PARENTS FREQUENTLY DESCRIBE the return of their child’s cancer as more devastating than the original diagnosis. They may feel betrayed, guilty, and/or angry. They worry that if the previous treatments did not work, what will? Mostly, they are afraid. And their often unspoken but most crushing fear is: What if my child dies?

If your child’s cancer has returned, it is worth remembering that you now have several strengths you didn’t have before. You have already done this. You know the language, and you have a relationship with the medical team. You probably have friendships with other parents of children with cancer and you know they will be there for you. You can also hope that during the time your child’s cancer was in remission, researchers were able to develop newer and more effective treatments. You know that something that seems insurmountable can be endured, one day at a time.

This chapter describes signs and symptoms of relapse, what emotional responses you might experience, and how to set goals and decide on a treatment plan. It provides information about immunotherapy, which was recently approved to treat some children with leukemia who relapse or who never entered remission. In addition, several parents and survivors share stories about how they managed to cope.