As a physician, it is important to communicate complex medical concepts in a way that is easy to understand for patients. When patients are diagnosed and are undergoing treatment a common question I get is “how do we know the treatment is working”? My crystal ball does not work very well, and I tell my patients the big picture plan of giving treatment that is easiest to take upfront with the least amount of side effects and greatest bang for the buck. If they are tolerating well and it is working, then we are all incredibly happy! It is my sincerest hope that understanding the bird’s eye view of therapy and assessing response can alleviate some of the fears and anxiety, thus allowing patients to focus on their lives with nutrition, activity, and keeping busy with what they love to do. We will give you the best therapy, the patient controls for what they can control, and the rest I say is in God’s hands.
When a person is diagnosed with a tumor, they may undergo treatment such as surgery, radiation therapy, liver directed therapy, nuclear therapy, immunotherapy, hormonal therapy, and/or chemotherapy. The goal of treatment is to shrink or remove the tumor and prevent it from growing or spreading.
There are three ways to assess tumor response to treatment:
- Clinical assessment: During treatment, doctors will closely monitor patients for any signs or symptoms of recurrent or progressive disease vs potential adverse effects from therapy, such as new tumor growths, lumps or bumps under the skin, pain, headaches, breathing difficulties or abdominal pain. This helps to determine if the treatment is working and if any adjustments are needed.
- Imaging tests: Imaging tests such as CT scans, MRIs and PET scans are the most common way to assess tumor response to treatment. These tests can show the size and shape of the tumor before and after treatment. If the tumor has shrunk or disappeared, it is considered a positive response to treatment. Sometimes, patients on immunotherapy may have a “progressive” that is inflammatory in nature, this is called pseudo-progression and considered a potential response to immunotherapy, ultimately with time, these tumors will regress if truly inflammatory versus a real progressive tumor or cancer that is refractory to treatment.
- Tumor markers: Blood tests, such as CEA or CA 19-9, are used to measure the level of cancer markers in the blood. These markers can be used to track the disease course and monitor the effectiveness of treatment. A newer way of assessing response is to use a tumor informed circulating tumor DNA test which can be not only detectable but also quantifiable. A great immunotherapy response is to see undetectable ctdna.
It is important to note that not all tumors respond to treatment in the same way, and some may not respond at all. However, by regularly monitoring the tumor through clinical assessment, imaging and lab tests, doctors can make adjustments to the treatment plan to ensure the best possible outcome for the patient. With the use of innovative technologies like ctdna combined with imaging, the assessment of response has become more accurate and reliable.
About the author
Dr. Sajeve Thomas is a distinguished medical professional and a compassionate guide in the field of oncology. With over a decade of dedicated experience as a board-certified medical oncologist/internal medicine specialist, Dr. Thomas has become a trusted expert in the treatment of melanoma, sarcoma, and gastrointestinal conditions. Currently practicing at the renowned Orlando Health Cancer Institute, he brings a wealth of expertise to the complex and challenging world of oncology.
As one of the principal investigators at his cancer center, Dr. Thomas plays a pivotal role in advancing medical knowledge through his involvement in numerous clinical trials. These trials encompass a spectrum of cutting-edge treatments, including targeted therapy, immunotherapy, intra tumoral therapy, and complex cellular therapies. His commitment to research and innovation underscores his dedication to offering the most effective and up-to-date treatment options to his patients.
Embrace the opportunity to engage with Dr. Sajeve’s expertise, and feel empowered to explore the vast expanse of oncology with renewed curiosity and understanding on “Ask MedOnCMD“