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Though there is still no cure for cancer, there are more cancer survivors than ever. With the most recent data, the National Cancer Institute estimated there were over 15.5 million cancer survivors in the United States in 2016. This is expected to grow to over 20 million within the next eight years.
Advancements in treatment and diagnostic tools have enabled more people to achieve cancer remission, even in the face of rare cancers like mesothelioma. Even though remission is a great milestone in one’s cancer journey, it shouldn’t be confused for being cured of cancer for good. Patients must understand the types of remission they may experience, as well as the likelihood of cancer recurrence.
What is Cancer Remission?
In general, there are two types of cancer remission that patients may hear about in their own cancer care: partial remission or complete remission. Though any type of remission is considered good news, patients will see different care plans moving forward and recurrence rates depending on if the remission is partial or complete.
Partial remission is achieved when a patient’s tumors have shrunk by at least 50% in size and remain shrunken for at least one month. Partial remission also alleviates many signs and symptoms of cancer, though the patient will still show some evidence of disease because the tumors are not completely gone. Patients experiencing partial remission may also hear their doctor say “stable disease” or that the cancer is “controlled.”
In cases of partial response, patients may see a vastly improved quality of life as their symptoms lessen. For some, the cancer can then be treated and monitored more like a chronic disease. However, these patients are also more likely to experience cancer recurrence, with the tumors growing and possibly spreading again.
Complete remission, also referred to as complete response or no evidence of disease, occurs when the patient no longer shows any symptoms of cancer. In physical examinations and scans, the doctor won’t see any tumors or other signs of disease. Complete remission is often achieved with early diagnosis and aggressive treatment, like surgery. But, it’s also important to remember that even with complete response, there may be cancer cells lingering that cannot be easily detected.
Even with mesothelioma, which typically brings a poor prognosis of about a year, some patients have been able to achieve partial or complete remission. Heather Von St. James is a 12-year pleural mesothelioma survivor after undergoing a radical surgery followed by grueling chemotherapy and radiation. She initially only had 15 months to live, and the aggressive treatment and continued care through her survivorship have allowed her to live beyond her best odds.
Again, an unfortunate reality of cancer is that even complete remission does not truly mean to be cured. Though more time in remission can mean a lesser chance of recurrence, some patients experience recurrence years after beating their initial diagnosis.
Understanding Cancer Recurrence
In the case of cancers like mesothelioma, which are known to be more aggressive and quick to grow and spread, recurrence rates are rather high. Cancer recurrence is when a patient who has been in remission for some time experiences a return of the cancer. In some cases, this can be even more aggressive in terms of progression and spreading than what the patient experienced before treatment and remission.
Undergoing cancer treatment and achieving remission again is possible even if the cancer returns, though patients will often need a different treatment plan. In the case of mesothelioma, patients who already underwent aggressive surgery like an extrapleural pneumonectomy in their first course of treatment may not be able to tolerate another surgery. The treatment plan may change to different combinations of chemotherapy and radiation, or seeking a clinical trial for emerging drugs like immunotherapy.
Mesothelioma patient Mavis Nye was able to go into remission after participating in an immunotherapy clinical trial after recurrence. She had seen her tumors shrinking from standard chemotherapy, though she eventually stopped responding to that treatment and saw aggressive tumor growth. Nye has said she was essentially on her deathbed with just three months to live and the immunotherapy clinical trial was her last hope. Since having this treatment, she has been in remission for over a year.
When in remission, patients may want to consider speaking with their oncologist about their remission rate, sometimes called the cure rate. This is the likelihood of how long they may remain in remission in a certain time period, which can also help provide insight into the likelihood of recurrence for their type of cancer.
The Importance of Continued Care
Even in survivorship, cancer patients still need to be proactive about their health and continue to receive scans to ensure the cancer hasn’t returned. Periodic check-ups with physical exams and scans can not only monitor any signs of cancer, but also help patients be proactive about any long or later-term side effects from the cancer itself or treatment.
Even though Von St. James is now a long-term survivor, she understands the cancer could potentially come back and it’s important to stay on top of her health care. Every six months, she goes to see her mesothelioma specialist and have scans to make sure there is still no evidence of disease.
Being in remission doesn’t mean being cured, but can start the survivorship journey. Even in instances of recurrence, there is still hope and cancer research continues to strive for new treatments that one day lead to a cure.