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Not all Cancer is Created Equal: Understanding Prognosis

Before modern treatments and early detection a diagnosis of cancer almost always meant death.  Because of that association fear is usually the first emotion people experience when they are diagnosed with a cancer.  But cancer is a very broad disease with many different types and stages.  Some are very serious and some are actually relatively simple to cure.  The type of cancer, its location, its size, its age, the health and age of the patient and more all affect the chances of a cure.  In fact, most cancer is curable if it is detected early and treated appropriately.While having a negative attitude will not make your cancer worse or prevent you from getting better, it can sap your energy and make the treatments seem more painful and more exhausting.  Don’t feel guilty, however, if you are not positive and upbeat about your recovery.  Feeling scared or angry is normal and understandable. Take some time to learn about your diagnosis and to understand your prognosis and you may feel more confident about your cancer treatment.The goal of this article is to define prognosis and to explain a bit more about how doctors determine a patient’s prognosis.

What is Prognosis? Prognosis is a medical estimation of how curable a certain cancer in a certain patient is.  The prognosis may be given as an adjective, such as excellent, good, fair or poor.  In other cases the prognosis is given in terms of cure and survival rates.  For example, a patient might be told that the five year survival rate for a specific cancer following treatment is 99%.  Doctors use many different variables to help them arrive at a prognosis.

Variables:

  • Type of cancer. For example, cancers of parts of the brain, liver, spine, or of the lymph system, blood and bone tend to be more serious than many other kinds of cancer.  Any cancer that is very aggressive, in an advanced stage or that has metastasized heavily is serious, however.
  • Stage and metastases.  Any cancer found early (Stage I) is easier to treat and has a better prognosis than cancer in Stage IV.  That being said, certain types of cancer are easier to treat than others, so Stage IV of one cancer may not be quite as serious as Stage IV of another. The amount that a cancer may have spread, or metastasized, is also a concern.  In Situ cancer, meaning cancer that is contained and has not spread, is much more treatable and has a much better prognosis than cancer that has spread considerably.
  • Size.  The size of a cancer tumor or the percentage of an organ or tissue affected factors greatly into prognosis.  Larger tumors tend to be harder to remove than small ones, especially if a large tumor has started to grow around vital organs such as intestines or major blood vessels.
  • Location.  Exactly where within an organ the tumor has formed can also greatly affect prognosis.  If a tumor forms immediately next to the lymph nodes of a breast, the outlook may be less positive than if the cancer forms inside a milk duct.
  • Aggressiveness.  All cancers grow at different rates.  Prostate cancer, for example, tends to be a slow growing, less aggressive cancer.  Many types of brain cancer are very aggressive and grow and spread rapidly.  If a cancer is slow growing the outlook is much better, especially when the cancer is detected early.  Occasionally a slow growing, non-aggressive cancer can change and for some unknown reason growth can speed up dramatically so it is always best to have a cancer treated immediately. 
  • Patient’s age. Younger patients tend to have stronger bodies and stronger immune systems than do older people and so may be better able to fight off cancer and to withstand harsh cancer treatments compared to older patients.  On the flip side often times younger people are not expected to develop cancer and so are not routinely scanned for certain cancers.  For example women are not given mammograms until they reach age 40.  Therefore, while young women are much less likely to develop breast cancer than are older women, young women are much more likely to have advanced cancer by the time the disease is diagnosed.  Younger women with breast cancer, then, tend to have a poorer prognosis than do older patients.
  • Patient’s health. A person in generally good health with a strong heart and no chronic illness will typically have a better prognosis than a person in poor health.
  • Preferred treatment method.  Sometimes a patient has some latitude when choosing a treatment plan and the Doctor will usually present a prognosis for each treatment method.  For example a patient with testicular cancer will probably be given the choice between the combination of surgery and chemotherapy and the combination of surgery and no chemo.  The oncologist (cancer doctor) will present survival rates and expected outcomes for both scenarios.

 

Learning as much as you can about your prognosis and what it means is much more important than dwelling on the diagnosis of cancer.  Cancer no longer means automatic death and focusing on your treatment plan and on recovery can make the process easier to handle.

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