Table of ContentsView AllTable of ContentsDefinitionMeasuring ResponseImpact of Targeted TherapiesImpact of ImmunotherapyOther Terminology
Table of ContentsView All
View All
Table of Contents
Definition
Measuring Response
Impact of Targeted Therapies
Impact of Immunotherapy
Other Terminology
Cancer doctors use the termstable diseaseto describe a tumor that is neither growing nor shrinking. Specifically, it means that there was neither an increase in size of more than 20% nor a decrease in size of more than 30% since the initial baseline measurement. Stable disease also means that no new tumors have developed and that cancer has notmetastasized(spread) to other parts of the body.
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Stable disease falls in the spectrum of treatment responses. And though people may be discouraged to hear that a tumor has not shrunk considerably, stable disease can sometimes be a good sign. For example, if a tumor was expected to grow and did not, stable disease may indicate that a therapy is, indeed, working.
While stable disease can have significant meaning, there are some limitations when it comes to defining it. Newer treatments (such astargeted therapiesandimmunotherapy) are also altering the ways doctors consider the idea of stable disease.
How Cancer Is Treated
Defining Stable Disease
To better understand stable disease, it is important to know where on the spectrum the term falls.
Stable disease does not necessarily mean that the tumor is unchanged. It only means that the changes are not enough to suggest there is either disease progression or a partial response to treatment.
Most health authorities require that there be a period ofat leastfour weeks between tumor evaluations before stable disease can be confidently established.
Limitations
The reason for this is that the tools used to measure the size of a tumor do so indirectly. Rather than looking at a tumor directly via surgery orlaparoscopy, doctors will monitor the size with imaging tests such ascomputed tomography (CT)andpositron emission tomography (PET) scans.
Measuring the Response
Stable disease doesn’t necessarily mean that a treatment isn’t working. What it means can vary significantly depending on the type of tumor you have, the particular treatment you are receiving, and your response to other treatments in the past.
Stable diseasemaymean that a treatment isn’t working, but it may also mean that a treatment is working very well.
If a tumor was expected to have grown in the interval between two scans and has remained stable, it may mean that the treatment is effective, even if there is not much of a change seen on imaging. Cancer may also be stable if the tumor was at risk of metastasis following a prior scan but no such spread was observed.
How Cancer Is Diagnosed and Monitored
Up until the last decade or so, clinical trials often required evidence of a 20% reduction in tumor size to say that a cancer therapy was actively working. This has changed, however, with the introduction of newer targeted therapies.
Targeted therapies are drugs that specifically target mechanisms of growth in cancer to stop the growth and prevent further spread. They do not, however, usually “cure” cancer.
With the introduction of targeted therapies, treatment response is now described with terms such asprogression-free survivaland anoverall survival benefit. If the treatment keeps cancer in check—allowing people longer survival with minimal symptoms—then stable disease could very well apply irrespective of the tumor size.
As a result of newer, more effective treatments, doctors increasingly measure success in terms of meaningful outcomes (such as quality of life and symptom-free disease) rather than simply the size of a tumor.
The Challenges in Curing Cancer
Stable disease can also be considered a positive sign in people provided newer immunotherapy drugs. Traditionally, doctors have aimed to achieve the fastest response when dealing with cancer.Chemotherapydrugs, for example, are used in first-line treatment because they kill cancer cells almost immediately.
Immunotherapy drugs work in a different way. They “take the brakes off” theimmune systemso that your own immune cells can fight cancer.
There is another phenomenon seen with immunotherapy that can also affect response, or at least the appearance of a response, on imaging studies. Referred to aspseudoprogression, it is an uncommon condition in which a tumor appears to have grown in response to immunotherapy even if it hasn’t.
It is now thought that the immunologic response can affect cells surrounding a tumor, creating benign lesions that mimic cancer cells on a CT or PET scan. In some cases, a biopsy may reveal that the tumor has completely disappeared and that all that is left are the residual lesion.
Pseudoprogression most often occurs with lymph nodes but may also affect the kidneys, liver, lungs, adrenal gland, and chest and abdominal walls.
While immunotherapy can be effective in treating certain forms of cancer, it may take time for the immune system to mount a robust defense. During this time, the cancer may appear to worsen even if the condition is stable.
How Cancer Immunotherapy Works
Other Terms Describing Cancer Response
There are different terms youroncologistmay use in describing your response to cancer treatment. While many of the terms are considered standard, the criteria for diagnosis are ever-evolving, and there are often challenges in standardizing definitions between health authorities and researchers.
Regardless of the criteria used, diagnoses are based on the changes in the size of target and non-target tumors.
Target tumorsare those that are specifically monitored to determine if the disease is progressing.Non-target tumors—whose presence have been noted, but whose measurements have not been taken—can also factor into a diagnosis if there are any significant changes in their numbers or size.
Some of the more commonly used terms include the following:
The Facts About Cancer Survival
A Word From Verywell
Given that metastatic cancer is responsible for up to 90% of all cancer deaths, the fear of progression or recurrence can be overwhelming for some. Even if your cancer is advanced, being told that you have stable disease should be reassuring. It means that your current treatment is able to impede the spread of cancer and may do so for the foreseeable future.
Coping with the Fear of Cancer Recurrence
10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Schwartz LH, Litière S, de Vries E, et al.RECIST 1.1-Update and clarification: From the RECIST committee.Eur J Cancer. 2016;62:132-7. doi:10.1016/j.ejca.2016.03.081Schwartz LH, Litière S, de Vries E, et al.RECIST 1.1-Update and clarification: From the RECIST committee.Eur J Cancer. 2016;62:132-7. doi:10.1016/j.ejca.2016.03.081Frenette A, Morrell J, Bjella K, Fogarty E, Beal J, Chaudhary V.Do diametric measurements provide sufficient and reliable tumor assessment? An evaluation of diametric, areametric, and volumetric variability of lung lesion measurements on computerized tomography scans.J Oncol.2015;2015:632943. doi:10.1155/2015/632943Chae YK, Pan AP, Davis AA, et al.Path toward precision oncology: Review of targeted therapy studies and tools to aid in defining “actionability” of a molecular lesion and patient management support.Mol Cancer Ther.2017;16(12):2645-55. doi:10.1158/1535-7163.MCT-17-0597Sambi M, Bagheri L, Szewczuk MR.Current challenges in cancer immunotherapy: Multimodal approaches to improve efficacy and patient response rates.J Oncol. 2019;2019:4508794. doi:10.1155/2019/4508794Beer L, Hochmair M, Prosch H.Pitfalls in the radiological response assessment of immunotherapy.Memo. 2018;11(2):138-43. doi:10.1007/s12254-018-0389-xBorcoman E, Nandikolla A, Long G, Goel S, Le Tourneau C.Patterns of response and progression to immunotherapy.Am Soc Clin Oncol.2018:38:169-78.8 doi:10.1200/EDBK_200643Subbiah V, Chuang HH, Gambhire D, Kairemo K.Defining clinical response criteria and early response criteria for precision oncology: Current state-of-the-art and future perspectives.Diagnostics (Basel). 2017;7(1):10. doi:10.3390/diagnostics7010010Tirkes T, Hollar MA, Tann M, Kohli MD, Akisik F, Sandrasegaran K.Response criteria in oncologic imaging: Review of traditional and new criteria.Radiographics. 2013;33(5):1323-41. doi:10.1148/rg.335125214Seyfried TN, Huysentruyt LC.On the origin of cancer metastasis.Crit Rev Oncog. 2013;18(1-2):43-73. doi:10.1615/critrevoncog.v18.i1-2.40
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Schwartz LH, Litière S, de Vries E, et al.RECIST 1.1-Update and clarification: From the RECIST committee.Eur J Cancer. 2016;62:132-7. doi:10.1016/j.ejca.2016.03.081Schwartz LH, Litière S, de Vries E, et al.RECIST 1.1-Update and clarification: From the RECIST committee.Eur J Cancer. 2016;62:132-7. doi:10.1016/j.ejca.2016.03.081Frenette A, Morrell J, Bjella K, Fogarty E, Beal J, Chaudhary V.Do diametric measurements provide sufficient and reliable tumor assessment? An evaluation of diametric, areametric, and volumetric variability of lung lesion measurements on computerized tomography scans.J Oncol.2015;2015:632943. doi:10.1155/2015/632943Chae YK, Pan AP, Davis AA, et al.Path toward precision oncology: Review of targeted therapy studies and tools to aid in defining “actionability” of a molecular lesion and patient management support.Mol Cancer Ther.2017;16(12):2645-55. doi:10.1158/1535-7163.MCT-17-0597Sambi M, Bagheri L, Szewczuk MR.Current challenges in cancer immunotherapy: Multimodal approaches to improve efficacy and patient response rates.J Oncol. 2019;2019:4508794. doi:10.1155/2019/4508794Beer L, Hochmair M, Prosch H.Pitfalls in the radiological response assessment of immunotherapy.Memo. 2018;11(2):138-43. doi:10.1007/s12254-018-0389-xBorcoman E, Nandikolla A, Long G, Goel S, Le Tourneau C.Patterns of response and progression to immunotherapy.Am Soc Clin Oncol.2018:38:169-78.8 doi:10.1200/EDBK_200643Subbiah V, Chuang HH, Gambhire D, Kairemo K.Defining clinical response criteria and early response criteria for precision oncology: Current state-of-the-art and future perspectives.Diagnostics (Basel). 2017;7(1):10. doi:10.3390/diagnostics7010010Tirkes T, Hollar MA, Tann M, Kohli MD, Akisik F, Sandrasegaran K.Response criteria in oncologic imaging: Review of traditional and new criteria.Radiographics. 2013;33(5):1323-41. doi:10.1148/rg.335125214Seyfried TN, Huysentruyt LC.On the origin of cancer metastasis.Crit Rev Oncog. 2013;18(1-2):43-73. doi:10.1615/critrevoncog.v18.i1-2.40
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Schwartz LH, Litière S, de Vries E, et al.RECIST 1.1-Update and clarification: From the RECIST committee.Eur J Cancer. 2016;62:132-7. doi:10.1016/j.ejca.2016.03.081Schwartz LH, Litière S, de Vries E, et al.RECIST 1.1-Update and clarification: From the RECIST committee.Eur J Cancer. 2016;62:132-7. doi:10.1016/j.ejca.2016.03.081Frenette A, Morrell J, Bjella K, Fogarty E, Beal J, Chaudhary V.Do diametric measurements provide sufficient and reliable tumor assessment? An evaluation of diametric, areametric, and volumetric variability of lung lesion measurements on computerized tomography scans.J Oncol.2015;2015:632943. doi:10.1155/2015/632943Chae YK, Pan AP, Davis AA, et al.Path toward precision oncology: Review of targeted therapy studies and tools to aid in defining “actionability” of a molecular lesion and patient management support.Mol Cancer Ther.2017;16(12):2645-55. doi:10.1158/1535-7163.MCT-17-0597Sambi M, Bagheri L, Szewczuk MR.Current challenges in cancer immunotherapy: Multimodal approaches to improve efficacy and patient response rates.J Oncol. 2019;2019:4508794. doi:10.1155/2019/4508794Beer L, Hochmair M, Prosch H.Pitfalls in the radiological response assessment of immunotherapy.Memo. 2018;11(2):138-43. doi:10.1007/s12254-018-0389-xBorcoman E, Nandikolla A, Long G, Goel S, Le Tourneau C.Patterns of response and progression to immunotherapy.Am Soc Clin Oncol.2018:38:169-78.8 doi:10.1200/EDBK_200643Subbiah V, Chuang HH, Gambhire D, Kairemo K.Defining clinical response criteria and early response criteria for precision oncology: Current state-of-the-art and future perspectives.Diagnostics (Basel). 2017;7(1):10. doi:10.3390/diagnostics7010010Tirkes T, Hollar MA, Tann M, Kohli MD, Akisik F, Sandrasegaran K.Response criteria in oncologic imaging: Review of traditional and new criteria.Radiographics. 2013;33(5):1323-41. doi:10.1148/rg.335125214Seyfried TN, Huysentruyt LC.On the origin of cancer metastasis.Crit Rev Oncog. 2013;18(1-2):43-73. doi:10.1615/critrevoncog.v18.i1-2.40
Schwartz LH, Litière S, de Vries E, et al.RECIST 1.1-Update and clarification: From the RECIST committee.Eur J Cancer. 2016;62:132-7. doi:10.1016/j.ejca.2016.03.081
Frenette A, Morrell J, Bjella K, Fogarty E, Beal J, Chaudhary V.Do diametric measurements provide sufficient and reliable tumor assessment? An evaluation of diametric, areametric, and volumetric variability of lung lesion measurements on computerized tomography scans.J Oncol.2015;2015:632943. doi:10.1155/2015/632943
Chae YK, Pan AP, Davis AA, et al.Path toward precision oncology: Review of targeted therapy studies and tools to aid in defining “actionability” of a molecular lesion and patient management support.Mol Cancer Ther.2017;16(12):2645-55. doi:10.1158/1535-7163.MCT-17-0597
Sambi M, Bagheri L, Szewczuk MR.Current challenges in cancer immunotherapy: Multimodal approaches to improve efficacy and patient response rates.J Oncol. 2019;2019:4508794. doi:10.1155/2019/4508794
Beer L, Hochmair M, Prosch H.Pitfalls in the radiological response assessment of immunotherapy.Memo. 2018;11(2):138-43. doi:10.1007/s12254-018-0389-x
Borcoman E, Nandikolla A, Long G, Goel S, Le Tourneau C.Patterns of response and progression to immunotherapy.Am Soc Clin Oncol.2018:38:169-78.8 doi:10.1200/EDBK_200643
Subbiah V, Chuang HH, Gambhire D, Kairemo K.Defining clinical response criteria and early response criteria for precision oncology: Current state-of-the-art and future perspectives.Diagnostics (Basel). 2017;7(1):10. doi:10.3390/diagnostics7010010
Tirkes T, Hollar MA, Tann M, Kohli MD, Akisik F, Sandrasegaran K.Response criteria in oncologic imaging: Review of traditional and new criteria.Radiographics. 2013;33(5):1323-41. doi:10.1148/rg.335125214
Seyfried TN, Huysentruyt LC.On the origin of cancer metastasis.Crit Rev Oncog. 2013;18(1-2):43-73. doi:10.1615/critrevoncog.v18.i1-2.40
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