4 ms·

For the MDs: Are there any documented cases of this (stage III -> remission) happening sans treatment?

mlyle 6y ago
Sure. Spontaneous remission of cancer-- even later stage cancer-- happens frequently enough to be well documented in literature. And especially so with lymphomas etc. https://www.google.com/search?q=spontaneous+remission+lymphoma https://www.google.com/search?q=spontaneous+remission+lympho... This one is Stage IV-b https://www.hematologyandoncology.net/archives/november-2012/classical-hodgkin-lymphoma-and-spontaneous-regression/ https://www.hematologyandoncology.net/archives/november-2012...
- tialaramex 6y ago
  As I understand it, having had Hodgkins when I was younger: Lymphoma will be called out specifically because lymphoma is potentially a relatively simple mutation. Cancer needs a bunch of unusual major characteristics from cells, and the lymphatic system already has all but one of those characteristics, it makes cells that are intended to wander about the body (whereas say your skin cells or brain cells are designed to always stay in one place), it sometimes makes lots of them (to fight disease, whereas most cells are replaced only slowly over a long period), however the cells aren't supposed to refuse to self-destruct. If a mutation disables the self-destruct in a lymphatic cell line now you've for a recipe for cancer. So if it's just one or two mutations, on the one hand it becomes more likely that you get it (and we see lots of 20-something men get Hodgkins whereas obviously very few of them get stuff like lung cancer) and on the other hand it is easier to cure, basically just kill the patient slowly, cross fingers the cancer cells die first then you save the patient. That's a very high level idea of the plan for the chemotherapy + radiotherapy used. In medicine the goal is to find reliable ways to do this that kill the fewest patients while reliably getting rid of the cancer, and then also aiming not to make the side effects suck too badly when you cure people (e.g. my lungs are trashed so that I permanently have a mild cough, which wasn't a huge annoyance for a middle aged guy who frankly doesn't eat well enough or exercise anyway, but I can see it'd ruin your life if you were previously a world class athlete and now you'll never achieve that potential). But obviously Mother Nature could very easily randomly cure some people from a single mutation by luck.
  - KraftKacke 6y ago
    To add to your point, lymphoma is special because stage IV does not _inherently indicate mutagenic burden or tumor diversity. Metastatic solid tumors _have to had "privilege escalation" mutations. AND those _indicate an overall greater genetic diversity. As always diversity promotes adaptation and here evolutionary evasion of the disease. However, staging incidentally still correlates with survival in non-hodgekins lymphoma as it's generally a nasty tissue class misbehaving. Treatment options got much, much better tho, with monoclonal antibodies and immune therapy.
  - nashalo_nighly 6y ago
    Wow do we know why it affects men disproportionately compared to women?
KraftKacke 6y ago
Yes, as other have pointed out. I want to add, you also sometimes see spontaneous remission of distant lesions caused by local treatment, e.g. radiation therapy. There is research into exacerbating the tumor "auto-vaccination" by pretreating the lesion with immuno-stimulants. Btw. 'full remission' doesn't mean cured, but clinical clearance or stagnation. Immune reactions may be limited to a major branch on the individual tree of lif.. death and other subclinical branches may emerge years later. There are other cancers which may feature very high tissue differentiation/maturation (early) and are dependent on a certain trigger. E.g. treating heliobacter pylori or chlamydia with antibiotics, may cause full remission in MALT lymphoma.

Sure. Spontaneous remission of cancer-- even later stage cancer-- happens frequently enough to be well documented in literature. And especially so with lymphomas etc. https://www.google.com/search?q=spontaneous+remission+lymphoma https://www.google.com/search?q=spontaneous+remission+lympho... This one is Stage IV-b https://www.hematologyandoncology.net/archives/november-2012/classical-hodgkin-lymphoma-and-spontaneous-regression/ https://www.hematologyandoncology.net/archives/november-2012...

tialaramex 6y ago
As I understand it, having had Hodgkins when I was younger: Lymphoma will be called out specifically because lymphoma is potentially a relatively simple mutation. Cancer needs a bunch of unusual major characteristics from cells, and the lymphatic system already has all but one of those characteristics, it makes cells that are intended to wander about the body (whereas say your skin cells or brain cells are designed to always stay in one place), it sometimes makes lots of them (to fight disease, whereas most cells are replaced only slowly over a long period), however the cells aren't supposed to refuse to self-destruct. If a mutation disables the self-destruct in a lymphatic cell line now you've for a recipe for cancer. So if it's just one or two mutations, on the one hand it becomes more likely that you get it (and we see lots of 20-something men get Hodgkins whereas obviously very few of them get stuff like lung cancer) and on the other hand it is easier to cure, basically just kill the patient slowly, cross fingers the cancer cells die first then you save the patient. That's a very high level idea of the plan for the chemotherapy + radiotherapy used. In medicine the goal is to find reliable ways to do this that kill the fewest patients while reliably getting rid of the cancer, and then also aiming not to make the side effects suck too badly when you cure people (e.g. my lungs are trashed so that I permanently have a mild cough, which wasn't a huge annoyance for a middle aged guy who frankly doesn't eat well enough or exercise anyway, but I can see it'd ruin your life if you were previously a world class athlete and now you'll never achieve that potential). But obviously Mother Nature could very easily randomly cure some people from a single mutation by luck.
- KraftKacke 6y ago
  To add to your point, lymphoma is special because stage IV does not _inherently indicate mutagenic burden or tumor diversity. Metastatic solid tumors _have to had "privilege escalation" mutations. AND those _indicate an overall greater genetic diversity. As always diversity promotes adaptation and here evolutionary evasion of the disease. However, staging incidentally still correlates with survival in non-hodgekins lymphoma as it's generally a nasty tissue class misbehaving. Treatment options got much, much better tho, with monoclonal antibodies and immune therapy.
- nashalo_nighly 6y ago
  Wow do we know why it affects men disproportionately compared to women?

KraftKacke 6y ago

Yes, as other have pointed out. I want to add, you also sometimes see spontaneous remission of distant lesions caused by local treatment, e.g. radiation therapy. There is research into exacerbating the tumor "auto-vaccination" by pretreating the lesion with immuno-stimulants. Btw. 'full remission' doesn't mean cured, but clinical clearance or stagnation. Immune reactions may be limited to a major branch on the individual tree of lif.. death and other subclinical branches may emerge years later. There are other cancers which may feature very high tissue differentiation/maturation (early) and are dependent on a certain trigger. E.g. treating heliobacter pylori or chlamydia with antibiotics, may cause full remission in MALT lymphoma.