Health
Not all cancers should be treated right away, medical experts say — here’s why
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When someone gets a cancer diagnosis, the initial reaction is usually to undergo treatment as quickly as possible — but for some types of disease, doctors may recommend a more conservative approach.
For certain cancers, immediate or aggressive treatment can cause more harm than good, according to multiple medical experts.
For example, treating slow-growing tumors with surgery, radiation or chemotherapy could create significant side effects without a survival benefit.
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“The fact that so many cancers will never kill you is not a justification for not knowing, because there is still plenty of room for ‘watchful waiting,’ as well as interventions that may improve quality of life even if they don’t extend life,” Dr. Marc Siegel, Fox News senior medical analyst, told Fox News Digital.
This is especially true as targeted cancer treatments emerge, which are more personalized and less likely to cause severe side effects, according to the doctor.
For precancerous, very early-stage breast conditions, careful monitoring may be more prudent than immediate surgery, research shows. (iStock)
“The fact that cancers are occurring earlier is a justification for heightened screenings, not the opposite,” Siegel added. “Information is power — what you do with that information is based on clinical judgment and the art of medicine.”
Below are some types of cancer that may not warrant treatment, according to research and doctors’ guidance.
No. 1: Prostate cancer (low-risk)
While some types of prostate cancer should be treated right away, others are better addressed by “watchful waiting,” according to Sanoj Punnen, M.D., a urologic oncologist with Sylvester Comprehensive Cancer Center, part of the University of Miami Health System.
“With respect to prostate cancer, for most low-risk cancers (Gleason 6 or grade group 1), we recommend initial observation and surveillance rather than immediate treatment,” he told Fox News Digital.
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The Gleason score is a grading system that ranks prostate cancer cells in terms of how abnormal they are, with 6 being the lowest grade and 10 being the highest grade (barely resembling normal cells).
“For high-grade tumors like Gleason 8, 9 or 10, we believe they progress quickly, so we recommend treatment to prevent the risk of metastasis,” said Punnen, who is also vice chair of research and a professor with the Desai Sethi Urology Institute at UHealth. “For low-risk tumors, we think they pose little risk, so we recommend just observation.”
“The fact that cancers are occurring earlier is a justification for heightened screenings, not the opposite.”
“But in the end, we can’t be sure, so our approach to observation includes serial monitoring of cancer status with PSA, MRI and occasional biopsy to ensure the tumor isn’t progressing.”
No. 2: Ductal carcinoma in situ (DCIS)
Also known as stage 0 breast cancer, DCIS is a non-invasive disease marked by abnormal cells in the lining of the breast milk ducts. The “in situ” is Latin for “in the original place,” which indicates that the cancer has not spread outside the milk ducts.
For this precancerous, very early-stage breast condition, careful monitoring may be more prudent than immediate surgery, research shows.
While some types of prostate cancer should be treated right away, others are better addressed by “watchful waiting,” according to a urologic oncologist. (iStock)
A 2024 study by the Dana-Farber Cancer Institute found that active monitoring for DCIS resulted in similar quality of life, mental health and symptom progression over a two-year period compared to a standard surgical approach.
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“These results suggest that in the short term, active monitoring is a reasonable approach to management of low-risk DCIS,” the lead researcher said in a press release. “If longer-term follow-up supports the safety of active management from a cancer outcome standpoint, this approach could be considered as an option for women with this condition.”
“But it is also critical that we understand how women feel when they are living with this ‘watch and wait’ approach and how it impacts their overall quality of life.”
Other research has suggested that women with low-risk DCIS did not have a higher rate of invasive cancer after two years of active monitoring, although each patient should discuss their individual risk level with an oncologist.
No. 3: Indolent (slow-growing) lymphomas
Non-Hodgkin lymphoma (NHL) is a type of cancer that starts in the lymphatic system, which includes the lymph nodes, spleen, thymus, bone marrow and other tissues.
Indolent lymphomas are those that “grow and spread slowly,” according to the American Cancer Society.
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The National Comprehensive Cancer Network (NCCN) recommends watchful waiting for asymptomatic, slow-growing follicular lymphoma, as a means of avoiding the toxicity of chemotherapy and immunotherapy until it’s absolutely necessary.
The Lymphoma Research Foundation confirms that doctors recommend “active surveillance” for some patients with slow-growing lymphoma.
Indolent lymphomas are those that “grow and spread slowly,” according to the American Cancer Society. (iStock)
“This approach may be started after the initial diagnosis or after relapse, depending on the situation,” the foundation states on its website. “Active treatment is started if the patient begins to develop lymphoma-related symptoms or if there are signs that the disease is progressing.”
Treatment should be started right away for aggressive (fast-growing) lymphomas.
No. 4: Chronic lymphocytic leukemia
One of the most common adult leukemias, chronic lymphocytic leukemia (CLL) originates in white blood cells (lymphocytes) in the bone marrow and then spreads to the bloodstream, according to the American Cancer Society.
CLL tends to grow slowly, with many patients experiencing no symptoms for years. Eventually, the cancer calls can spread to the lymph nodes, liver and spleen.
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Some studies have shown that early treatment for CLL does not improve survival rates compared to observation, and that the benefits may not outweigh the risks.
In a 2023 study presented at the European Hematology Association 2023 Congress in Frankfurt, Germany, researchers found that early treatment did not prolong overall survival compared to a placebo in patients with early, asymptomatic CLL.
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“I believe it’s fair to conclude that ‘watch-and-wait’ should remain the standard of care in the era of targeted drugs,” said researcher Petra Langerbeins, M.D., when presenting the findings.
No. 5: Low-grade endometrial cancer
For most patients with endometrial cancer, surgery is the first treatment, which entails removing the uterus, fallopian tubes and ovaries, according to the American Cancer Society.
However, in certain patients with low-grade cancer, such as older people, those with “frailty” and people with major health issues, doctors may recommend deferring surgery, which can pose a high risk.
The American Thyroid Association’s guidelines officially recommend active surveillance for very low-risk microcarcinomas. (iStock)
In cases where the patient has medical comorbidities or wants to preserve fertility, hormone treatment may be used instead of surgery, per the ACS.
“It’s usually also considered for cancer that is lower-grade, low-volume and slow-growing,” the above source stated.
No. 6: Some early kidney cancers
In cases of kidney cancer with small tumors (≤3 cm) or benign lesions, doctors may recommend monitoring them instead of undergoing surgery for removal.
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The American Urological Association confirms that active surveillance is an option for some small renal masses (localized tumors).
“I believe it’s fair to conclude that ‘watch-and-wait’ should remain the standard of care in the era of targeted drugs.”
Deferred treatment is particularly recommended for older patients or those with “significant comorbidities,” research shows.
“Shared decision-making about active surveillance should consider risks of intervention/competing mortality versus potential oncologic benefits of intervention,” the UAU states in its guidance.
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Data from the Delayed Intervention and Surveillance for Small Renal Masses (DISSRM) Registry showed that patients with active surveillance had a 99% or greater cancer-specific survival rate — virtually the same as patients who received immediate treatment.
No. 7: Small papillary thyroid cancers
Papillary thyroid cancer (PTC), the most common type of thyroid cancer, may not warrant treatment for small tumors measuring 1 centimeter (10 mm) or less, which are called microcarcinomas.
A young multiracial female is undergoing a diagnostic medical imaging procedure in a state-of-the-art hospital setting with CT simulator. The image illustrates the use of cutting-edge technology for healthcare and treatment in a modern medical environment. The portrayal highlights precision, care, and the sophistication of contemporary medical practices. (iStock)
Research found that when using active surveillance for 10 to 20 years, less than 10% experienced significant growth, only 5% developed lymph node spread and there were no thyroid-cancer deaths.
The American Thyroid Association’s guidelines officially recommend active surveillance for very low-risk microcarcinomas.
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While many patients with low-risk tumors can safely delay treatment, this does not apply to all cancers or all patients.
As cancer behavior and personal health factors vary widely, patients should consult their doctor to determine the most appropriate course of care based on their individual risk level.
Jill Biden says Joe’s debate performance made her wonder if he had a stroke
Former first lady Jill Biden revises her account of former President Joe Biden’s disastrous 2024 debate, now alleging she feared he was suffering a stroke. This new statement from the first lady contrasts sharply with her earlier public affirmations of his performance. Contributor Ben Domenech scrutinizes the timing and motivations behind this sudden shift.
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Former first lady Jill Biden has expressed her concerns about former President Joe Biden’s health status, noting that she feared he was having a stroke during a 2024 debate against President Donald Trump.
Biden struggled his way through the performance, with long periods of silence, confused facial expressions and stammered speech. In a recent interview with CBS, Jill Biden commented that she was “frightened.”
“I don’t know what happened,” she said. “I mean, when I watched it, I thought, ‘Oh my God, he’s having a stroke,’ and it scared me to death.”
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A stroke occurs when there is bleeding in the brain or when blood flow to the brain is blocked, according to Mayo Clinic.
Identifying a stroke may be difficult, as symptoms can vary.
Stroke symptoms can include balance loss, weakness, slurred speech, face drooping, confusion and severe headaches. (iStock)
The American Stroke Association (ASA) identifies the following key warning signs, using the acronym “B.E. F.A.S.T.”
- B – Balance loss
- E – Eye (vision) changes
- F – Face drooping
- A – Arm weakness
- S – Speech difficulty
- T – Time to call 911
In a situation in which someone could be having a stroke, “the only” thing to do is to call 911, Fox News senior medical analyst Dr. Marc Siegel told Fox News Digital.
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The doctor emphasized other symptoms to watch for, including weakness on one side, slurred speech, difficulty processing information and confusion.
The ASA also warns that severe headaches can also be a sign of stroke.
At the first sign of stroke, 911 should be contacted immediately, as 1.9 million brain cells die every minute that a stroke goes untreated. (iStock)
Siegel advised against giving the person an aspirin, as it could worsen bleeding in the brain if that is the cause of stroke.
With an ischemic stroke, that type of medication could be helpful.
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The ASA says 1.9 million brain cells die every minute that a stroke goes untreated, which means earlier treatment leads to higher survival rates and lower risk of disability.
“In medicine, we use the term ‘time is brain,’” Siegel said. “This means that the faster you bring the patient to the emergency room, the faster they can receive emergency treatment if indicated to reopen the blocked artery in the brain, if there is one.”
Brain imaging should be done within the first several hours after seeking medical attention for a stroke, according to a top physician. (iStock)
Brain imaging can also be done on arrival at the ER, which should occur within the first several hours, Siegel said.
Anyone who is experiencing a stroke should not drive themselves to the hospital, according to the CDC. Instead, the person should get a ride or call 911 — as treatment begins inside the ambulance.
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About 80% of strokes are preventable, the American Heart Association states.
Prevention includes managing high blood pressure, diabetes, atrial fibrillation and other risk factors.
One in four survivors have another stroke within the next five years, per CDC data, so those at higher risk should prepare a prevention and treatment plan.
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Fox News Digital’s Alexander Hall contributed to this report.
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Health
Single infusion of controversial drug changed severe depression symptoms within hours, study finds
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People experiencing severe depression with suicidal symptoms may not have to wait weeks for traditional antidepressants to take effect.
A recent review suggests that a single intravenous ketamine infusion can provide rapid relief for some patients.
Originally developed as an anesthetic, ketamine is a medicine that can reduce pain and, in some cases, help treat depression, but it can also be misused as a recreational drug, experts warn.
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Researchers from the University of Connecticut School of Medicine reviewed 26 clinical trials that included more than 1,100 patients. Approximately 626 received ketamine and 540 served as controls who did not take the drug.
Most of the trials included patients with major depressive disorder, but 11.5% included those with bipolar depression and 7.7% included people with both unipolar and bipolar depressive diagnoses.
A recent review suggests that a single intravenous ketamine infusion can provide rapid relief for some patients with treatment-resistant depression. (iStock)
Compared to a placebo, a single treatment significantly reduced depression in just four hours and dramatically lowered suicidal thoughts within 24 hours, the study found.
Patients reported fewer depressive symptoms after a week and reduced suicidal thoughts for up to a month after one ketamine infusion. Those who received repeated ketamine infusions showed a similar reduction of suicidal and depressive symptoms at the end of the treatment.
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The most common adverse effects of ketamine – including headaches, numbness, dissociation (“out of body” experiences), nausea, dizziness and visual disturbances – were temporary and resolved within hours of the infusion.
Rarer, more serious side events included hospitalization, suicide attempts and suicide, but most were unrelated to ketamine, the review stated.
The analysis was published in May in JAMA Psychiatry.
Treatment-resistant depression
Major depressive disorder is a formal psychiatric diagnosis affecting approximately 280 million people globally, according to recent research.
Effective treatment involves a combination of therapy and medication, frequently antidepressants. However, for a few patients, symptoms do not respond to multiple therapies, a condition known as treatment-resistant depression, doctors say.
“When all existing treatment options fail, patients with severe depression could consider ketamine infusions.”
These patients are at a higher risk of very serious, sometimes tragic consequences, including suicidal thoughts, suicide attempts and death.
“When all existing treatment options fail, patients with severe depression could consider ketamine infusions,” lead author Taeho Greg Rhee, PhD, of the University of Connecticut School of Medicine, told Fox News Digital. “This is still a safer option when compared to electroconvulsive therapy (ECT).”
Compared to a placebo, a single treatment significantly reduced depression in just four hours and dramatically lowered suicidal thoughts within 24 hours, the study found. (iStock)
Traditional antidepressants stabilize mood by slowly elevating serotonin levels in the brain, but it can take weeks for the full effect to be achieved.
Ketamine, in contrast, works rapidly by blocking glutamate, a neurotransmitter that can impact emotions negatively when levels are too high in the brain, according to Cleveland Clinic.
Implications for care
The authors say their findings have two important potential clinical applications.
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First, ketamine’s rapid effects can be a life-saving treatment in the emergency room for patients presenting with suicidal ideation.
Experts caution that the medication should only be administered in closely monitored settings, such as clinics, to ensure safe treatment. (iStock)
Second, the effects of a single ketamine infusion are relatively short-lived – as almost all patients relapsed with depressive symptoms after a single infusion – so those with treatment-resistant depression will need repeated sessions.
“While intravenous ketamine is not yet FDA-approved for treating depression, it may still be used with off-label indications for those with severe depression and/or with a high risk of suicidal behaviors,” said Rhee.
Experts urge caution despite promise
Dr. Lama Bazzi, a psychiatrist in private practice in New York City, has had several patients receive ketamine infusions.
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“For a small subset of patients in a major depressive episode or struggling with suicidal thoughts, intravenous ketamine can be genuinely lifesaving,” Bazzi, who was not involved in the study, told Fox News Digital. “The relief they experience is almost immediate, offering them distance from the intensity of their emotions.”
However, she cautions that the medication should only be administered in closely monitored settings, such as clinics, to ensure safe treatment.
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Ketamine is not a panacea, Rhee agreed, warning of the potential risk of abuse and addiction.
“It should only be used medically,” he advised.
Ketamine’s rapid effects can be a life-saving treatment in the emergency room for patients presenting with suicidal ideation, some experts claim. (Getty Images)
Dr. Marc Siegel, Fox News senior medical analyst, noted in previous comments to Fox News Digital that ketamine is increasingly being used to treat severe depression, but emphasized that it should be administered under careful medical supervision because of its potential risks.
Study limitations
Although the studies compared ketamine with a placebo, some patients may have realized they were receiving the drug. This could have influenced how they reported their symptoms and how effective they perceived the treatment to be, according to the researchers.
“It should only be used medically.”
Another limitation is the small sample size of the studies, which could make the effects seem disproportionately magnified.
Also, as this was a review of many different studies, it is challenging to apply the findings to the general population, the researchers noted.
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“While long-term outcomes have not been studied, I believe that when patients are severely depressed or suicidal, ketamine is sometimes the only choice that almost always works,” Bazzi added.
Anyone interested in exploring alternative depression treatments should first consult a doctor.
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