Tuesday, October 7, 2014

Cancer in remission

Every patient with cancer wants to hear the word CURE, from their doctor. But will an Oncologist (cancer doctors) ever use this word CURE?

A normal cell has a cell cycle. It is born, it grows in size, it matures, it performs its functions, it reproduces and then it perishes. When a normal cell changes, it starts growing and reproducing abnormally and uncontrollably and when it no longer dies it is called as a cancer cell.
Even when treatment for cancer is given successfully, since the tendency of the cancer cell is to grow and reproduce one can never be sure if all the cancer cells have been destroyed by the treatment.
So what is the difference between cancer cure and cancer remission? Doctors almost never use the term cure; rather, they usually talk about remission.
Remission is a term that doctors often use to refer to a condition when there is absence or no evidence of the disease. It implies that there is a potential chance for recurrence (relapse). In cancer when the term remission is used it means that there is no trace of the disease at that point of time. Or the disease may be so small that it cannot be detected by physical examination or by any scan.
Cure is a term not normally used when speaking of cancer, because of our inability to very accurately predict if cancer will come back or not in any given individual.
Remission can be of two types.
Complete remission- means that after the treatment there are no symptoms and signs in a patient to indicate the presence of cancer. However, even when a person is in remission, there may be microscopic collections of cancer cells that cannot be identified by current investigations. This means that even if a person is in remission, in the future, can have a recurrence or relapse of their cancer.
Partial remission- means that a major percentage of the signs and symptoms of cancer disappear, but some of them may still remain.
Complete remission would therefore be better than partial remission because with partial remission the chances of recurrence are higher.
Doctors will sometimes refer to 5-year cure rate or a 10- or more year cure rate. What is really meant by this is a 5- or more year remission rate. The longer the remission time lasts, the greater the possibility that the cancer actually has been cured. However there are cases of cancer recurrence many, many years after remission begins.
So in Breast cancer, we say when the disease is in stage 1 there is a 95 percent 5-year cure/remission rate. It means that after five years, 95 percent of people with that cancer will still be in remission (meaning that one has an extremely high likelihood of not having a recurrence for at least five years). As the longevity increases, doctors can now often give remission rates for 10, or even 20 years. In many ways, the approach to most cancer treatment is to make it a chronic disease that lasts for many years.
In cancer, can we really talk about cure?
No. We can only talk about remission. But the remission may be so long or the chances of relapse of the disease could be so low that one could consider cancer to be completely cured.
All the research that is happening in the field of Oncology is with an aim of prolonging the remission rate.
With the present, advanced modalities of cancer treatment the chances of long remission rate is very high and surely there is a HOPE for all the cancer patients

Dr. Jayanthi Thumsi
Senior Consultant, Breast Cancer Surgeon
BGS Global Hospitals
Super Specialty Quaternary Care

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