can travel 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 (metastasized) to areas farther away from where your cancer was first located.

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 doctor might suspect a cancer recurrence based on certain tests, or you might suspect a recurrence based on the signs and symptoms you experience.

After your last round of treatment, your doctor 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. It's important to follow this schedule of appointments and watch for any changes in your health.

Watching for a recurrence of cancer is often very different from screening for the original cancer. And the goals of the two are different. For most forms of cancer, a local recurrence may still be curable, so early detection of a local recurrence is very important. Unfortunately, for most cancer recurrences found at a distant site, the chance of cure is not good. All cancers are different so it's important to talk to your doctor about what type of cancer you have and what can be done if it were to recur at a distance. This should guide what tests you undergo during routine checkups after your initial treatment.

Many gains have been made in the treatment of cancer recurrences. In many cases, local and regional recurrences can be treated successfully. However, cancer that has spread to distant locations is less likely to be cured.

While some people achieve a cure by treating their cancer recurrences, in some cases a cure isn't possible. Treatment may be helpful to shrink your cancer to keep it under control. This slows the cancer's growth, which can extend your survival or relieve pain and other symptoms you might experience.

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 and what side effects you're willing to endure. Your doctor will also take into account what types of treatment you had previously undergone and how your body responded to those treatments.

You might also consider joining a clinical trial, where you'll have access to experimental medications. Keep in mind, though, that a cure isn't guaranteed. Talk to your doctor about clinical trials that are available to you.

A cancer recurrence brings back many of the same emotions you felt when you were first diagnosed with cancer. But in many ways, these emotions are different. Just because you've dealt with these feelings before doesn't mean they're any easier to deal with this time. Common emotions include:

• Distress. When you ended treatment for your initial cancer, you slowly started to move on with your life, thinking the cancer was gone. In the weeks, months or years that passed, cancer became less and less a part of your daily life. The shock of having cancer come back after you assumed it was gone can cause distress — sometimes more so than your first diagnosis did.
• Self doubt. You may doubt the wisdom of your past treatment decisions or the lifestyle choices you made since your last cancer experience. But you didn't cause your recurrence. Nothing you could have done would have prevented your cancer from recurring. Don't doubt your judgment as you make decisions about your current cancer treatment.
• Anger. You might be angry with your doctor for not stopping your cancer the first time. But you and your doctor made treatment choices based on the information and treatments that were available. No one is to blame. If it makes you feel more comfortable, seek a second opinion or switch to a new doctor.
• Fatigue. It's normal to feel like you can't deal with cancer again. Whether it's the side effects of treatment you're dreading or having to tell your friends and family that your cancer is back, you've done it before. Take heart in the fact that you were able to do it the first time, even though you might have doubted yourself back then.

All of these feelings are normal, but that doesn't mean you can't do anything about them. Start by thinking back to your first cancer experience. The same coping mechanisms you used then are likely to work now. Whether it was a best friend, a family member or a support group you turned to, you know that that person or group provides good emotional support.

You have other advantages this time around. Rely on these to help you cope. For example:

• 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 to expect in terms of side effects.
• You've built relationships. You've worked closely with your doctor and you know your way around the hospital. This can make you feel more comfortable.
• 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 past experiences to plan ahead.

Use these past experiences to your advantage. They can help you feel more in control when making decisions about your treatment. And don't be afraid to express your feelings to your doctor. The conversation that results can give you a better understanding of your situation and it can help you make treatment decisions.