Cancer-free Vs Remission
Gaetan Boren
If you have cancer, you may have questions about how serious your cancer is and your chances of survival. The estimate of how the disease will go for you is called prognosis. It can be hard to understand what prognosis means and also hard to talk about, even for doctors.
When you have cancer, you and your loved ones face many unknowns. Understanding your cancer and knowing what to expect can help you and your loved ones make decisions. Some of the decisions you may face include:
Many people want to know their prognosis. They find it easier to cope when they know more about their cancer. You may ask your doctor about survival statistics or search for this information on your own. Or you may find statistics confusing and frightening, and think they are too impersonal to be of value to you. It is up to you to decide how much information you want.
Doctors estimate prognosis by using statistics that researchers have collected over many years about people with the same type of cancer. Several types of statistics may be used to estimate prognosis. The most commonly used statistics include:
Because statistics are based on large groups of people, they cannot be used to predict exactly what will happen to you. Everyone is different. Treatments and how people respond to treatment can differ greatly. Also, it takes years to see the benefit of new treatments and ways of finding cancer. So, the statistics your doctor uses to make a prognosis may not be based on treatments being used today.
Still, your doctor may tell you that you have a good prognosis if statistics suggest that your cancer is likely to respond well to treatment. Or they may tell you that you have a poor prognosis if the cancer is harder to control. Whatever your doctor tells you, keep in mind that a prognosis is an educated guess. Your doctor cannot be certain how it will go for you.
NCI collects and reports on cancer statistics through its SEER Program, which stands for Surveillance, Epidemiology, and End Results. From the Cancer Stat Facts page on the SEER web site, you can find answers to the most commonly asked questions about cancer statistics for many cancer types. You can also browse the latest SEER Cancer Statistics Review.
Survival statistics most often come from studies that compare treatments with each other, rather than treatment with no treatment. So, it may not be easy for your doctor to give you an accurate prognosis.
If you remain in complete remission for 5 years or more, some doctors may say that you are cured. Still, some cancer cells can remain in your body for many years after treatment. These cells may cause the cancer to come back one day. For cancers that return, most do so within the first 5 years after treatment. But there is a chance that cancer will come back later. For this reason, doctors cannot say for sure that you are cured. The most they can say is that there are no signs of cancer at this time.
Surgeons do their best to remove all of the cancer during surgery. But it is always possible to leave behind a small group of cancer cells. Your surgeon may recommend more treatment if they feel that there is a risk that the cancer could come back. This is sometimes called adjuvant treatment.
Chemotherapy drugs kill cancer cells. They do this by attacking cells that are in the process of doubling to form 2 new cells. But not all the cells in a cancer divide at the same time. Normal cells go into a long rest period between divisions. Cancer cells do too, although the rest period may be much shorter.
Giving chemotherapy in a series of treatments helps to catch as many cells dividing as possible. Cells that were resting when you had your first treatment, may be dividing when you have your next and so will be more likely to die.
It is unlikely that any chemotherapy treatment kills every single cancer cell in the body. Doctors try to reduce the number of cancer cells as much as possible. The immune system kills off the remaining cells or they may die off.
Radiotherapy makes small breaks in the DNA inside the cells. These breaks stop cancer cells from growing and dividing and often make them die. Normal cells close to the cancer can also become damaged by radiation, but most recover and go back to working normally. If radiotherapy doesn't kill all of the cancer cells, they will regrow at some point in the future.
Some immunotherapies or targeted cancer drugs may get rid of a cancer completely. Others may shrink the cancer or control it for some months or years. So a cancer may seem to have gone and may not show up on any scans or blood tests. But there may be a small group of cells that remain in the body. They can start to grow again after a while or when the treatment stops.
Sometimes cancer can become resistant to cancer drug treatment. Cancers develop from normal cells that have changed or mutated to become cancerous. The mutation happens in the genes of the cell. These gene changes make the cell behave differently to a normal cell. Cancer cells can continue to mutate so that they become more and more abnormal.
Some mutations can make the cells resistant to cancer drugs. You can sometimes have a different type of treatment if this happens. But sometimes cancers develop resistance to many drugs at the same time. This is called multi drug resistance.
Scientists have found a group of genetic mutations that they think can cause drug resistance. These mutations mean that the cancer cell can keep the drugs out. The resistant cells have high levels of a substance called p-glycoprotein. P-glycoprotein is a protein found in cell walls. The protein acts as a pump and removes toxins from cells. Cells with high p-glycoprotein levels are very good at keeping cancer drugs out.
These days, doctors are able to cure many cancers. But some cancers can come back many years after treatment. So you may find that your doctor is very unwilling to use the word 'cure'. This is so even though there is no sign that you have any cancer left. Doctors usually say that your cancer is in remission. This means that there is no sign of cancer in your body. If there are any cancer cells left:
Doctors can't be sure that the cancer has completely gone after treatment. So they may suggest that you have some type of long term treatment. This might include hormone therapy or a targeted cancer drug. This is called adjuvant treatment.
It can be very difficult to live with the fact that your cancer may come back. Even if doctors tell you that they are 95% certain your cancer has gone for good, you may find it very upsetting that no one can say for sure that you're cured.
For most people who are in this situation, each day lowers the risk of a recurrence. Most cancers that are going to come back will do so in the first 2 years or so after treatment. After 5 years, you are even less likely to get a recurrence. For some types of cancer, after 10 years your doctor might say that you are cured.
You may find it helpful to talk to other people in the same situation. This is especially so if you are finding it hard to cope with the fact that you have had cancer. Or you could talk to a trained counsellor. This can help you to find ways of dealing with the fear and worry.
You can phone the Cancer Research UK nurses if you would like to talk to someone outside your own friends and family. Talk to the Cancer Research UK nurses on freephone 0808 800 4040, from 9am to 5pm, Monday to Friday.
Some cancers have very high survival rates, especially when caught early. For instance, the five-year survival rate for prostate cancer is nearly 100 percent when the disease is detected and treated early.
If you are considered in complete remission for more than five years, some doctors may say that you are cured. But that does not mean there may still be undetected cancer cells that may cause a recurrence years later.
Most cancer survivors need follow-up appointments, regular screenings and, possibly, ongoing treatments to help keep cancer from returning. You may want to ask your health care team about survivorship programs to help guide you in post-cancer care.
Remission, cancer-free and no evidence of cancer can all mark important milestones in your cancer journey. Your cancer care team can explain to you in detail what these words and phrases mean for you.
Most cancers, if they recur or relapse, meaning there is now visible disease, typically do so within five years after the last treatment. After that point, the risk of recurrence decreases so substantially that the benefits of ongoing surveillance monitoring with tumor markers or imaging do not outweigh the risks.
After five years of surveillance, I typically tell patients that I believe they are cured because ongoing surveillance is so unlikely to demonstrate recurrence. With cancer, unfortunately, this is never 100 percent certain. There are some cancers that can come back more than five years after treatment, but these are typically the outliers and not the norm.
Unfortunately, given the variable nature of cancer, nothing is absolute, and these terms are not well defined. The terms in and of themselves might mean different things to different providers. That is why I usually define the terms from my perspective when I meet patients and I am consistent with that message moving forward. NED and remission are often used interchangeably.
My best advice for patients in remission is to enjoy and live your life. Unfortunately, there are a number of things, cancer recurrence included, that can cut life short unexpectedly. Each day we have on this earth is a gift.
Lifespan, Rhode Island's first health system, was founded in 1994 by Rhode Island Hospital and The Miriam Hospital. A comprehensive, integrated, academic health system with The Warren Alpert Medical School of Brown University, Lifespan's present partners also include Rhode Island Hospital's pediatric division, Hasbro Children's Hospital; Bradley Hospital; Newport Hospital; Gateway Healthcare; Lifespan Physician Group; and Coastal Medical.
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