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Why Some Doctors Won't Say Your Cancer Is "Cured"

New treatments have improved survival, but no one can predict how you will do.

Why Some Doctors Won't Say Your Cancer Is "Cured"

A diagnosis of cancer can carry understandable fear and distress. But powerful new therapies that harness our immune defenses promise better survival, experts say, as do new insights into how cancer cells grow and thrive.

Not only can some cancers be successfully treated and potentially “cured” today, they say, but others—long considered beyond hope—are manageable as chronic disease, sometimes for many years. Some 15 million Americans have had or are currently living with cancer, according to the American Society of Clinical Oncology.

Predicting how an individual might fare when facing cancer, however, remains difficult, depending on many factors, including:

  • The type of cancer one has and where in the body it first occurs.
  • The size of the cancer and whether it has spread elsewhere in the body.
  • The biology of the cancer cells themselves—are they aggressive or slow-growing?
  • Being over age 60 with competing health issues, such as heart disease or diabetes, that also may shorten survival.

“Prognosis is really a medical term for guessing,” says Erev Tubb, MD, Chief of Hematology and Medical Oncology at Saint Francis Healthcare in Wilmington, Delaware. “With a great deal of certainty, I can tell you if you only have a few days to live, but rarely can I say whether or not you’ll survive six months.” Or longer.

That limited predictability reflects the complexity of these many diseases, collectively known as cancer.

Learning the terminology of treatment
Not surprisingly, perhaps, some cancers respond better to therapy than others. For patients, that means understanding the terminology cancer doctors use to describe how well treatments are working against a particular cancer. Cancers can be stabilized, go into partial remission or complete remission or progress to worsening disease.

  • If a cancer neither grows, nor spreads during treatments, that’s defined as stable disease, requiring careful monitoring for any change.
  • If tumors shrink by at least 50 percent or more in size, patients are considered to be in partial remission, according to the American Cancer Society. A partial remission may allow some individuals to take a break from the rigors of chemotherapy or other treatments until a cancer begins growing again.
  • A complete remission, in comparison, as the name suggests, describes an absence of all measurable tumors and signs of cancer on imaging tests.
  • Usually, doctors say, a relapse—or cancer’s return—occurs within the first five years of beginning treatment.

Although some doctors consider patients cured, if after treatment, they remain in complete remission—free of all signs and symptoms of cancer for five years or more—many avoid the term "cure" altogether.

Dr. Tubb says he prefers the phrase “continued long-term remission,” even when there’s a high likelihood a cancer won’t come back after treatment. That more guarded assessment allows for the remote possibility of a recurring malignancy many years out, if treatments leave behind microscopic cancer cells that later grow and divide into new disease.

“We’re trying to move away from false hope or false fear,” Tubb says, referring to oncologists’ efforts to find balance between promising too little and promising too much. “I try to establish at the outset a realistic expectation as to long-term life expectancy based on the best available data and the patient's overall condition.”

Ramping up the immune system
But, as a clearer molecular picture of cancer has emerged over the past two decades, so too have new approaches, including more precise and targeted therapies that take aim at specific genes inside cancer cells that help cancer grow and spin out of control. Physicians now combine many of these newer therapies with the mainstays of cancer therapy—surgery, radiation and chemotherapy—to achieve better effect.

One of the more promising is immunotherapy, which uses our immune systems to “recognize cancer as it should,” Tubb says, rendering cancer cells more vulnerable to attack. Several types of immunotherapy are already in the clinic, providing long-term remissions in cancers once considered uniformly deadly, such as advanced lung, head and neck, liver and kidney cancers, as well as melanoma, the most lethal form of skin cancer.

Particularly effective, experts agree, has been a class of drugs called checkpoint inhibitors. These drugs block a mechanism—the checkpoint—that cancer cells use to escape detection. But other strategies remove an individual’s own immune cells, alter them genetically to kill the cancer cells, then re-infuse them into the bloodstream.

Still early in development, these interventions mean treatments may someday be tailored to each patient. Researchers already have discovered genetic similarities shared across many cancers, Tubb says, which may broaden treatment options for many cancer patients in the future.

“I know we can only expect a certain amount of improvements right now,” he says, “but we’ve already seen dramatic changes in treating some cancers.” And, these advances, he adds, have made him cautiously optimistic about the progress ahead.

Medically reviewed in May 2018.

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