As you make progress in your cancer journey, you may hear health care providers use terms like remission, cancer-free and no evidence of disease. These all sound positive — and generally they are. They mark milestones in your cancer treatment.
But what do they mean, exactly? And how are they different from each other?
We connected with Hung Khong, MD, an oncologist with Banner MD Anderson Cancer Center at Banner Gateway Medical Center, to learn more about these terms and their meanings.
“To many (if not all) patients and their families, these terms can be very confusing. To add to the confusion, doctors may use them based on their own understanding or habit,” he said.
We’ll take a deeper dive into these terms here. But it’s important to ask your health care provider what they mean, since people may use these words in different ways.
What does remission mean?
Remission means signs of cancer are decreasing or have disappeared. It’s usually used for stage IV (4) cancer, which is the most advanced stage of cancer. It doesn’t mean that the cancer is gone, but it shows that cancer is responding to treatment.
“A remission is the same as a response,” Dr. Khong said. “And a remission can be partial or complete and can last for months or years.” There are different descriptions or types of remission:
- A partial remission is when the cancer shrinks by at least 30%, but there are still signs of cancer on examination or scans.
- A complete remission is when no cancer can be detected. It doesn’t guarantee all the cancer cells are gone, but it’s a major milestone.
- In remission, you can start to return to your daily activities, rebuild your strength and focus on your well-being. You may still need long-term monitoring and treatment, even when you are in partial or complete remission.
What does cancer-free mean?
“‘Am I cancer-free’ is the most common question that I get asked by patients with early-stage cancer, usually after surgery to remove the cancer and/or chemotherapy,” Dr. Khong said.
Cancer-free means that cancer cells are gone and there’s no detectable cancer. It’s usually used when you need monitoring for recurrence.
“However, this is one of the most difficult terms to define. Since individual cancer cells are microscopic (very tiny) and cannot be seen by examination or scans, it is impossible to say a patient is cancer-free with 100% certainty. Therefore, I usually qualify this term with the statement, ‘Free from what we or scans can see or detect,’” Dr. Khong said. If you’re considered cancer-free, you’re finished with treatments and can usually return to your regular lifestyle.
What does no evidence of disease mean?
No evidence of disease (NED) is similar to complete remission, and the two terms are often used interchangeably. It means that there are no signs of cancer at the time of an evaluation. It’s usually used in follow-up appointments. It’s a positive sign, but not a guarantee that the cancer won’t return.
“In practice, this term is usually used in stage IV cancer, where the cancer is completely removed by surgery or disappears in response to treatment. It’s used in the same way as ‘complete remission.’” Dr. Khong said.
How your provider evaluates your cancer state
To decide if you’re in remission, cancer-free or have no evidence of disease, your health care provider may:
- Monitor your symptoms and overall well-being
- Perform a physical exam
- Review imaging studies such as CT scans, MRIs and PET scans
- Check biopsies for evidence of cancer
- Review blood tests for tumor markers
What can affect your odds of cancer recovery?
Different factors play into how likely you are to be in remission, cancer-free or have no evidence of disease:
- Early detection: Finding cancer at early stages generally improves your odds of recovery.
- The stage of your cancer: “In stage IV cancer, a complete recovery is uncommon. For other stages, the higher the stage, the higher your risk is for cancer returning,” Dr. Khong said. “Ask your doctor what stage you’re at and what that may mean for you moving forward.”
- The type of cancer you have: Certain types of breast, prostate and other cancers have survival rates of 90%. However, certain lung and other cancers have lower survival rates.
- Your diet: A plant-based diet rich in vegetables and fruits with limited processed foods, artificial sweeteners and sugar is best.
- Exercise: Aim for 30 to 60 minutes of exercise a day as long as your health care provider gives you the OK.
- Sleep: You need seven to eight hours of restful sleep per night.
- Stress management: Keep stress to a minimum to maintain a healthy immune system. Try yoga, massage, music, meditation or positive thinking.
What happens next?
Most cancer survivors need follow-up appointments, regular screenings and, possibly, ongoing treatments to help keep cancer from returning. You may want to ask your health care team about survivorship programs to help guide you in post-cancer care.
You’ll also need time for emotional and physical healing. You may want to slowly reintroduce your regular activities and lean on your family and friends for support.
As a cancer survivor, you may feel conflicting emotions like gratitude, stress and fear of the cancer coming back. You may also face issues such as survivor’s guilt, anxiety or depression. If so, ask your provider for a referral to a psychologist or counselor.
You can also seek help from local or online community groups and online resources like the American Cancer Society, the National Coalition for Cancer Survivorship and the Livestrong program.
The bottom line
Hearing that your cancer is in remission, you are cancer free and there is no evidence of cancer can all mark important milestones in your cancer journey. Your cancer care team can explain to you in detail what these words and phrases mean for you.
If you would like to connect with a cancer care provider, reach out to Banner Health.
