There are so many terms to learn when first diagnosed with cancer, it can be hard to keep up with this new language. One of the first questions that many people with cancer have when they’re first diagnosed is ‘Can my cancer be cured?’. Oncologists may start throwing out words like partial remission, complete remission, complete response, and NED, or No Evidence of Disease. What do these phrases mean, and how are they different from one another? This post will talk about Remission vs NED in Cancer, the meaning and prognosis of each. But first, let’s talk about how doctors even come up with how they determine response to treatment.
Soon after learning about your cancer diagnosis, your care team will talk to you about your tumor grade and the stage of the cancer. The results from PET scans, CT scans, MRIs, and biopsies tell your medical team how big the original tumor is, whether it is metastatic cancer (if it has spread to other parts of your body), or if it’s what’s called localized. This means the cancer is confined to a general area in your body and hasn’t spread. Other information about the cancer like tumor markers can be learned from blood tests or tissue biopsies help give your healthcare providers a general picture of the cancer cells in your body.
The test results and scan results help your doctors determine the treatment options that will give you the best likelihood of killing the cancer cells. They’ll recommend a treatment plan that could include chemotherapy, radiation therapy, surgery, immunotherapy or other hormone therapy for your specific type of cancer and cancer stage.
Survival Statistics
Often, oncologists will talk about survival statistics, also called the 5-year survival rate. This is a number of the percentage of people who will be alive 5 years after their initial diagnosis. For example, the survival rate for thyroid cancer is 98 percent. This means out of 100 people, 98 of them will still be alive in five years. These rates are based on the averages found in clinical studies conducted over time.
It is important to remember that the 5-year survival rate is a general number, and not an absolute guarantee. Even if your type of cancer has a poor prognosis (it has a lower rate of people living 5 years or more after diagnosis), it does not mean your cancer journey will be the same. You may survive a shorter or longer amount of time.
Survival rates are affected by a number of factors, including:
- age of the patient
- location of the initial tumor
- stage at which the cancer was diagnosed
- how quickly treatment is started after diagnosis
- parts of the body the cancer may have spread to
- other health conditions the patient has
- side effects experienced by the cancer treatment
- how effective different cancer treatments are against the tumor
- the likelihood of that type of cancer recurring, even if initial treatments were effective
Five-year survival rates were first introduced in the 1930s, when it was considered to be impossible to live that long after diagnosis. Thankfully, with all of the different types of treatments available now, the five-year survival rate for all cancers combined is almost 70%. In the mid 1970s, it was only 49%.
Phrases and Definitions
The goal of treatment, of course, is to kill all cancer cells in the body, and most of the general population would then say that means the cancer has been cured. There are, however, different ways and ‘levels’ your body may respond to treatment. It’s helpful to understand what these different types of responses to treatment are, and what they can mean for the next steps in your cancer journey. The phrases that your oncology team may use and their definitions include:
Controlled or Stable Disease
Doctors may say your cancer is stable or controlled if the cancer is still there after treatment, but does not appear to be growing – the size remains stable. Some tumors can remain stable even without treatment for a long time. Your doctors may suggest additional rounds of the same treatment, changing to or adding a different type of therapy to your treatment plan, or stopping treatment and watching to see if the tumors start growing again.
Progression
Progression is when the cancer does not respond to treatment as hoped and actually continues to grow. Your doctor will likely suggest a different medicine or type of treatment to see if it is more effective in treating the cancer. When treatment options have been exhausted or if there is a new drug that looks promising in treating your type of cancer, your doctor may recommend clinical trials as an experimental treatment option.
Metastasized
When a tumor metastasizes, it means that it has spread to other parts of the body. Metastases can occur during treatment, where it is discovered after the first set of scans after chemotherapy or radiation for example, or as part of a recurrence, which is discussed below. If the cancer spreads during cancer treatment, the recommendation will likely be to try new treatments, including clinical trial options.
Remission
Remission means that your signs and symptoms of cancer are reduced. There are four types of remission:
- Partial remission, also called partial response, is when the size of your tumors have shrunk by at least 50% and remain shrunken for at least one month.
- Near-complete remission is when you have no signs of cancer, but tests still show some abnormal results, like scar tissue.
- Complete remission is when all signs and symptoms of your cancer have disappeared.
- Spontaneous remission is very rare, but this is when the cancer unexpectedly gets better when it has been expected to get worse. Often the cause for this is unclear.
Remission can last for months, years, or even the rest of your life.
Recurrence
Recurrence is when the cancer returns after previously being in remission. Cancer can be found in the same place as the original tumor, or can be in another part of the body. There are three types of recurrence based on location of the cancer:
- Local recurrence is when the cancer comes back in the same place it first started.
- Regional recurrence is when the cancer comes back in the lymph nodes near where it first started.
- Distant recurrence means the cancer has come back in another, distant part of the body from where it first started. Distant recurrences often occur in the liver, bones, lungs or brain.
NED
The term NED stands for No Evidence of Disease. This means there is no evidence of cancer in your body based on scans and blood work. These tests cannot detect cancer anywhere in your body. This is reason to celebrate – the treatment was effective and has killed the cancer cells to undetectable levels!
However, just because there are no visible signs of cancer, this does not mean that there are no tumor cells at all in your body. There may still be some lurking around, but there’s just not enough of them to be seen on a scan. That’s why it is important to schedule regular scans and blood work. At the follow-up appointment after these scans, your team will talk about if there is any evidence of the cancer returning, or if your NED status remains unchanged.
Other phrases that are often used interchangeably with NED are complete remission and complete response.
When is My Cancer Cured?
Typically, if an oncologist is going to use the word ‘cured’, it will be after you have had no evidence of disease for 5 years. This is another big milestone to celebrate!
Of course, with cancer, there are no guarantees. Many doctors are hesitant to say cured or cancer free, because it is impossible to say with 100% certainty that someone has zero cancer cells in their body.
There may be a risk of your cancer recurring at any time, or developing another type of cancer. This is why it is important to not skip regular scans and follow up appointments and to work with your doctor and integrative health team to minimize the chances of your cancer coming back.
Conclusion
It can be confusing to understand the words and phrases used to describe the ways you may respond to cancer treatment. Hopefully this mini-glossary has helped make these phrases clearer, so that you can better understand and communicate with your medical team.
