Spontaneous Remission of Lung Cancer and Other Cancers

Spontaneous Regression of Cancer an Exceptional Patients

doctor looking at a normal x-ray without evidence of cancer
What is meant by spontaneous remission of cancer and how often does it occur?. Istockphoto.com/Stock Photo©creo77

Do any cancers including lung cancer ever just "go away" without treatment? Is there such a thing as spontaneous remission of tumors? If so, how often does it occur, and why does it happen? Let's take a look at a recent well-documented case, and then address what we currently know about "exceptional patients."

A Case Report of Spontaneous Remission of Lung Cancer

A 2010 report in Surgery Today brought up what others have found in the past, and what is well documented as a spontaneous remission from lung cancer.

A 69-year-old woman was found to have lung adenocarcinoma, a form of non-small cell lung cancer,  Her cancer had spread to her adrenal glands - adrenal metastases - and  therefore, was labeled as stage IV non-small cell lung cancer. Stage IV lung cancer is the most severe stage of the disease with the poorest survival rate.

One month following her diagnosis, and before she had any treatment, both the tumor in her lung and the metastasis to her adrenal gland had shrunk considerably on both a CT scan and a PET scan. (A PET scan is an imaging test which uses radioactive glucose, and allows physicians to get a more accurate assessment of tumor activity than on a CT or MRI alone.) She then underwent surgery for lung cancer and was doing well 14 months later.

Spontaneous Remission of Cancer - Definition and Terms

Spontaneous remission of cancer is defined as the remission of cancer without any treatment, or with treatment that would not be expected to cause a tumor to decrease as much as it does.

Spontaneous remission may be partial or complete and may be temporary or permanent.

Also known as "St. Peregrine's tumor," cancer has been noted to sometimes mysteriously disappear for centuries. Peregrine Laziozi was a 13th-century priest with cancer (possibly a bone tumor of his tibia) whose cancer disappeared after he was scheduled for an amputation of the leg containing the tumor.

The cancer was gone—there  was no sign of the tumor.

Certainly, a misdiagnosis may have been made in the 13th century, but in the 21st century, we have indisputable evidence that spontaneous resolution does sometimes occur.

How Common is Spontaneous Regression of Tumors?

Though we have clearly documented cases of spontaneous regression, it's hard to know how common this phenomenon actually is. We know it is not rare, with over a thousand case studies in the literature. In addition to those studies which document a cancer which goes away without any treatment, it's not clear how often a cancer make go away despite treatment or at least decrease in size despite treatment.

Some have estimated the incidence to be roughly 1 out of 100,000 people, but it's difficult to know if that number is even in the ballpark. It does appear to be more common with some tumors rather than others, with spontaneous regression of blood-related cancers such as lymphoma, and skin cancers such as melanoma being reported more commonly.

While most studies of spontaneous remission look back in time trying to determine why a cancer simply went away, a 2008 prospective study suggested that spontaneous remission is much more common than we think. In this study looking at screening mammography, it was found that some invasive breast cancers detected by mammogram spontaneously regress. This study published in the Archives of Internal Medicine estimated that 22 percent of invasive breast cancers went away without treatment. Since these tumors were asymptomatic—women did not feel a lump—they would not have had any way of knowing that they had invasive cancer without screening. Since there are many cancers that we do not have screening methods for, it could be that early invasive cancer occurs—and goes away before diagnosis—much more often than we think.

What Causes Spontaneous Remission of Cancer?

We're not entirely sure what the molecular basis is that lies beneath the spontaneous regression of cancer. Theories have been cited which have spanned the spectrum from spiritual reasons to immune causes. That said, an immunologic basis could certainly make sense.

Spontaneous Remission, Infection, and The Immune System

Looking at people who have had a spontaneous remission of their cancers it's quickly noted that most of these regressions are associated with an acute infection. Infections often result in a fever and stimulation of the immune system.

We know that our immune systems have the ability to fight off cancer. That is, in fact, the logic behind immunotherapy. Immunotherapy medications, while still in their infancy, have resulted in dramatic remissions of cancer for some people, even in the advanced stages of cancer. These drugs work in different ways, but a common theme is that they essentially enhance the ability of our own immune systems to fight cancer.

Infections which have been associated with spontaneous remission include diphtheria, measles, hepatitis, gonorrhea, malaria, smallpox, syphilis, and tuberculosis.

Characteristics of Exceptional Patients

Surprisingly, despite over a thousand case studies in the literature, there has not been a lot of research looking into what lies behind spontaneous remission other than this association with infection. That is, with the exception of one integrative oncologist and a Harvard student who published a book "Radical Remission: Surviving Cancer Against All Odds," looking at people with cancer who have better outcomes than would be predicted.

The answer to what makes a patient exceptional isn't simple. There aren't any clear steps, for example, that people can follow. And it doesn't appear to be tied to trying the latest integrative treatments. What is not surprising is what some of this research has found—the characteristics of people who do have spontaneous remission.

One underlying attribute is connectedness—something that's clearly been found to make a difference in quality of life, at least, for those with cancer. This included connectedness to God (or a higher power), self, family and friends, physicians and nurses, and other patients. Certainly taking part in a cancer support community has helped many people cope with the emotional aspects and isolation of living with cancer. There's just nothing like talking to someone who has been there. There have been many studies suggesting as well that survival is better in those who are well connected to family and friends.

Yet another non-surprising characteristic of those who have experienced spontaneous remission is that of advocacy. With the advances in medical research surrounding cancer, which is difficult for any one physician to stay on top off, being your own advocate or advocating for your loved ones with cancer is a good idea to begin with, and may improve outcomes.

What Can We Learn?

Certainly, spontaneous remission is uncommon, and it would be casting false hope to spend too much time considering this possibility. Yet talking about the uncommon finding of spontaneous remission emphasizes something important for everyone living with cancer. Statistics are numbers. They tell us how the "average" person did in the past during treatment. They are less reliable at predicting how any one single person will do, or how anyone will respond now that newer and better treatments are available. 

Taking a look at some of the characteristics of "exceptional patients" with cancer may give us some clues how to raise our odds. Since connectedness and community is important, consider joining a cancer support community Ask for and be willing to receive help and support from family and friends. And learn how to advocate for yourself as a cancer patient.

Taking a look at spontaneous remission, and this case of someone whose lung cancer "mysteriously disappeared" reminds us that we have much to learn and that hopefully, that new knowledge will guide us in new and better directions in our care for people with cancer in the future

Sources:

Engebretson, J., Peterson, N., and M. Frenkel. Exceptional Patients: Narratives of Connections. Palliative and Supportive Care. 12(4):29-276.

Frenke, M., Lev Ari, S., Engebretson, J. et al. Activism Among Exceptional Patients with Cancer. Supportive Care in Cancer. 2011. 19(8):1125-1132.

Haruki, T., Makamura, H., Tanaguchi, Y. et al. Spontaneous Regression of Lung Adenocarcinoma: Report of a Case. Surgery Today. 2010. 40(12):1155-8.

Jessy, T. Immunity over Inability: The Spontaneous Regression of Cancer. Journal of Natural Science, Biology, and Medicine. 2011. 2(1):43-49.

Zahl, P., Maehlen, J., and H. Welch. The Natural History of Invasive Breast Cancers Detected by Screening Mammography. Archives of Internal Medicine. 2008. 168(21):2311-6.

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