Remission

A 35 year old male patient with stage IV Lymphoma. Upon physical examination by the oncologist, he was found to have enlargement of lymph glands in his neck, under the arm and in his groin as well as enlarged Liver and Spleen. Chest X ray has shown that he has large lymph glands in his chest and a CT Scan of abdomen has shown a few abnormal areas in the liver as well as in lymph glands. His blood tests show anemia and elevation of his liver function tests and a bone marrow test is positive and shows evidence of lymphoma involvement. Detailed laboratory examination of bone marrow shoed certain genetic and chromosomal abnormalities that are seen in this disease.

Patient is then started on chemotherapy. One week later he is examined by the oncologist, who notices that the lymph glands in the neck are smaller. Two weeks later his liver and spleen are smaller. So we can say: The disease in this patient has responded to the chemotherapy and has entered a partial remission. Under this circumstance, there is no need for any further testing.

One month later, patient is examined and the disease has continued to respond. Two months later, after 2-3 cycles of chemotherapy, patient is found not to have enlarged nodes and both spleen and liver are normal in size. The blood tests for liver function tests have all normalized by now. A chest X-ray at this time shows no disease in the chest. Since this patient has had a very good response to treatment, the same chemotherapy is continued and there is no particular need for any other X rays. At this time we can say that the patient has entered a Clinical Complete Remission. Clinical refers to our observation based on simple examination and a chest X ray and blood tests.

Six month later, patient has now completed his chemotherapy and his examination is completely normal. At this point, all the tests that were positive and showed evidence of disease have to be repeated again. These are the Blood tests, chest X ray, CT Scan and bone marrow test. If all the test are normal and there be no evidence of the disease we then can say that the patient is in complete clinical, radiological, pathological and Cytogenetic remission.

• Clinical Remission based upon examination as simple blood test

• Radiological Remission based on CT Scans

• Pathological Remission based on bone marrow biopsy study.

• Cytogenetic Remission based on the genetic and chromosomal study oft he bone marrow.

Examination of bone marrow is the crucial element in determination of remission status in In leukemias.

Tumor markers are essential in determination of remission in patients with cancers of

• Testis

• Ovaries

• Gestational Trophoblastic Disease

Tumor markers are also used in other cancers as mean to determine the response to therapy and for early detection of a recurrence.

In patients with Multiple Myeloma, the remission status is determined by measuring the immune globulin levels in the blood, as well as repeating the bone marrow tests.