The first thing that some patients (or their loved ones) think when they are told that they have cancer is that they might die soon.

This is natural. In fact, few people die of cancer soon after they are diagnosed, although rapidly fatal cancers can occur. More people are living longer with cancer than ever before, and a cornucopia of new drugs being tested today offers real hope to cancer patients.

Statistics on all persons diagnosed with cancer in the United States from 1990 to 2010 indicate that 64 percent survived at least five years (many are presumed cured). Still, not enough people do survive cancer for long enough, and we cannot escape the present-day reality that cancer claims far too many lives.

Therefore, the first question that many (but not all) people with cancer ask of their oncologists is, “What is the prognosis?”

In considering the prognosis, you and your oncologist should address two central questions:

– First, is there a reasonable expectation for cure? and

– Second, if the cancer is not considered curable, what is the estimated survival?

It is vital for patients and their loved ones to have a clear understanding of whether the cancer they are confronting is likely to be cured.

Some cancers are cured with surgery or radiation alone; others require chemotherapy; still others, such as the blood and lymph cancers, may  require a stem-cell transplant to achieve cure. If the cancer is potentially curable, then you will need to discuss the recommended treatments, their side effects, and how treatment will affect all facets of your life. If cure is not a likely possibility, then you will need to discuss all of the above plus another crucial element: the goals of  treatment.

– Is long-term disease control a realistic goal?

– Is short-term comfort and relief of suffering a more appropriate objective?

– Will a goal intermediate between these two be more achievable?

The treatment of curable cancers and those not likely to be cured are discussed later.

The type of cancer, stage of the cancer, medical condition of the patient, and the effectiveness of available treatments are critical determinants of a cancer’s curability.

Oncologists weigh these plus a number of other factors in estimating prognosis. Before we explore how doctors estimate prognosis, it is important to understand what is meant by “incurable cancer.”