A lot of people seem to think that this is how cancer treatment works:
- You get cancer
- You get treated for it
- If you’re alive at the end of treatment it means that it worked and you’re cured. You’ve defeated cancer! Here’s a gold star.
- If you get it again (it “recurs”), you’re back where you started and steps 1 to 3 are repeated.
This is totally inaccurate, but people are forgiven for believing this, because this is how it is with most other diseases. Cancer, unfortunately, is not like most other diseases.
What really happens is this: you receive the treatment that decades of research and clinical trials have determined is the best possible one. The definition of “best possible” varies depending on what kind of cancer you have and what stage it is at. If at the time of diagnosis your cancer is of the type and/or is so advanced as to be incurable, then “best possible” could mean the treatment that prolongs your life the most. At the time of diagnosis, my cancer was in the curable category, so “best possible” meant a regimen designed to get rid of it completely. (N.B. “Curable” does not, as you will see, mean that everyone who has it will be cured-it simply means that there are people who’ve had it who have successfully got rid of it, so a cure is in the realm of possibility.)
In the case of curable cancers, if at the end of your treatment there is no evidence of any remaining cancer cells in your body, you are declared to be in “remission”. This is where the first popular misconception creeps in. BEING IN REMISSION DOES NOT MEAN THAT YOU’VE “DEFEATED” CANCER AND YOU’RE CURED. Typically, you’ve to wait for 5 years after the end of treatment to determine if it’s really gone away. If your cancer does not resurface in those 5 years, there is a very high chance that you’ve been cured of it. If it doesn’t resurface in the next 5 years either, then you can be almost certain that it’s gone for good.
That was simple. Now to the obvious question: what happens if it does resurface within 5 years after the end of treatment? A recurrence typically reduces the chances of a cure-the extent of that reduction depends on how soon after treatment it occurs, and in the manner it occurs (is it in the same place as before? Is it only in one place, or several? And so on). My cancer, for instance, recurred within a few months of the end of treatment (not good), and in several places that it wasn’t there the first time around (also not good). This reduces the chances of a cure dramatically, making a cancer that looked very curable when it was first diagnosed look almost incurable now. This is where the second popular misconception creeps in. The prognosis the second time looks very different from what it was the first time. I’m not back to where I started; I’m on a different trajectory altogether.
Popular misconception number one- When my treatment ended the first time, I was cured of cancer (I was not).
Popular misconception number two- Since I managed to get rid of it the first time (I did not), I can hopefully do it again (no, it isn’t the same as before, and I didn’t get rid of it the first time anyway).
xkcd says the same thing much better than I ever can here.