The Path to Remission

If a patient experiences complete remission, the primary symptoms associated with head and neck cancer should disappear or at least be markedly improved; there should be no evidence of the primary tumour on physical exam and CT or MRI scans should also have no evidence of disease at the site of the tumour or in other areas of the body.

Although you may now be in remission, it is critical that you continue to be vigilant to find out if the cancer returns or if a secondary cancer grows. There is a higher probability of cancer returning (recurrence) or a new cancer occurring in the first few years.

Although this may be stressful and cause anxiety for you, it is best to identify cancer at an early stage. For example, among patients who are diagnosed with stage I head and neck cancer, 90 percent are likely to be cured, whereas among patients who are diagnosed at stage II head and neck cancer, only 70 percent are likely to be cured.

Therefore, you will need to undergo periodic follow-up physicals, scans and other tests according to a schedule. The specific schedule will depend on the specific type of cancer you had, in addition to the specific course of treatment you received. The clinicians will carefully assess you to confirm that the cancer has not returned and that you still have no evidence of disease.

Staying Vigilant

Although this may be stressful and cause anxiety for you, it is best to identify cancer at an early stage. For example, among patients who are diagnosed with stage I head and neck cancer, 90 percent are likely to be cured, whereas among patients who are diagnosed at stage II head and neck cancer, only 70 percent are likely to be cured.

Therefore, you will need to undergo periodic follow-up physicals, scans and other tests according to a schedule. The specific schedule will depend on the specific type of cancer you had, in addition to the specific course of treatment you received. The clinicians will carefully assess you to confirm that the cancer has not returned and that you still have no evidence of disease.

Your Lifestyle

Although your cancer may now be in remission, you may still experience stress and anxiety as a result of your cancer journey. Some patients report feelings of stress and anxiety that increase up until they have the follow-up exam and tests, and then decrease as soon as they are told there is no evidence of disease and that the cancer has not returned. The term for this specific type of stress and anxiety is “scanxiety.”

Other toxicities may be identified at the time of the follow-up exams. For example, approximately 25 percent of patients who had surgery and radiation therapy combinations developed hypothyroidism, the decrease of thyroid hormone production, post-treatment.

You may experience ongoing functional challenges after your treatment is completed, depending on what type of cancer removal surgery, reconstruction or prosthetics you had and how the side effects of other treatments affected you. Some people recover completely and find a “new normal” with relative ease. Others continue to struggle, sometimes for the rest of their lives, to overcome functional challenges with breathing, swallowing and speaking. You may receive speech and/or swallowing rehabilitation; prosthetic devices to help you eat, breathe or speak; and perhaps ongoing therapy to help you continue to improve your quality of life.

A great many head and neck cancer patients adapt quite well and return to a full and rich life after achieving remission.

Recurrence

If you have been successfully treated for cancer that is in remission, but it returns, you have what is called recurrent cancer. Approximately 50 percent of patients successfully treated for squamous cell head and neck cancer will develop recurrent disease within two years of successful treatment.

Recurrent cancer can occur near the original site of the tumour, known as recurrent locoregional cancer, or at distant sites in the body, known as recurrent metastatic cancer. Approximately 30 to 40 percent of patients successfully treated for head and neck cancer will develop recurrent locoregional cancer, whereas between 20 to 30 percent of patients successfully treated for head and neck cancer will develop recurrent metastatic disease.

The best way to handle the possibility of recurrence is to remain vigilant for several years following the end of your treatment. See your doctor regularly for follow-up visits and imaging to reassure yourself that you remain cancer-free or to detect a recurrence as early as possible. Just as it was with your initial diagnosis, the earlier you detect the cancer, the better your prognosis will be.