Untreated cancer
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Prognosis and Survival of Untreated Cancer
Untreated Hepatocellular Carcinoma (HCC)
The prognosis for untreated hepatocellular carcinoma (HCC) varies significantly based on the stage of the disease. A study involving 600 untreated HCC patients managed by the Italian Liver Cancer Group found that the overall median survival was 9 months, with tumor progression being the principal cause of death. Survival rates decreased progressively with advancing stages of the Barcelona Clinic Liver Cancer (BCLC) classification: BCLC 0 had a median survival of 38 months, BCLC A 25 months, BCLC B 10 months, BCLC C 7 months, and BCLC D 6 months. Factors such as female gender, presence of ascites, and multinodular tumors were identified as independent predictors of survival in advanced HCC cases.
Untreated Rectal Cancer
Untreated rectal cancer is rare due to modern medical interventions, but historical data provide insight into its prognosis. A review of archival literature revealed that the median survival for untreated rectal cancer patients was within the second year after symptom presentation, with a 5-year actuarial survival rate of 4.4%. Notably, survival patterns differed before and after 1925, with pre-1925 patients having a median survival of 21.5 months and post-1925 patients 10.2 months.
Untreated Head and Neck Cancer
The natural history of untreated head and neck cancer shows a grim prognosis. A study of 808 patients from 1953 to 1990 reported a median survival of 3.82 months, with performance status being the most significant predictor of survival. Approximately 50% of patients died within 4 months of diagnosis, although some survived up to 4 years depending on tumor location, extent, and performance status. Another study in Korea found that the median survival for untreated head and neck cancer was 9 months, with older age and low income being significant factors for not receiving treatment.
Untreated Breast Cancer
Historical data on untreated breast cancer indicate a potential for prolonged survival in some cases. A study analyzing 250 patients followed until death found a median survival time of 2.7 years, with 5- and 10-year survival rates of 18.4% and 3.6%, respectively. Another review highlighted that untreated breast cancer patients could survive almost 3-4 years, with 5-10% living longer than 10 years. These findings underscore the variability in the clinical aggressiveness of breast cancer, ranging from virulent to chronic disease.
Untreated Colorectal Cancer
Untreated colorectal cancer is almost uniformly fatal. A review of 60 patients in a community hospital showed that 48% died within 30 days of presentation, and two-thirds died within 1-2 months. Only two patients survived more than a year, indicating the high lethality of untreated colorectal cancer.
Untreated Cervical Intraepithelial Neoplasia Grade 2 (CIN2)
For women with untreated CIN2, the long-term risk of developing cervical cancer is significantly higher compared to those who receive immediate treatment. A study involving 27,524 women found that the cumulative risk of cervical cancer after 20 years was 2.65% for those under active surveillance, compared to 0.76% for those who underwent immediate treatment. This highlights the importance of continued follow-up for women opting for active surveillance.
Genetic Heterogeneity in Untreated Cancers
Genetic heterogeneity within untreated cancers is a critical factor in understanding their progression and treatment response. An analysis of seven types of untreated epithelial cancers found that driver-gene mutations were predominantly homogeneous within primary tumors and their metastases. This suggests that targeted therapies could be effective across different metastatic sites, emphasizing the potential for curative combination therapies.
Conclusion
The prognosis for untreated cancers varies widely depending on the type and stage of the disease. While some cancers like breast cancer may allow for prolonged survival in a subset of patients, others like colorectal and head and neck cancers are almost uniformly fatal without treatment. Understanding these natural histories is crucial for patient counseling and developing future therapeutic strategies.
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