Wednesday, November 19, 2008

What's "Cancer-Free"?

A reader wrote:

"I found it puzzling as to why the cancer returned so quickly... as you had been declared "cancer-free"... unless there had been some latent/undetected remnants which had failed to be removed from the ops or by the chemo." [The reader went on to suggest my doctor had made a mistake.]

Here's my response:

I think most people are confused about what "cancer-free" means. In the U.S., doctors have stopped using the term. They now use the term, "No evidence of disease" or "N.E.D." This is because there is, technically, no such thing as cancer-free. You can use every fancy scan available in the medical world but if only one tiny little cancer cell has gotten into your blood stream, lymph system, or is hiding somewhere in your tissues, it will not be picked up, and there will still be a possibility that cancer will return some day.

A tumor needs to be the size of a pea to be detected on any scans. That's millions of cancer cells. So just imagine one single cancer cell somewhere in your body - there's no way that any scan or any doctor, no matter how technologically advanced or clever, can find a stray cancer cell. Therefore, you can never be said to be cancer-free.

If my doctor made any mistake at all, it was in being too optimistic, telling me I was cancer-free, when she should have said there was no evidence of disease. She was trying to give me hope, so I don't fault her for that. If she had given me the above explanation about why I could never be cancer-free at that point in my treatment, I might have considered her a pessimistic killjoy.

I feel sorry for doctors. They tell the medical truth and they're accused of being pessimistic. They put a positive spin on the news and they're accused of hiding the truth. I think my doctor gave me the news I needed in the way I needed it at that time. I think she really believed my cancer was gone - at least for a long, long time. She was just as confounded and shocked as I was to learn it had returned so quickly.

Nobody can guarantee that your cancer won't come back. Likewise, for people who've never had cancer, nobody can guarantee that you'll never get it. But if you life a healthy lifestyle and are lucky enough to keep cancer at bay for another twenty, thirty or more years, you might as well consider yourself cancer-free and die with good ole NED instead.


Anonymous said...

I am no expert on cancer, but from what I've read in medical books, our body contains millions of cells, including good and bad cells. The bad cells are always in a "dormant mode". These cells will only be activated when the good cells stop growing and the bad cells multiply by themselves, forming a tumour.

I had a classmate suffering from nose cancer. He was 60 years old and he completed a course of chemotherapy. The doctors then said that he had no more evidence of cancer, but he is worried about a relapse. We encourage him not to give up, as we want him to pull through to graduate together. I have another classmate who is suffering from lymph cancer. She is now undergoing treatment too. She had no family history of cancer. She believes lack of rest could have caused her cancer.

My family has history of cancer.

Shin said...


I'm no expert on cancer either, but I'm pretty sure your explanation (good cells vs. bad cells) is not correct. I don't think that's the way cancer or our bodies work. So if there are any other readers interested in the actual facts, please go and do your own research.

Click HERE to read one of my earlier blog posts about some possible causes of cancer.

NB: Only 5 to 10 percent of all cancers are hereditary. That means the overwhelming majority of cancers has nothing to do with family history.

Well Wisher said...

You might as well say that all human beings will die anytime due to anything. In this case, if one could choose a dying mode, I wouldn't choose cancer because of its cost. An SIA air crash tops the list because its compensation is high. Second would be being killed while protecting loved ones from assailants because I'd be their hero. Just kidding. Now I know what to wish for you: Hope that you have a strong body and mind to go about your daily chores.

Shin said...

Well Wisher,

I wrote about this topic in an earlier blog post, "I Choose Cancer".

Anonymous said...

Hi Shin.

I watched the programme on Channel 8 about your fighting cancer. Tears flowed and I felt your bravery.

I read your blog. I know about breast cancer because my sister was dignosed with it and thank god it was discovered early (she removed one of her breasts). I know how painful it is and especially in your case as it has spread to the rest of your body.
Well done girl, for the spirit to live and the will to continue, especially for the kids.

I wish you well and will pray for you.


zephyr said...

Hi Shin.

I don't know if I would have chosen cancer like you, but cancer has definitely chosen me. This just means dealing with the situation as we move along. If we blame the messengers (the doctors), we will never be able to work with them on dealing with it. I do believe that the whole experience really depends on the people in the equation. And having the right doctor/s who is willing to listen carefully and understand me and my concerns is really important - more so than whether the person is a senior consultant or not. Our doctor is our "buddy-in-war".

Ger said...

Hi Shin.

I seek to get your approval to provide your blog link in one of my blog entries as I caught your story on Channel 8's documentary and your courage and optimism left an impression.

With thanks,

Shin said...


Thanks for your interest in my blog. Of course you can link to it in your blog.

As far as I know, blogs are public domain. I don't think it's physically or legally possible to block people from linking to a public URL. Not that I want to, of course.


Remy said...

Hi Shin.

I'm so sorry to hear that. But I hope that you will get well. ( :



Shin said...


I don't consider this bad news necessarily - just a medical fact.

As I said, if you've never had cancer yourself, there is no guarantee that you won't get cancer some day. That could be considered bad news as well, or just a statement of fact.

But most people with no cancer don't go around dreading that they will some day get cancer, just as I don't spend my days thinking about my cancer and when it will actually kill me.

Chuan's blog said...

Hello Shin.

I am your age. I just came across your blog today through someone else's blog. I just want to wish you well and to tell you to focus on living your life. STOP living in fear and live life to the fullest! Take your medication, go for your treatments, but in between, have a blast! Laugh! Get up and go! And have a great life!! : )

Shin said...

Chuan's blog,

Thanks for your encouraging words.

Regular readers of this blog will know, however, that I don't live in fear. Actually, I'm just about the happiest person I know, cancer or no cancer.

Lately, my biggest problem is to stop myself laughing so much that I start a coughing fit that leaves me breathless. If anyone were ever actually in danger of dying of laughter, it would be me (thanks to my hilarious kids).

I wish all of my friends could be as lucky, loved, and happy as I am.

Ger said...

Thanks Shin,
Here's my blog in case you're curious to know what I've mentioned in the entry:

JOHNHOON said...

Actually I don't know what is cancer.I just know about stroke.My grandmother and my aunt have stroke last few year.They are so pity.They can't control their body.

Cath said...

Hi Shin,

I think it's worrying how many of us still have misconceptions of cancer and seem to lack general knowledge on it. In effect, we're putting ourselves at the mercy of our doctors, believing that they always know what's best for us. But as you've pointed out, doctors are humans too and can't be all-knowing.

A lot of the "suffering" that patients and their families go through when something like cancer happens is to do with the fear of not knowing. Until my mum was diagnosed with cancer, I had very little knowledge of the disease, except that it could be deadly. Neither did I know, like you said, that most cancers are *not* hereditary. I had a hard time accepting that my mother might have cancer at first. In fact, my constantly reminding the doctors that we had "no family history of cancer" may have contributed to a misdiagnosis in the early months when my mum had symptoms. She very nearly couldn't be saved. A doctor said to me, "Sometimes they don't find out what is wrong even till the end." At that time, I wanted desperately to save my mother, but I felt really helpless when even the doctors didn't seem to know what was going on.

But it doesn't have to be this way for those of us who may experience cancer in our lifetime (be it ourselves or our loved ones). If we take the first step to find out more about the disease, how we can prevent it from occurring or coming back, we can take charge of the disease and help ourselves and our families better, should the disease "choose" us one day.

I don't mean find out more in a paranoid way, of course, but simply treat information about cancer as basic information that we need to know, rather than something that we learn when we absolutely have to. Doctors generally don't think much of info from websites. But there are credible websites out there that give accurate information on the disease.

Cancer may be deadly for some people, but it's not usually frightening if we manage it the way we would any other difficult situation in our life.

I wish you and your family all the best. Thank you for updating your blog regularly. I'm sure the three irreplaceable people in your life are just as proud of you as you are of them. You really are a strong woman and mum, in spite of the flaws you pointed out in an earlier post.

Jessie said...

I was diagnosed with breast cancer Stage 2 in early 2003 and went through surgery, chemo, radio and oral drugs. I had a bad reaction to the first oral drug, which gave me liver sclerosis. I just finished my five years on another oral drug in August this year and am hoping to be able to get off the liver drugs by early 2009.

I live... one day at a time...