Why do many people with stage 4 cancer sometime appear very healthy?
Stage 4 cancer, millions of survivors are not only living longer, but they’re also learning to live better. And one of the best paths to doing that is to take steps to take control your health .
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I saw this odd behaviour watching the passing of my uncle. I did not know it at the time but now understand that even when cancer has become debilitating modern treatments can put it into remission for some time during which patients can live near-normal lives.
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A disturbingly high proportion of some cancers are not even diagnosed until they reach are advanced (stage 4). Advanced cancer or metastatic cancer is defined as cancer that has spread to other parts of your body. Once cancer has reached this point it can no longer be treated locally by surgery alone. Cancer stage only describes how far the cancer has spread, not how much it interferes with your life.
A lot of people reach stage 4 before diagnosis
If we consider the top 5 most commonly diagnosed cancers (this example is from in Australia, which is typical of the Western World) we find that at least 42% of lung cancer diagnoses did not occur until stage 4. Many in the unknown group will also be stage 4.
Sadly an early site of lung cancer metastasis is the brain. The first signs stage 4 lung cancer may have nothing to do with the lungs, being due to lung cancer having spread to the brain as metastases.
Patients with lung cancer can seem “fine” a few weeks before they die, which means the cancer has been at stage 4 while they have been “healthy”.
Some other common cancers are even worse than lung cancer for late diagnosis. Pancreatic cancer in particular has the worst survival rate of all major cancers due to its late diagnosis.
Internal cancers are frequently diagnosed late.
Internal cancers, such as lung, liver, pancreatic, oesophageal (esophageal), brain and bowel and rectal (colorectal) cancer as well as mesothelioma are often diagnosed late because they can become metastatic without showing obvious symptoms. Internal organs do not have pain sensors to alert to cancer growth. Unless diagnosis is made by screening, or incidentally during another procedure, diagnosis requires a noticeable interference in a persons ability to function. In many organs this occurs late because the organ has sufficient redundancy to compensate for loss of function. A few internal organs, however, such as the prostate, show dysfunction at an early stage.
In contrast the growth of external cancers, such as melanoma and breast cancer can usually be seen early. Colorectal cancer may be found relatively early due to screening, and because it often produces blood in bowel movements.
High function after diagnosis at an advanced stage
Treatment of advanced cancer, often with chemotherapy and/or immunotherapy can often produce remission; that is reduce the cancer to a level below detection.The remainder of the organ might continue functioning at a normal level. However far too often small numbers of cancer cells remain that have resistance to the therapy. These subsequently grow into an invasive cancer that can no longer be treated with the same method. The period of remission is often greater than a year, during which patients may feel “fine” and go back to normal activities.
My much-loved uncle Don was diagnosed with stage 4 lung cancer with nodules already appearing in his brain. He was aggressively treated with chemotherapy, during which he was so sick it seemed he would die. Soon after he seemed to recover, appearing to be back to his old self. Not understanding cancer at the time, I thought he was cured. Sadly the cancer returned to his brain 12 months later and he began suffering seizures just before he died.
Far too often advanced cancer in remission subsequently relapses and until that point patients and relatives may feel they have been cured.
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