Treatment of Cancer mass, as seen in the scans (CT/PETCT/MRI):
Treatment of invisible cancer cells around cancer growth:
Treatment of Cancer mass, when detected in other organs also (stage IV):
Treatment of undetected disease elsewhere in the body (not detected on imaging):
Follow-up is the program of regular pre-arranged appointment with your primary oncologist at specified intervals, after the completion of prescribed treatment, even if you are feeling perfect. During every visit make it a point to reinforce your ideas of improving your feelings & general health (refer to blog on survivorship program for details).
First few follow-ups are to monitor the effects of treatment. It's essential to realize that even when the scans show no cancer, it's safer to presume that there is a hidden threat and take the following precautionary steps. This pragmatism relieves the nagging feeling whether cancer has disappeared or is going to come back. This mind-set also helps in coping with the psychological & physical after- effects of cancer and treatment. Again, this type of outlook in life, in turn, improves the probability of getting rid cancer.
Further, "Cancer free" report (if not, additional treatment is required) is the first requirement for the cure. Also, this is the most and maybe the only key opportunity for consolidating the position of advantage. The subsequent improvement in the possibility of remedy comes from improving the lifestyle and body immunity.
The follow-up also helps in early detection and treatment of side effects (if at all when it happens).
Generally, the first follow up is at six weeks after the day of completion of the last dose of chemotherapy or radiation. Subsequently, it is every three months during the first year, every six months during the next 2- 3 years and every year afterwards. It is required to adhere to this schedule, routinely.
To repeat, again and again, it's safer to assume that risk of getting back maybe there despite the positive findings of the examinations. This assumption may support the mind to get rid of the inner fear– the ever-persisting voice deep in mind will it come back? In other words, now may be the right time to take steps to initiate the reversal process that created the "cancer". This advice comes from the "soil and seed theory" of cancer; where cancer - the "the seed" grows, when the human body or organ - "the soil" becomes weak.
Invoke resilience of mind and beyond: Short-term stress increases immune- protection involved in wound healing, vaccination, and response to anti- infectious and anti-cancer agents etc. On the other hand, chronic stress suppresses these beneficial immune reactions. It is possible to convert chronic stress to advantage by cognitive behavioural therapy (CBT) techniques (refer below). Not only one should gain the original confidence, but also strive to be better than before getting cancer.
There is never a guarantee that even if the disease disappears entirely after the treatment that cancer will never be back. Your oncologist will give information about the probability of cure or control. This data is not of much help for the individual. Always the human tendency is to worry about the percentage of failure figures and not of feeling confident over the success rate.
You likely to hear the words: "no evidence of any cancer", "it is gone" or "removed all cancer" etc. Even so, there's a chance that some microscopic cancer cells may be surviving. Worrying about this would be unnecessary if all the cells are gone. Also, over time, the remaining few cells can get wiped out by the immune cells continually scanning our body, finally resulting in cure (assisted by the survivorship program that you follow).
Survivorship program will be of use one more way. Sometimes another cancer unrelated to the first one, which can start after 10 to 15 years. Having cured of one cancer is not a protection against a second or even a third altogether different cancer. Therefore, consider initial cancer as angels signal, and the dedicated survivorship program will help in the prevention of second cancer that can come after decades. Survivorship program, since self-driven, is an inexpensive investment, sometimes leading to a better life than before cancer.
It is usual to worry about cancer coming back. However, for some people, these feelings become a "fear" that gets in the way of daily life and getting free of cancer. Only "YOU" can help yourself in overcoming this.
How to deal with these persistent undesirable thoughts?
You have a vital role in deciding on the choice of treatment. Most of the time oncologist will able to give you different options and recommend the one that is most applicable to you. Next step is to accept the same, or if you decide from other alternatives (which are acceptable as per the guidelines), then you need to choose the same without any worries (cannot revisit that particular decision at a later date). Later, if the situation changes, one can review the options afresh.
The final word is, whatever decisions you take, even with delivery of best and most expensive of the treatments, your doctor cannot give you any guarantee of cure or control or prognosis. The doctor cannot assure what he cannot know, and the doctor (or anybody) does not see the future. Each patient is different in responding to the prescribed treatment, despite the similar disease. We should avoid thinking about what don't know, and what we cannot change. Acceptance of this unconditionally in mind does improve adherence to treatment, control/cure rate and your quality of life immensely.