Chapters Index (French) French Version Welcome page Contact

Nowadays, we can unfortunately only cure around half of cancer patients.

For many patients, after initial treatment, complete clinical remission is obtained: no tumour can be found either clinically or using imaging techniques, and patients appear to be cured.

Such ‘apparent cure’ is observed in many cancers:

• in breast cancer (after surgery, radiotherapy and hormonotherapy or chemotherapy),
  
• in head and neck cancer (after surgical excision and complementary radiotherapy),
  
• in oesophageal cancer (after surgery of radical radiotherapy),
  
• in rectum cancer (after radical surgery),
  
• in prostate cancer (after radical prostatectomy or radiotherapy),
  
• and so on...

Patients will benefit from a long period with no symptoms.

Such clinical remission can last for very varying periods of time.

Depending on the type of cancer, a proportion of patients will in fact be definitively cured and no sign of recurrence will be seen until death occurs, provoked by another disease or event (cardiovascular, cerebral, infectious, accident and so on).

For many other patients, apparently cured, this period will abruptly come to an end with relapse which is demonstrated:

• Either by biological assays (which are more or less specific),
  
• Or by systematic clinical examination,
  
• Or by other systemic screening procedure (see below),
  
• Or by clinical symptoms in relation either to the original tumour or to remote metastases.

For almost all patients, this relapse will change the treatment intent from a curative treatment phase (the patient can be cured and all available ressources should be used to obtain such full recovery) to a palliative treatment phase (we know that we can no longer cure the patient).

At this latter period, the treatment aims are:

• To prolong the patient’s lifespan,
  
• To relieve the patient from his/her painful or unpleasant symptoms,
  
• To improve quality of live, for as long as possible.

However, choosing the treatment is not easy. We do not know for how long the patient in front of us is going to live even if, statistically, we do know (with relative precision) the mean duration of life after relapse, since:

• certain patients suffer very rapid evolution,
  
• others have long-lasting cancer development, whilst preserving good quality of life,
  
• some therapeutic responses are unusual by their unexpected quality or duration,
  
• on the contrary, treatment or cancer complications may lead to a major deterioration in quality of life without shortening the lifespan (for instance, paraplegia is a major disability which is not predictive of rapid death).

We therefore need to find the thin line that exists between two major treatment dilemmas:

• Either under-treating the patient, hence not offering him/her all the possible chances,

• Or over-treating the patient with pointless iatrogenic complications with no change in the fatal prognosis.