What does it mean when a patient suffering from malignant tumor (cancer) has been declared cured?

What does it mean when a patient suffering from malignant tumor (cancer) has been declared cured?

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Comment by Anongoodnurse, has made me curious as to what a doctor means when (s)he says "The cancer is cured" to a patient.

My idea up till this point (based on what I read and what I learned in my classes from my professors) was that the prognosis was declared based on the survival rates and that cancers could never be declared cured as no one could be sure that every single malignant cell has been eradicated.

However Anongoodnurse commented:

Curable cancers are not few and far between.

So I would like to know what it means when it is said "Cancer is cured"

Though the answer by Anongoodnurse has been accepted, I would like to have other answers too, please feel free to contribute

TL;DR - ask someone who has survived 45 years after treatment of their testicular cancer. The patient (and most doctors) would consider that a cure.

I believe the kxcd cartoon explains prognosis quite well. There is something that @Crags has overlooked, though, and that is the caveat "Once most cancers spread out into your body, they're incurable".

I would consider that sentence to be quite correct. A good prognosis is very different from a cure. Most of the surgeons, radiation therapists and oncologists I have worked with make that distinction. (Even surgeons, whose mottoes include "A chance to cut is a chance to cure." and "Nothing heals like cold hard steel." are careful not to use the word cure, unless it is a cure.)

I am not an oncologist, but oncologists do write papers. From one of them:

METHODS: We analysed postmenopausal women with localised invasive breast cancer. The primary endpoint disease-free survival (DFS), and the secondary endpoints time to recurrence (TTR), incidence of new contralateral breast cancer (CLBC), time to distant recurrence (TTDR), overall survival (OS), and death after recurrence were assessed… FINDINGS: At a median follow-up of 100 months (range 0-126), DFS, TTR, TTDR, and CLBC were improved significantly in the ITT and hormone-receptor-positive populations.

Although this study only followed patients for 100 months (8.3 years), some studies are much longer, and a cure is what you or I would think of as a cure: disease-free survival, not of months, but for a lifetime, that is, non-recurrence of the cancer.

Your professors sound like they are using the standard approach to cure, which is to hedge one's bets:

In medicine, a disease is considered cured when it's been successfully treated and does not return. The concept of “cure” is difficult to apply to cancer because undetected cancer cells can sometimes remain in the body after treatment, causing the cancer to return later (referred to as a recurrence or relapse). Many cancers are considered “cured” when there is no cancer detected five years after diagnosis. However, recurrence after five years is still possible.

In the past, cure was defined as 5-years cancer free. We now know that that is survival, not cure. The same can be said of 10 years (thought that one runs more true to cure). The fact is, most studies don't follow patients indefinitely. That doesn't mean no cancer is "cured". The patients (even many of those in the xkcd comic) without recurrence are cured. Therefore it is a fallacy to say cancer can never be cured. Semantics and statistics are at play.

As I said in my comments, there are curable cancers.

Curable cancers: non-invasive basal cell carcinoma:

Nearly every basal cell cancer can be cured, especially when the cancer is found early and treated.

(This is not a hedge. The authors are lumping aggressive BCCs in here with the less aggressive BCCs.)

Certain early prostatic cancers:

These results suggest that a patient has a high likelihood of biochemical cure after treatment for prostate carcinoma with conventional doses of external beam RT if he has not demonstrated biochemical failure within 5 years of treatment. Patients with lower pretreatment PSA levels and lower Gleason scores may require longer follow-up than those with less favorable characteristics to achieve the same certainty of cure. Patients who achieve a PSA nadir ≤ 0.4 ng/mL and require ≥ 2.0 years to reach this nadir have the highest probability of cure.

Cervical cancer:

Early cervical cancer can be cured by removing or destroying the precancerous or cancerous tissue.

Colorectal cancer:

Conclusion: Patients who survive 10 years appear to be cured of their disease, whereas approximately one third of actual 5-year survivors succumb to a cancer-related death. In well-selected patients, there is at least a one in six chance of cure after hepatectomy for CLM. The presence of poor prognostic factors does not preclude the possibility of long-term survival and cure.

Childhood acute lymphocytic leukemia:

Impressive improvements of survival rates in pediatric acute lymphoblastic leukemia (ALL) have been achieved during the last decades.1-21 Today, a long-term cure can be attained for approximately 75% of patients.

(Although good survival rates - defined by *event free survival - are defined at 6 years in this paper, there are papers which follow to 15 years with little change in the group. Like most studies, longer times mean more patients are "lost to follow-up".)

It goes on and on.

Finally, my comment was an admonition to you to be wise with your words, not an absolute.

Understanding Statistics Used to Guide Prognosis and Evaluate Treatment
The cure of cancer: A European perspective
Basal cell carcinoma: Diagnosis, treatment, and outcome
Cervical cancer
Risk-adjusted therapy of acute lymphoblastic leukemia can decrease treatment burden and improve survival: treatment results of 2169 unselected pediatric and adolescent patients enrolled in the trial ALL-BFM 95

Survival Rates for Osteosarcoma

Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time (usually 5 years) after they were diagnosed. They can’t tell you how long a person will live, but they may help give you a better understanding of how likely it is that treatment will be successful.

Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they can’t predict what will happen in any particular person’s case. These statistics can be confusing and may lead you to have more questions. Talk with your doctor about how these numbers may apply to you (or your child), as he or she is familiar with your situation.

Stent vs. Surgery for Malignant Obstruction

For a person experiencing a malignant obstruction, choosing between a full surgery or the placement of a stent placed can often be difficult. To many, a stent will seem the obvious choice. After all, stents can be placed relatively easily, often with minimally invasive laparoscopic surgery and far shorter recovery time.

But is "easier" always the right answer?

A 2011 study   published in the journal Gastrointestinal Endoscopy posed just this question. According to the report, 144 people with advanced colon cancer underwent treatment to correct a malignant obstruction of which half had surgery the other half had a stent.

In reviewing the short- and long-term results, key difference began to emerge:  

  • Overall, the short-term success rates for stents and regular surgery were not significantly different. Both procedures worked well to treat a blocked colon.
  • During early recovery, the group that had received stents had approximately half the rate of early complications in the surgery group (15.5 versus 32.9%, respectively).
  • However, as the recovery progressed, the period of time that the blockage remained clear was far shorter in the stent group, with some people even requiring a second stent.
  • Over the long term, while the rate of major complications was more or less the same for both groups, the stent group had significantly more late complications compared to the surgery group.

Will Harvard Cure Cancer?

Down in Mexico they squeeze peach pits and apricot kernels to get laetrile--active ingredient: amygdallin--and they smuggle it across the U.S. border to patients in the States. A man named Ernest T. Krebs Sr., M.D., first administered the drug in the twenties and Dr. Krebs junior followed his father in 1951, and claimed he could effectively inject the stuff. Trouble is, laetrile breaks down into cyanide, and the Food and Drug Administration has never approved its use. The FDA also says that it can't allow the marketing of quack medicines.

What makes laetrile so in demand is what the Krebs claimed was its "antineoplastic" activity. That means it's supposed to shrink tumor growth, or as they say in medicine, cure cancer. People who are convinced laetrile will arrest their cancers sometimes manage to get around the FDA, and one particularly desperate man in Oklahoma City who won a case last month was granted a six-month supply of laetrile. The FDA is fighting the verdict.

Dr.M. Judah Folkman doesn't like to see his name associated in print with cures for cancer. No matter how obscure the reference, Folkman says, he is "deluged, absolutely deluged" with abject pleas for treatment, and the publicity is not worth the suffering it causes.

Folkman, Andrus Professor of Pediatric Surgery, is involved in cancer research at the Boston Children's Hospital that has been heavily publicized since the Monsanto Corporation invested $23 million for the right to patent any product of Folkman's research over the next 12 years. Harvard University and Monsanto negotiated the contract after Folkman sought to use the St. Louis firm's extensive tissue-culture equipment for work on his study of a large protein that, he hypothesizes, allows cancers to grow: Tumor Angiogenesis Factor (TAF).

Folkman published his findings slightly over one year ago, concluding that TAF is a protein that malignant tissue releases, instructing neighboring tissue to supply the budding tumor with a blood supply. Other pathologic conditions, as well as cancers, depend on the obedience of the victim in setting up an arterial supply to the lesion, or disease focus. What doctors speculate Monsanto is investing in is an agent or antibody that could block the action of the TAF protein. Such a pharmaceutical could be administered systematically upon diagnosis of a primary tumor, and the presence of the anti-TAF might insure that secondary and hidden tumor formations in other parts of the body would never gain the nourishment they need but die before reaching a half-inch in length.

Dr. Bert L. Vallee, Cabot Professor of Biological Chemistry, is included in Folkman's investigations because he is expert at research on molecular biology.

Those involved with cancer research at Harvard, however, note that much more than Folkman's heavily bankrolled investigation of TAF is proceeding well in the Medical area. Increasingly, basic scientists--those not concerned with the clinical aspects of medicine--have responded to the flood of federal funding for study of the disease since the National Cancer Act of 1971. Anatomists, cell biologists, microbiologists, pathologists, biochemists, biophysicists, and immunologists are basic scientists who have come to the field only lately, as it earned respect beyond its clinical aspect as a horrible, and usually incurable, rotting disease.

The artist's conception of the Dana Building that Dr. Emil Frei III has on his office wall closely resembles the actual building, which you can see out the window near the Children's Hospital, between Francis and Binney Streets in Boston. Frei is director of the Sidney Farber Center for the study of cancer, which will take up the new and angular black building that is a grim but gleaming testament to the gravity of the disease it was built for.

The new Dana building is funded largely by the National Cancer Institute, which just last week extended another $5 million to the Farber center for completion of the facilities. It is a Harvard teaching hospital and will have 100 beds for patients. The center is operating now on an outpatient basis, accepting about 25,000 visits a year from cancer patients.

Frei, professor of medicine, says that plans for the new center are proceeding "smashingly," and he gives equally glowing accounts of the progress cancer treatment is making and of the bold new field of "medical oncology." Frei is a lanky man with wisps of reddish hair and a sweeping white coat that somehow properly identifies him as a modern crusader, the image one senses he enjoys.

His own clinical research has been most successful recently with a program for the treatment of bone cancer, osteogenic sarcoma, by chemotherapy, or the administration of chemicals. The field that Frei extols--medical oncology--is the study of tumors, and it is neither clinical nor pure research by his definition. Rather, Frei explains, it is a field only now "coming to fruition," involving scientist from almost all disciplines, and concerned especially with the effects of radiation therapy and chemotherapy on malignancies. In the Farber Center, Frei boasts, "No man can be an island optimal evaluation and treatment for cancer involves the multiple occupation of a number of clinicians."

While Frei brims with oliched pronouncements on the history of cancer treatment over the last ten years, he also recognizes the intense controversy in the medical community surrounding the glorification of the medical oncologist amid the wash of federal spending. "Progress and controversy," Frei wrote recently, "are handmaidens."

Problems arise, first of all, over the techniques of treatment. Both radiation therapy and chemotherapy are methods for the destruction of malignant growths in a live human being, and both can have extremely toxic side effects on the patients. Frei says that he feels limited by the federal laws that required detailed informed consent of the patients he would treat by these methods, and that it is hard to innovate with new drugs when the Food and Drug Administrations is very conservative about authorizing their administration to human beings.

"All patients tested with new drugs," Frei says, "are patients with incurable cancer and have received all known acceptable treatment." Testing new and unknown drugs on these individuals, he says, may be worthwhile if only for the hope it gives the patient. "Hope," he says, "is an extremely important factor." What's more, Frei explains, failure to innovate in the National Cancer Institute hospitals may only lead desperate patients to seek new and glorious treatments from quacks. Laetrile, Frei points out, only becomes more attractive in the absence of innovative drug programs.

The FDA requires extensive tests of a drug on animals before it will approve the chemical for human administration. Even that approval, however, is for very limited use until investigations prove the drug's effectiveness. Wayne Pines, a spokesman for the federal agency, says the FDA has approved 25 drugs for commerical distribution in the treatment of cancer, and has granted licenses for the experimental investigation of another 175 chemicals.

Frei says that academic boards of authorities should be allowed to decide what chemicals can be administered to terminal cancer cases. As he said on the telephone to a colleague two weeks ago, "Many (cancer) centers have much more sophisticated people sitting around a table than the FDA has." Frei's image of a self-contained cancer center where researchers determine the limits on experimentation suggests the type of facility where heady and expert investigators can experiment on human beings with impunity, but he emphasizes the ethical obligation to serve the patient first, above any commitment to research. But Frei adds, "For patients with disseminated cancer where there is no cure, therapeutic treatment is treatment. The important dividend to appreciate is that even if that drug does not work, in a patient, the door of hope has been held open."

The cancer research boom of the last decade may, as Frei and others come close to admitting, reflect only the concern of legislators for a visible disease, second only to heart disease in its annual toll. Dr. Kurt J. Isselbacher, Mallinckrodt Professor of Medicine at Mass General Hospital, has an official interest in the academic acceptance of the field. He is chairman of Harvard's cancer committee and says, as does Frei, that the basic biology of the cancer tumor, and the subtle distinctions that make its cells malignant, are valid concerns for the basic scientist/pure academic.

Five years ago, the Medical School gave academic approbation to the once-clinical field of radiation therapy by creating a department of that name. Isselbacher and his committee are now considering whether to create another such department in medical oncology.

Dr. Samuel Hellman, Fuller American Cancer Society Professor of Radiation Therapy and chairman of the radiation therapy department, explains that the field is oriented more towards research than towards purely clinical considerations of dosages. "There's a tremendous amount of work being done on basic biology of tumor cells to make treatment more specific," he says. Radiation's effects on the DNA, or chemical genetic messenger system, of both malignant and normal cells, for instance, is an important area of basic cancer research, Hellman adds.

Hellman acknowledges the problems of performing clinical research on living cancer victims, noting that "perfectly ethical" experimentation is "difficult but possible." It depends, he says, on frank discussion with the patient of the malady and possible cures.

Both Hellman and Frei emphasize the modern and increasingly effective nature of "modality" treatment, involving several clinicians and even basic scientists in experimental cures. However, as Frei said in his phone conversation with a colleague, basic scientists are new to such clinical experimentation. He said that the same experimentation that a hospital's human studies committee approves may face opposition from basic scientists. "The trouble comes from the basic scientists," he said, "from the people who have never been involved in the treatment of anything more risky that poison ivy."

Isselbacher indicates that such "jurisdictional disputes" between clinicians, oncologists and basic scientists are inveitable, especially because the medical oncologist, like Frei, must have a special temperament just to work in a field where such a large percentage of one's patients die. "The dedication and commitment of treating cancer patients is not easy," Isselbacher explains. "I can appreciate that someone who does not live with cancer patients all the time might prove frustrating to Dr. Frei."

Figures compiled by Isselbacher's committee two years ago indicate that about one-quarter of the Med School's senior faculty was engaged in cancer study, although the percentage was lower for lower ranks in the medical faculty. Isselbacher acknowledges that the extent of federal funding has made cancer research glamorous, and that of reasonable concern is just what will happen to cancer-related, academic departments when the disease is cured or out of fashion.

Hellman says that the concern of basic scientists with the disease will persist because of the distinct nature of the cancer cell. Efforts to distinguish the malignant cell by what was presumed would be its faster rate of replication or by identification of foreign proteins on the cell have proved difficult, he says. Such studies involve virologists (studying viruses), pathologists, and molecular biologists. Other research in the last ten years has suggested that a cancer could be linked to a failure of the body's immune system when asked about vogues in research, Hellman says, "My prejudice is, we're being over-immuned."

Tell that to Dr. Baruj Benacerraf, Fabyan Professor of Comparative Pathology, and he will shrug expansively. Benacerraf had been studying immunology, he says, "years before cancer became fashionable," and when the two fields overlapped, he had investigated the connection. Benacerraf's experiments with transplanting mouse tumors had indicated that tumor cells prompt immune defenses by the mouse. He says that some evidence suggests that the tumor might confuse the immune system's sense of what is self that immune mechanisms begin to treat the malignant cells as "self" and then actually encourage growth of the tumor.

Other molecular biological research on tumor cells is aimed at identifying proteins on the surface of the cell, like Folkman's Angiogenesis Factor, which are foreign to the victim. Genetically, too, "the cancer cell is of a given differentiated type that loses control of its own growth," Benacerraf says. He is on the fourth floor of Building D at the stolid gray Med School quadrangle, and when he alludes to other investigations of cancer, it is usually by reference to the floor or building on the quadrange where the research is being conducted. His only apparent bias seems to be against the clinicians, whose "gross" methods of extinguishing cancer do not deal with the cause of the problems, but assume the pathologic presence of tumors in actual patients.

Kurt Isselbacher does not like the question, Will cancer be cured at Harvard? Cancer is many diseases and many scientists here are working on them. Certain methods that have been experimented with at Harvard, including Frei's protocol for osteogenic sarcom and Hellman's treatment for hematologic cancer, have been effective but apparently not conclusive.

Dr. David S. Rosenthal, assistant professor of medicine at the Peter Bent Brigham Hospital and a hematologist, says it is significant that three of Harvard's teaching hospitals--the Brigham, Beth-Israel, and the new Dana Center--have adopted the same protocol for treatment of Hodgkin's disease, a cancer of the lymph tissue. But this does not mean a definitive cure, Rosenthal says only a high probability of cure at certain stages in the cancer.

Coordination of the multitude of Harvard clinicians at the Dana Center will be difficult, Isselbacher says, especially as there may be some disputes over who "gets" certain patients for study. Obsession with a cure, however, Isselbacher indicates, is delusory, as no doctor's individual research is likely to produce the answer. Such obsession, Isselbacher says, is not the proper attitude with which to view an academic field that is so broad-based. Besides, Isselbacher says, "The natural history of the disease is such that, it isn't like pneumonia, that in just two weeks you can find out whether Drug A is better than Drug B." Even the simplest clinical experiments may require a five-year waiting period.

Obsessions with cure, however, only encourage the creation of quack cures, Isselbacher says, and bootlegged nostrums from Mexico

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Treating stage III bladder cancer

These cancers have reached the outside of the bladder (T3) and might have grown into nearby tissues or organs (T4) and/or lymph nodes (N1, N2, or N3). They have not spread to distant parts of the body.

Transurethral resection (TURBT) is often done first to find out how far the cancer has grown into the bladder wall. Chemotherapy followed by radical cystectomy (removal of the bladder and nearby lymph nodes) is then the standard treatment. Partial cystectomy is rarely an option for stage III cancers.

Chemotherapy (chemo) before surgery (with or without radiation) can shrink the tumor, which may make surgery easier. Chemo can also kill any cancer cells that could already have spread to other areas of the body and help people live longer. It can be especially useful for T4 tumors, which have spread outside the bladder. When chemo is given first, surgery to remove the bladder is delayed. The delay is not a problem if the chemo shrinks the cancer, but it can be harmful if it continues to grow during chemo. Sometimes the chemo shrinks the tumor enough that intravesical therapy or chemo with radiation is possible instead of surgery.

Some patients get chemo after surgery to kill any cancer cells left after surgery that are too small to see. Chemo given after cystectomy may help patients stay cancer-free longer, but so far it’s not clear if it helps them live longer. If cancer is found in nearby lymph nodes, radiation may be needed after surgery. Another option is chemo, but only if it wasn't given before surgery.

An option for some patients with single, small tumors (some T3) might be treatment with a second (and more extensive) transurethral resection (TURBT) followed by a combination of chemo and radiation. If cancer is still found when cystoscopy is repeated, cystectomy might be needed.

For patients who can’t have surgery because of other serious health problems, treatment options might include TURBT, intravesical therapy, radiation, chemotherapy, immunotherapy, or some combination of these.

What does it mean when a patient suffering from malignant tumor (cancer) has been declared cured? - Biology

Select a category from the list to view only the terms in that category, or select 'Any' to view all terms.

The difference between two risks, usually smaller than a relative risk.

Refers to symptoms that start and worsen quickly but do not last over a long time.

Treatment given after the main treatment to reduce the chance of cancer coming back by destroying any remaining cancer cells. It usually refers to chemotherapy, radiation therapy, hormone therapy, and/or immunotherapy given after surgery.

A federal (national) law that protects people with disabilities from discrimination. It requires employers to make reasonable accommodations in the workplace for qualified individuals with a disability. Learn more from the U.S. Department of Labor .

Asking your insurance company to reconsider its decision to deny payment for a service or treatment. You have the right to ask your insurance company to conduct a full and fair review of its decision, known as an internal review. If the company still denies payment after considering your appeal, the Affordable Care Act allows you to have an independent review organization decide whether to uphold or overturn the plan’s decision, usually called an external review.

Costs that are related to a cancer diagnosis but not specifically due to medical care given to treat the disease also called non-medical costs. Transportation and childcare during treatment are two common associated costs for people with cancer.

The middle value of a set of numbers, calculated by adding all of the values and dividing by the number of values in the set.

Refers to a tumor that is not cancerous. The tumor does not usually invade nearby tissue or spread to other parts of the body.

The removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. Learn more about biopsy .

The soft, spongy tissue found in the center of large bones where blood cells are formed.

A medical procedure in which diseased bone marrow is replaced by healthy bone marrow from a volunteer donor. Learn more about bone marrow transplantation .

A group of more than 100 different diseases that can begin almost anywhere in the body, characterized by abnormal cell growth and the ability to invade nearby tissues. Learn more about the basics of cancer .

Cancer that starts in skin or tissues that line the inside or cover the outside of internal organs.

A health care professional, often a nurse with experience in cancer, who helps coordinate the care of a person with cancer before, during, and after treatment. At a medical center, a case manager may provide a wide range of services for patients that may include managing treatment plans, coordinating health insurance approvals, and locating support services. Insurance companies also employ case managers.

The basic units that make up the human body.

The use of natural, synthetic (made in a laboratory), or biologic (from a living source) substances to reverse, slow down, or prevent the development of cancer. Learn more about chemoprevention .

The use of drugs to kill cancer cells. Learn more about chemotherapy.

Refers to a disease or condition that persists, often slowly, over a long time.

A request made to an insurance company to pay for services covered by a patient’s policy.

An assessment that a research finding will have practical effects on patient care.

A research study that tests new treatments and/or prevention methods to find out whether they are safe, effective, and possibly better than the current standard of care (the best known treatment). Learn more about clinical trials.

The percentage of health care costs an insured patient pays after meeting a health care plan's yearly deductible. For example, an 80/20 co-insurance rate means that the insurance company pays 80% of approved health care costs, and the patient pays the remaining 20% of costs out-of-pocket.

A set fee, in dollars, that an insurance provider requires a patient to pay each time care is received. For example, a visit to the oncologist may cost a patient $30 each time the insurance provider pays the rest of the visit's costs. The amount of the co-pay is set by the insurance provider, not the doctor's office.

Consolidated Omnibus Budget Reconciliation Act. A federal law that allows employees in danger of losing health insurance under certain circumstances, such as leaving a job or reducing their hours, to pay for and keep their insurance coverage for a limited time.

A group of individuals who share a common experience, exposure, or trait and who are under observation in a research study.

A diverse group of treatments, techniques, and products that are used in addition to standard cancer treatments. Learn more about types of complementary therapies .

A measure of the number of times out of 100 (similar to a percentage) that test results will be within a specified range. It is a measurement used to indicate the reliability of an estimate.

A factor in a scientific study that wasn’t addressed that could affect the outcome of the study, such as smoking history in a study of people with cancer.

A group of individuals who do not receive the treatment being studied. Researchers compare this group to the group of individuals who do receive the treatment, which helps them evaluate the safety and effectiveness of the treatment.

The benefits and services an insurance company will pay for as part of an insurance policy.

To fully restore health. This term is sometimes used when a person's cancer has not returned for at least five years after treatment. However, the concept of “cure” is difficult to apply to cancer because undetected cancer cells can sometimes remain in the body after treatment, causing the cancer to return later, called a recurrence. Recurrence after five years is still possible.

The amount of approved health care costs an insured patient must pay out-of-pocket each year before the health care plan begins paying any costs.

Insurance that provides an income on either a short-term or a long-term basis to a person with a serious illness or injury that prevents the person from working.

The measure of time after treatment during which no sign of cancer is found. This term can be used for an individual or for a group of people within a study. This term is usually used in the context of scientific research.

The results measured at the end of a study to see whether the research question was answered.

A set of services that an insurance plan is required to provide to patients. There can be no dollar limits each year on the cost that insurance pays for essential health benefits. According to the Affordable Care Act, plans offered in small group and individual markets must provide items and services in at least 10 categories for the plan to be certified and offered in the health care exchanges. Benefit categories include emergency services, preventive wellness and chronic disease management, and prescription drugs. More information is available at .

The measure of time after treatment that a group of people in a clinical trial has not had cancer come back or get worse. This term is also usually used in the context of scientific research.

This federal law offers specific protections for employees during medical leave (when the employee is ill) and family leave (when the employee must care for a spouse, child, or parent who is ill). Learn more from the Department of Labor .

This is a type of private health insurance in which a person visits a doctor, submits a claim form, and the insurance plan pays the bill using a co-insurance structure. Deductibles are common.

Medical examinations and tests the doctor recommends after the active treatment period. This care is used to monitor a patient’s recovery and check for signs of recurrence.

Health Insurance Portability and Accountability Act. This is a set of national rules that help protect the privacy of a patient's personal medical information, provide patients with access to their medical records, and help people with health problems, such as cancer, get health insurance for themselves and their family members. Learn more from the U.S. Department of Health and Human Services.

Health Maintenance Organization a type of private health insurance. In an HMO, a person chooses a primary care doctor from an approved list called the network. Specialist care must be approved by that primary care doctor, called a referral.

Treatment that removes, blocks, or adds hormones to destroy or slow the growth of cancer cells. It is also called hormonal therapy or endocrine therapy.

A procedure that creates pictures of internal body parts, tissues, or organs to make a diagnosis, plan treatment, find out whether treatment is working, or observe a disease over time.

A type of cancer treatment designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. It may also be called biologic therapy. Learn more about immunotherapy .

In place. Refers to cancer that has not spread to nearby tissue, also called non-invasive cancer.

Health care providers or facilities that are part of an HMO or PPO plan's approved list or network are considered “in network.” In general, in-network care costs patients less than out-of-network care.

The number of new instances of a disease or condition in a particular population during a specific period. Learn more about statistics used to estimate risk and recommend screening .

The amount of money an insurance plan will pay in total benefits. Once a patient's medical bills reach the total, or cap, the plan will no longer provide coverage. Both lifetime and annual caps were eliminated under the Affordable Care Act. For more information read the section summarizing this law or visit .

A combination of medical treatments for cancer and complementary therapies to help manage the symptoms and side effects of cancer. Learn more about integrative medicine .

Cancer that has spread outside the layer of tissue in which it started and has the potential to grow into other tissues or parts of the body, also called infiltrating cancer.

A procedure that evaluates a sample of blood, urine, or other substance from the body to make a diagnosis, plan treatment, check whether treatment is working, or observe a disease over time.

Side effects of cancer treatment that occur months or years after a diagnosis of cancer because of the related treatments, such as chemotherapy, radiation therapy, or surgery. Learn more about the long-term side effects of cancer treatment .

A cancer of the blood. Leukemia begins when normal white blood cells change and grow uncontrollably.

The probability of developing a disease or dying from that disease across a person’s lifetime.

Cancer that is confined to the area where it started and has not spread to other parts of the body.

Insurance that helps people with long-lasting illnesses or disabilities pay for non-medical daily services and care that ordinary health plans don't cover, such as help with eating, bathing, and dressing. Depending on the plan, care can be given in the home or outside the home.

A network of small vessels, ducts, and organs that carry fluid to and from the bloodstream and body tissues. Through the lymphatic system, cancer can spread to other parts of the body.

A cancer of the lymphatic system. Lymphoma begins when cells in the lymph system change and grow uncontrollably. Sometimes a tumor is formed.

The middle value in a range of measurements ordered by value.

This is a type of government health insurance for people with low incomes who meet certain conditions. Medicaid is jointly funded by the federal and state governments, but each state operates its program individually (including deciding who can receive Medicaid benefits for that state). Learn more at .

This is a type of health insurance provided by the federal government for people 65 or older, as well as for some people with disabilities. Medicare is divided into four parts: Parts A, B, C, and D. Part A covers in-patient hospital care. Part B provides financial coverage using premiums, deductibles, and a co-insurance structure for other medical expenses, such as doctor visits. Medicare Advantage plans, or Part C, are insurance plans managed by private, approved companies. Part D provides prescription drug coverage. Learn more at .

The spread of cancer from the place where the cancer began to another part of the body. Cancer cells can break away from the primary tumor and travel through the blood or the lymphatic system to the lymph nodes, brain, lungs, bones, liver, or other organs.

The number of deaths in a particular population during a specific time.

Treatment given before the main treatment. It may include chemotherapy, radiation therapy, or hormone therapy given before surgery to shrink a tumor so that it is easier to remove.

Services provided by an insurance plan that are outside the “essential benefits” category. Patients may be responsible for some or all of these costs.

A comparison of whether the likelihood of an event is similar between two groups a ratio of 1 means it is equally likely between both groups.

A doctor who treats cancer and provides medical care for a person diagnosed with cancer. The five main types of oncologists are medical, surgical, radiation, gynecologic, and pediatric oncologists. Learn more about the types of oncologists .

A nurse who specializes in caring for people with cancer.

Specific dates where eligible individuals are able to select or change to a new health care plan. Once this time ends, you may need to wait until the next open enrollment period, usually a year later, to join a health care plan, unless you qualify for a special enrollment period. Find additional information at . Medicare participants can go to to learn about Medicare open enrollment. If you have private insurance, talk with a health insurance plan representative to learn more.

Health care providers or facilities that are not part of an HMO or PPO plan's approved list or network are considered “out of network.” Out-of-network care often costs patients more than in-network care and may involve a deductible and require pre-approval for certain services.


Assessment of pathological response to chemotherapy has played an important role in head and neck carcinomas, esophageal carcinoma, osteogenic sarcoma, and small cell lung carcinoma. Pathological complete response is defined as fibrosis or fibro inflammation without microscopic evidence of carcinoma and histologically negative nodes. Non-pCR is defined as any evidence of viable carcinoma, either at the primary site or at the resected regional LN. Those patients who achieve complete pathological response have long-term survival advantage. Junker et al.[9] found that in NSCLC patients, not only complete responders but also extensive responders with 㰐% residual tumor also had good long-term survival.

The common histological features of tumor regression are coagulative necrosis, fibrosis, foam cell/giant cell reaction, as well as mixed inflammatory infiltrate. The amounts of fibrosis correlate well with extent of tumor regression, which in turn is a surrogate marker of tumor response. Squamous carcinoma was associated with a higher probability of treatment response than adenocarcinoma.[9]

To conclude, pathological response can be of two types: Responder and non-responder groups. The common histological changes seen are fibrosis, necrosis, and foam cell/giant cell reaction in some cases, increase in residual tumor nuclear grade is seen. The radiological assessments may not correlate well with the pathological response.[10]

Goals of chemotherapy treatment

If your doctor has recommended chemotherapy as an option to treat your cancer, it’s important to understand the goals of treatment when making treatment decisions. There are three main goals for chemotherapy (chemo) in cancer treatment:

If possible, chemo is used to cure cancer, meaning that the cancer is destroyed – it goes away and doesn’t come back.

Most doctors don’t use the word “cure” except as a possible or intended result of treatment. So, when giving treatment that might have a chance of curing a person’s cancer, the doctor may describe it as treatment with curative intent.

Although cure may be the goal in these situations, and is the hope of many who have cancer, it doesn’t always work out that way. It often takes many years to know if a person’s cancer is really cured.


If a cure is not possible, the goal of cancer treatment may be to control the disease. In these cases, chemo is used to shrink tumors and/or stop the cancer from growing and spreading. This can help the person with cancer feel better and live longer.

In many cases, the cancer doesn’t completely go away, but is controlled and managed as a chronic disease, much like heart disease or diabetes. In other cases, the cancer may go away for a while, but it’s likely to come back.


Chemo can also be used to ease symptoms caused by the cancer. This is called palliation, palliative chemotherapy, or treatment with palliative intent.

When the cancer is at an advanced stage, probably cannot be controlled, and has spread, the goal of giving chemo may be to improve the quality of life or help the person feel better. For instance, chemo may be used to help shrink a tumor that’s causing pain or pressure so the patient feels better and has less pain.

It’s important to know that treatment used to reduce symptoms or improve comfort is called palliative care. For example, anti-nausea treatments or pain medicines are palliative, and can be used at all stages of treatment. It can be confusing when chemo is used as a palliative treatment, because it’s most often used to try to cure or control the cancer. But when it’s used with the goal of comfort, chemo becomes part of a palliative care plan.

Child-Pugh score (cirrhosis staging system)

The Child-Pugh score measures liver function, especially in people with cirrhosis. Many people with liver cancer also have cirrhosis, and in order to treat the cancer, doctors need to know how well the liver is working. This system looks at 5 factors, the first 3 of which are results of blood tests:

  • Blood levels of bilirubin (the substance that can cause yellowing of the skin and eyes)
  • Blood levels of albumin (a major protein normally made by the liver)
  • The prothrombin time (measures how well the liver is making blood clotting factors)
  • Whether there is fluid (ascites) in the abdomen
  • Whether the liver disease is affecting brain function

Based on these factors, there are 3 classes of liver function. If all these factors are normal, then liver function is called class A. Mild abnormalities are class B, and severe abnormalities are class C. People with liver cancer and class C cirrhosis are often too sick for surgery or other major cancer treatments.

The Child-Pugh score is actually part of the BCLC and CLIP staging systems mentioned previously.

Getting help and support

You may find it helpful to talk to other people in the same situation if you are finding it hard to cope with the fact that you have had cancer. Or you could talk to a trained counsellor. This can help you to find ways of dealing with the fear and worry.

You can get in touch with a counsellor by contacting one of the counselling organisations.

You can phone the Cancer Research UK nurses if you would like to talk to someone outside your own friends and family. Talk to the Cancer Research UK nurses on freephone 0808 800 4040, from 9am to 5pm, Monday to Friday.

You can also look at our section about coping emotionally with cancer.

Or you can share your experiences with other people and find out how they coped by using our online forum, Cancer Chat.