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Understanding Cancer Prognosis

If you have cancer, you may have questions about how serious your cancer is and your chances of survival. The estimate of how the disease will go for you is called prognosis. It can be hard to understand what prognosis means and also hard to talk about, even for doctors.

Many Factors Can Affect Your Prognosis

These factors include:

  • The type cancer and where it is in your body
  • The stage of the cancer, which refers to the size of the cancer and if it has spread to other parts of your body
  • The cancer’s grade, which refers to how abnormal the cancer cells look under a microscope. Grade provides clues about how quickly the cancer is likely to grow and spread.
  • Certain traits of the cancer cells
  • Your age and how healthy you were before cancer
  • How you respond to treatment

Seeking Information About Your Prognosis Is a Personal Decision

When you have cancer, you and your loved ones face many unknowns. Understanding your cancer and knowing what to expect can help you and your loved ones make decisions. Some of the decisions you may face include:

  • Which treatment is best for you
  • If you want treatment
  • How to best take care of yourself and manage treatment side effects
  • How to deal with financial and legal matters

Many people want to know their prognosis. They find it easier to cope when they know more about their cancer. You may ask your doctor about survival statistics or search for this information on your own. Or, you may find statistics confusing and frightening, and think they are too impersonal to be of value to you. It is up to you to decide how much information you want.

If you do decide you want to know more, the doctor who knows the most about your situation is in the best position to discuss your prognosis and explain what the statistics may mean.

If you need help coping with your prognosis, you may find our information on Coping With Cancer helpful.

Understanding Statistics About Survival

Doctors estimate prognosis by using statistics that researchers have collected over many years about people with the same type of cancer. Several types of statistics may be used to estimate prognosis. The most commonly used statistics include:

  • Cancer-specific survival
    This is the percentage of patients with a specific type and stage of cancer who have not died from their cancer during a certain period of time after diagnosis. The period of time may be 1 year, 2 years, 5 years, etc., with 5 years being the time period most often used. Cancer-specific survival is also called disease-specific survival. In most cases, cancer-specific survival is based on causes of death in medical records, which may not be correct.
  • Relative survival
    This statistic is another method used to estimate cancer-specific survival that does not use information about the cause of death. It is the percentage of cancer patients who have survived for a certain period of time after diagnosis compared to people who do not have cancer.
  • Overall survival
    This is the percentage of people with a specific type and stage of cancer who have not died from any cause during a certain period of time after diagnosis.
  • Disease-free survival
    This statistic is the percentage of patients who have no signs of cancer during a certain period of time after treatment. Other names for this statistic are recurrence-free or progression-free survival.

Because statistics are based on large groups of people, they cannot be used to predict exactly what will happen to you. Everyone is different. Treatments and how people respond to treatment can differ greatly. Also, it takes years to see the benefit of new treatments and ways of finding cancer. So, the statistics your doctor uses to make a prognosis may not be based on treatments being used today.

Still, your doctor may tell you that you have a good prognosis if statistics suggest that your cancer is likely to respond well to treatment. Or, he may tell you that you have a poor prognosis if the cancer is harder to control. Whatever your doctor tells you, keep in mind that a prognosis is an educated guess. Your doctor cannot be certain how it will go for you.

If You Decide Not to Have Treatment

If you decide not to have treatment, the doctor who knows your situation best is in the best position to discuss your prognosis.

Survival statistics most often come from studies that compare treatments with each other, rather than treatment with no treatment. So, it may not be easy for your doctor to give you an accurate prognosis. 

Understanding the Difference Between Cure and Remission

Cure means that there are no traces of your cancer after treatment and the cancer will never come back.

Remission means that the signs and symptoms of your cancer are reduced. Remission can be partial or complete. In a complete remission, all signs and symptoms of cancer have disappeared.

If you remain in complete remission for 5 years or more, some doctors may say that you are cured. Still, some cancer cells can remain in your body for many years after treatment. These cells may cause the cancer to come back one day. Most types of cancer usually return within the first 5 years after treatment. But, there is a chance that cancer will come back later. For this reason, doctors cannot say for sure that you are cured. The most they can say is that there are no signs of cancer at this time.

Because of the chance that cancer can come back, your doctor will monitor you for many years and do tests to look for signs of cancer’s return. They will also look for signs of late side effects from the cancer treatments you received.

Video Series

Watch Understanding Your Cancer Prognosis, a video series  that offers the perspectives of three cancer patients and their doctor. The videos explain key points about prognosis and how doctors and patients can talk about it in a clear and supportive way. Two viewer guides are also available: for patients (PDF-210KB) and for provider care teams (PDF-210KB).

Understanding Your Cancer Prognosis

You will need Adobe Flash Player 8 or later and JavaScript enabled to view this video.
 

More Videos in the Prognosis Series

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One Couple's Creative Response
Vanessa, an artist, and her husband Roy discover how to support each other’s need for different kinds of information about her colorectal cancer prognosis.
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Diving Out of the Dark
Andrew wants details about the likely outcome of his treatment for non-Hodgkin lymphoma, and has learned to ask until he gets the information he is looking for.
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From Anger to Acceptance
Barbara’s attitude since her diagnosis with pancreatic cancer? No doctor is going to tell her how long she has to live.
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For Doctors, a Patient-Centered Approach
Anthony L. Back, M.D., coaches other oncologists about how to discuss prognosis with their patients. Good communication, he says, is part of providing good care: “Talking to patients and their families about prognosis is complicated. But done well, these conversations promote trust, enable patients to plan, and strengthen healthy coping.”
  • Posted: November 24, 2014