The phrase “No Evidence of Disease” (NED) marks a positive milestone in a cancer patient’s journey. It indicates that after treatment, diagnostic tests like scans, blood tests, and physical examinations, reveal no detectable signs of cancer in the body. While encouraging, understanding the precise meaning of NED is important.
Understanding “No Evidence of Disease”
The term “No Evidence of Disease” is used carefully by medical professionals, reflecting the limitations of current diagnostic technologies. While tests may show no visible signs of cancer, this does not definitively mean every cancer cell has been eradicated. Imaging tests, like CT scans, detect tumors or cell groups only when they reach a certain size, typically millions of cells. Microscopic cancer cells could still exist in the body, undetectable by current methods.
This distinction is crucial because undetectable cells can grow and cause cancer recurrence. NED signifies a favorable outcome where the disease is not currently detectable, acknowledging the possibility of lingering cells beyond current detection. Achieving NED is a positive step, indicating treatments effectively eliminated all measurable disease.
NED Compared to Remission and Cure
“No Evidence of Disease” is closely related to, and often used interchangeably with, the term “complete remission.” Remission generally refers to a period where the signs and symptoms of cancer are reduced or have disappeared. There are two main types: partial remission, where the cancer has shrunk but is still present, and complete remission, where all detectable signs of cancer are gone from tests and physical exams. NED is considered a form of complete remission, meaning that tests show no remaining cancer.
The term “cure,” however, is rarely used definitively by doctors. A “cure” implies cancer is completely gone and will never return, which doctors cannot guarantee due to possible microscopic cells and recurrence, even years later. While NED represents the closest a patient can get to a “cure,” medical professionals prefer terms like NED or complete remission to manage expectations. Some doctors might consider a patient cured if they remain in complete remission for a very long period, often five years or more, as recurrence risk significantly decreases over time.
Life Beyond NED: Monitoring and Ongoing Care
Achieving “No Evidence of Disease” marks a transition from active treatment to careful monitoring and ongoing care. Regular follow-up appointments are essential, typically involving physical exams, blood tests, and surveillance scans to check for recurrence. The frequency of these appointments may be more intensive initially (every 3-4 months for the first 2-3 years), then gradually decrease, though they often continue for many years. For some cancers, like rectal cancer, intensive surveillance might become less frequent after three years of NED.
Living beyond NED involves emotional and psychological adjustments. Fear of recurrence (FCR) is common among cancer survivors, characterized by worry about cancer returning or progressing. This fear can be triggered by follow-up appointments, anniversaries, or new physical symptoms. Support systems, including counseling or support groups, can address these emotional aspects. Adopting healthy lifestyle habits like a balanced diet, regular physical activity, maintaining a healthy weight, and avoiding smoking and excessive alcohol can contribute to overall well-being and potentially reduce recurrence risk.