Cancer Terms: What is Remission, Cancer-Free, and No Evidence of Disease

Cancer is an incredibly difficult diagnosis to face. And along with the diagnosis comes a whole new vocabulary and barrage of terms to learn when dealing with the disease. 

What all patients hope to hear is that treatment was successful. Terms that are typically used include “remission,” “cancer-free,” or “no evidence of disease,” but these terms aren’t always understood. 

What is remission and what does it mean when a patient is “in remission”?

When I tell a patent they are in “remission,” I typically mean that following a treatment (surgery, definitive radiation, chemoradiation, or chemotherapy) there is:

• No evidence of visible disease on medical imaging.
• I have a reasonable expectation that it won’t come back.
• But they have risk for recurrence within a specified period, typically five years.

Most cancers, if they recur or relapse, meaning there is now visible disease, typically do so within five years after the last treatment. After that point, the risk of recurrence decreases so substantially that the benefits of ongoing surveillance monitoring with tumor markers or imaging do not outweigh the risks. 

After five years of surveillance, I typically tell patients that I believe they are cured because ongoing surveillance is so unlikely to demonstrate recurrence. With cancer, unfortunately, this is never 100 percent certain. There are some cancers that can come back more than five years after treatment, but these are typically the outliers and not the norm. 

What does “cancer-free” mean?

The term “cancer-free” is a little more ambiguous and its definition varies depending on who you talk to. In fact, it is so ambiguous that it is not a term I typically use. 

After a potentially curative treatment, I usually define disease status as remission rather than cure. I think some may use the term to mean there is no visible cancer at the time of encounter – but I prefer to define this state as remission. I don’t think I would use “cancer-free” until I was ready to say that someone is cured. 

What does “No Evidence of Disease” mean?

“No evidence of disease” or, NED, is a term I use frequently, meaning there is no evidence of visible or detectable disease at the moment. The best example is when a patient who had cancer has repeated imaging and/or bloodwork drawn for tumor markers and neither demonstrates any findings of recurrent malignancy.

When the patient comes for a surveillance visit, I would say that “the surveillance workup at this time demonstrates no evidence of disease and the patient was reassured that he/she remains in remission at this time.”  

Are the terms interchangeable and used consistently by individual doctors?

Unfortunately, given the variable nature of cancer, nothing is absolute, and these terms are not well defined. The terms in and of themselves might mean different things to different providers. That is why I usually define the terms from my perspective when I meet patients and I am consistent with that message moving forward.  NED and remission are often used interchangeably. 

Are there certain timeframes that determine whether someone is “cancer-free?” 

For most cancers, it is reasonable to state that if it doesn’t come back in five years, it is unlikely to return. Sadly, some cancers do come back after five years, but this is not common. 

Does “cancer-free” or “in remission” mean the cancer is cured?

The Webster’s definition of cure is “a complete or permanent solution or remedy.” For that reason, I don’t tell a patient that a cancer is cured until I have followed them for five years after completion of treatment and they haven’t had recurrence. Up until that time, they might still have had hidden disease that has not grown enough to be seen in imaging studies. If you have questions about what these terms mean, just ask your doctor, so you are both on the same page. 

Can cancer return after a patient is declared cancer-free?

I suppose it depends on how you define “cancer-free,” but the short answer is yes, unfortunately. Some cancers, particularly slow growing cancers, can recur after an appropriate surveillance period. 

Living life in remission

My best advice for patients in remission is to enjoy and live your life. Unfortunately, there are a number of things, cancer recurrence included, that can cut life short unexpectedly. Each day we have on this earth is a gift. 

We must plan for the worst but hope for the best. Continue to pursue your regular health care screenings and come to your surveillance visits. Don’t let your cancer diagnosis rule your life. The whole reason we are here is to treat people, and ideally cure them, so they can continue to live –so live your life!

For more information on cancer treatment, visit the Lifespan Cancer Institute website here.