by Susan Jenks,
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
- 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
St. 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
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.
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
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.