“We got it all” or, “You’re in remission” Should Not Mean the End of Treatment

Written by Dr. Keith I. Block, MD


“We got it all.” Words every cancer patient loves to hear.  And it is indeed news worth celebrating.  However, you shouldn’t be fooled into thinking this favorable pronouncement means treatment is over and you can go back to life as it was before cancer.  Consider this:  What is the “it” that they got all of?  “It” is the tumor and any detectable cancer cells.  What they didn’t “get” is the biochemical and molecular environment within your body that made the cancer possible and helped fuel its growth.  A tumor is merely the most visible manifestation of an underlying, systemic disruption of the body’s processes.  In other words, the macroscopic evidence – the tumor – is the most obvious indication of the illness.  As important as it is to address the tumor, it is not by any means enough.

The confident announcement that “we got it all” is also somewhat misleading in another way.  When all detectable cancer cells have been eradicated, there is still the possibility that some undetectable cancer cells lurk in places far from the original tumor.  According to some estimates, up to half of all cancer patients in remission have some micrometastases – that is, cancer cells that have migrated to other parts of the body – where they are in the process of creating another tumor.  With all good intentions, surgeons are simply unable to know whether there are any residual cells in circulation looking for a site where they can dock, harbor and replicate in order to rear their heads at a future day.  This is why you should think of remission not as the end of treatment, but as the start of the next phase in your treatment, what I call a “remission maintenance program.”

While conventional cancer treatment generally ignores this phase, it is actually the time for a very aggressive approach to treatment.  Why?  Simply put, a patient in remission may still harbor malignant cells (ones that were resistant to chemotherapy or radiation), that – though we are getting diagnostically better with new testing techniques discovering CTCs, “circulating tumor cells” – not even the best diagnostic technologies can detect these with certainty.  Worse yet, cancer patients face what I call, “the valley of death.”  This is the chasm between what we know and what actually gets implemented in clinical care.  In other words, though we can measure CTCs, only some clinical centers routinely provide this as part of their – our – care of patients.

But it is the unfortunate existence of CTCs that are often why some patients, even those who have achieved a complete remission, sometimes suffer a recurrence months or even years later.  And why, at the Block Center, we recommend all of our patients participate in a remission maintenance program, an ongoing, comprehensive, individualized program that includes diet, fitness, supplementation, stress care strategies and anti-tumor therapies.  Of course this requires a reassessment of laboratory biomarkers that can provide a heads up if a patient’s situation is shifting and showing signs toward a greater risk of a recurrence.  Rather than waiting passively, I encourage my patients to be aggressive and pursue a full treatment plan before a recurring problem can take hold.  Instead of pursuing a plan of “watchful waiting” as was coined years back for observing prostate cancer patients before moving to invasive therapy, I am far more interested in my patients pursuing a plan of what I call “active participating.”  As opposed to only going back to your doctor for the next scan, and waiting anxiously to see if the disease has come back, I want my patients being proactive and engaged in strategies for preventing a recurrence.  And in addition to recurrence prevention, this remission treatment plan will help rebuild your strength as well as bolster your energy.  It is during this time that many of my patients describe feeling that life as a cancer survivor is more vibrant, even more enriched, than it was before their diagnosis.

While it is optimal that a “remission maintenance program” be individually tailored, based on objective evaluation and assessment of each patient, there are some strategies I will generally recommend to all of my patients:

  • Eat a mostly plant-based diet that includes lots of fruits and vegetables.
  • Reduce or, better still, eliminate meat and dairy.
  • Eat more cold-water fish (such as salmon, sardines, tuna, and cod).  Try to have cold-water fish a couple of nights a week.
  • Stay well-hydrated by drinking plenty of healthful fluids (including water, white or green tea, herb teas, purple grape, and apple juices).
  • Get plenty of sleep.
  • Exercise regularly and stay fit.
  • Learn to effectively manage stress. Practice meditation, yoga, or your preferred stress-reducing technique every day.
  • Develop (or maintain) a close network of supportive friends and family.

If your response to hearing “we got it all,” is to move confidently and resolutely into the next phase of treatment, you won’t be going back to life as it was before cancer.  You will be purposefully engaged in optimizing your health and well-being, and focused on strategies to maintain your remission.  What I understand and know with certainty, is that after all you’ve gone through since your diagnosis, you deserve to be done with cancer and never see this troublesome beast again.

Originally Posted: March 1, 2011

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