Remission, cancer-free, no evidence of disease: What’s the difference?

To a cancer patient, one of the most magical words in the English language may be “remission.” For those fortunate enough to hear it, it imparts not only a much-hoped-for dose of good news, but also a profound sense of relief.

But what does the term “remission” actually mean? And how does it differ – if at all – from “no evidence of disease,” or even “cancer-free?”

We asked medical oncologist Phat Le, M.D., for insight.

What’s the difference between remission, cancer-free, and no evidence of disease?

A lot of people use those terms synonymously, but “remission” and “no evidence of disease” (also known as NEOD or NED) are probably the closest by definition. Officially, both mean that no cancer is currently detectable in the body. That may be based on scans, bloodwork or some other kind of test, such as a breast biopsy or a bone marrow biopsy.

“Cancer-free” is a little more complicated, because it’s not based on something we can measure. Instead, it implies that not only is there nothing detectable in your body as cancer, but we also believe no residual cancer is left anywhere, so there’s no chance of the cancer ever coming back. And that’s a lot trickier to say, because there’s always at least a very slight risk of recurrence, if you’ve ever had cancer before.

So, how do doctors determine which term to use with a particular patient?

That’s really based on the doctor and what they feel comfortable with. Personally, I tend to use “remission” and “no evidence of disease” the most.

Does the type of cancer influence which term you use?

No. But it will determine which type of surveillance testing your doctor chooses.

With solid tumors like lung cancer, for instance, doctors might order a CT scan. But with prostate cancer and ovarian cancer, doctors might use blood tests to look for tumor markers or certain proteins. Doctors also look for evidence of diseased cells in blood or bone marrow samples with leukemia, lymphoma and other blood cancers.

Does the length of time a cancer survivor has gone without a relapse affect which term doctors use?

No. Not really. There are no special terms used for going 5, 10 or any other number of years without a recurrence.

But sometimes, doctors will declare a patient “cancer-free” after a certain amount of time has passed without a relapse. It usually coincides with the transition from active surveillance into survivorship, when patients begin needing fewer or less frequent check-ups.

What’s the one thing people should know about this topic?

Though all of these terms are sometimes used interchangeably, it’s important to ask your oncologist specifically what they mean. Because I may use it one way, and another physician might use it another.

It’s also important for all cancer survivors to be on some type of surveillance program. Some cancers are considered very low-risk, so if you’ve already gone 5 or 10 years without a recurrence, it’s highly unlikely that you’ll ever have one. But it’s still not impossible. So, you need to keep an eye on it, just to make sure that if the cancer ever does come back, you catch it as soon as possible.

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