Prognosis / Disease recurrence

Disease recurrence

Recurrence risk refers to the chance the cancer will come back at various times after diagnosis. The risk varies greatly based on the Stage of disease at the time it is initially diagnosed and treated.

Overview of MCC disease recurrence

Disease recurrence and survival are two critical measures of prognosis (how a patient will do after a cancer cancer A term used to describe diseases in which abnormal cells continually divide without normal regulation. Cancerous cells may invade surrounding tissues and may spread to other regions of the body via blood and the lymphatic system. diagnosis). Recurrence refers to whether the cancer ever comes back and “disease-specific survival”. The figures below show how MCC stage affects the chance of recurrence from MCC.

Signs and symptoms of a recurrence

A recurrence of the cancer can appear as a skin lesion lesion An area of abnormal tissue that may be either benign or malignant. , enlarged lymph nodes or via imaging studies that detect new tumors within the body. In most cases, a biopsy biopsy The removal of cells or tissue in order to determine the presence, characteristics, or extent of a disease by a pathologist usually using microscopic analysis. of a new lesion will be required to be certain if the lesion represents MCC or not.

Recurrence risk after MCC

“Kaplan-Meier” curves are a standard way to depict both recurrence-free survival and MCC-specific survival (see Survival rates page for more information) over time starting from diagnosis. In the Kaplan-Meier curves* shown below, each tick mark indicates a patient who was “censored” at that point and is no longer included in the data to the right of that point. Reasons for “censoring” include no follow up available beyond that date, or death from a non-MCC cause.

Recurrence-free survival is the chance that MCC has not recurred at a given time after diagnosis. Recurrence-free survival varies by stage stage Physicians determine the stage of cancer by performing physical exams and tests. Stages describe the extent of cancer within the body, especially whether the disease has spread (metastasized) from the primary site to other parts of the body. , as shown below, but about 80% of all MCC recurrences occur in the first two years after diagnosis.

Recurrence free survival for 467 patients for all stages.
Recurrence free survival for 467 patients for all stages. These data are from the patients with stage IA (n=118), stage IB (n=60), stage IIA (n=32), stage IIB (n=22), stage IIIA (n=81), stage IIIB (n=125) and stage IV (n=29) enrolled in the Seattle based MCC cohort through December 2015. Staging was per AJCC 7th Edition system.
Recurrence free survival for 232 patients with stage I or II MCC.
Recurrence free survival for 232 patients with stage I or II MCC. These data are from the patients with stage IA (n=118), stage IB (n=60), stage IIA (n=32) and stage IIB (n=22) enrolled in the Seattle based MCC cohort through December 2015. Staging was per AJCC 7th Edition system.
Recurrence free survival for 235 patients with stage III or IV MCC, breaking down stage IIIB known and unknown primary tumors.
Recurrence free survival for 235 patients with stage III or IV MCC, breaking down stage IIIB known and unknown primary tumors. Some patients present without an identifiable primary MCC tumor (lesion) on the skin. These patients are referred to as having an “unknown primary tumor” and often present instead with an enlarged lymph node containing MCC. Unknown primary Stage IIIB patients have a lower risk of MCC recurrence relative to Stage IIIB patients with known primary tumors. These data are from patients with stage IIIA (n=81), stage IIIB known primary tumors (n=58), stage IIIB unknown primary tumors (n=67) and stage IV (n=29) enrolled in the Seattle based MCC cohort through December 2015. Staging was per AJCC 7th Edition system.

What to do next

These graphs can be very helpful in determining how closely a patient needs to be followed. For example, after 2-3 years, the frequency of visits, blood tests and scans can typically start to decrease.

How physicians determine your prognosis

At the time of diagnosis, your medical team will ‘stage’ your cancer. The stage is based on many factors including the size of the tumor, the results of a sentinel lymph node biopsy sentinel lymph node biopsy Removal and examination of the "sentinel" lymph node(s). Sentinel nodes are the first lymph nodes to which cancer cells spread from a primary lesion. To identify the sentinel lymph node(s), a radioactive substance and/or dye is injected near the primary lesion. The surgeon uses a Geiger counter to find the lymph node(s) containing the radioactive substance or looks for the lymph node(s) stained by the dye. The surgeon then removes the sentinel lymph node(s) and sends them to a pathologist to check for the presence of cancer. and scans, etc. Please see the Staging page to learn more. The stage of the cancer can predict the chances of having a recurrence of MCC.

A Closer Look

A recent manuscript analyzed Overall Survival (chance of dying of anything) based on the new 8th edition staging system1. The Nghiem lab is currently analyzing MCC Specific (disease specific) survival and recurrence rates for this new staging system and that information will be posted here sometime in 2017, after the 8th Edition AJCC staging system goes into use.

FAQs

What kind of follow-up do I need?

After your initial treatment, you will need to be followed closely by a physician to do regular skin and lymph node exams and take a thorough history. Visits should be approximately every 3 months for year 1 and then every 3-6 months for year 2, and then annually after that.

How are metastases detected?

A physical exam may reveal a new skin lesion, an enlarged lymph node or an enlarged liver that may signal the spread of MCC. A lesion of metastatic MCC may appear as a 1-3 cm, flesh-colored to red-purple bump that feels firm, is deeper compared to the primary lesion, and grows rapidly over a period of 2-4 weeks. The AMERK serology test can be an inexpensive, safe and sensitive approach to detect early recurrence. See the Symptoms and Appearance of MCC page for common sites of MCC metastasis. Blood tests, such as liver function tests (LFTs), may be used to detect the spread of MCC to internal organs, such as the liver. If a doctor is suspicious of distant metastases, he or she may use non-invasive imaging techniques, such as chest X-ray, CT (computed tomography) scans, and PET (positron emission tomography) scans.

Understand the Science

The following clinical publications and scientific research provide additional in-depth information about disease recurrence.

Analysis of Prognostic Factors from 9387 Merkel Cell Carcinoma Cases Forms the Basis for the New 8th Edition AJCC Staging System.

The first consensus Merkel cell carcinoma (MCC) staging system was published in 2010. New information on the clinical course prompts review of MCC staging. Methods: A total of 9387 MCC cases from the National Cancer Data Base Participant User File with follow-up and staging data (1998–2012) were a...

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