One of the questions most frequently asked by patients and their family members concerns the difference in prescribing follow-up examinations between one doctor and another. Indeed, it doesn’t seem to make much sense that one doctor should prescribe a lot of follow-up examinations every three months, while another may prescribe very few examinations every six months, or even only one annual physical examination without any other tests. 

This situation is a source of confusion, frustration and demands. However, there is a explanation: the value of follow-up examinations is more psychological than material. Indeed, the early diagnosis of disease relapse is of very little practical use, given that it concerns the growth of metastatic cells that were spread before the surgical operation FIGURE 13.

Fig 13. Relapse with metastases in spite of adjuvant therapy The white circle indicates the primary tumor that has already spread metastases at the time of surgical intervention ( the long thin red arrow). In this case the residual cancer cells are resistant to adjuvant therapy; they will grow despite adjuvant therapy and the disease will relapse. Unfortunately today it is not yet possible to predict if adjuvant therapy will work, or if it does not work, as in this case.

Therefore, while performing a lot of examinations at very short intervals may reveal a few metastases when they are still small, this will not, in fact, change the situation in comparison with a diagnosis made 2-6 months later. Indeed, visible metastases are only the “tip of the iceberg”; many more are destined to appear in time FIGURE 14.

Fig 14. On relapse, metastases may appear at different times and grow at different speeds. Sometimes the relapse occurs a few months after surgery; other times, even several years after surgery. This is due to the different growth rate of the metastases. No one knows why certain metastases grow very fast and others are very slow.

For the same reason, it generally makes no sense to operate in order to remove metastases “completely”. After only a few months, further metastases will appear and we will be back to square one; but this time, the patient will have been weakened by a surgical operation that has proved useless. WHY SURGERY IS ALMOST NEVER PERFORMED ON METASTASES. 

As we will see later, however, there are exceptions to this “dogmatic” rule that relapses are incurable.  SOME DISTANT METASTASES ARE OPERABLE.

This website is intended for patients and their family members, and it is unfortunate that we have to illustrate a concept and then contradict that same concept by quoting exceptions. However, this is precisely because the subject is so complex, and it is precisely why specialists are necessary. 

In conclusion, follow-up is generally recommended both for psychological reasons (reassurance) and to identify those exceptional cases that are still curable because disease relapse has been diagnosed early. 

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