colon cancer stage 4 life expectancy no chemo

Suzanne Dixon, MPH, MS, RDN, is an award-winning registered dietitian and epidemiologist, as well as an expert in cancer prevention and management. Now, when a person has only a few or small areas of metastases, treatment of the metastases may be considered. While surgery remains a primary form of colon cancer treatment, it is not appropriate for everyone. Your body's disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that blind the immune system cells from recognizing the cancer cells. Routine exercise may improve colon cancer survival, with some studies reporting anywhere from a 40% to 70% reduction in post-treatment mortality compared to people who engage in no exercise. Primary malignant melanoma of the rectum: Report of two cases. It can be distressing to be diagnosed with colon cancer and even more distressing to be faced with the survival statistics. Race plays a central, albeit indirect, role in cancer survival rates due mainly to the lack of access to quality healthcare. Ann Oncol. Targeted drug treatments focus on specific abnormalities present within cancer cells. Numerous factors can influence survival times, including the type and stage of cancer as well as certain modifiable and non-modifiable risk factors. The American Cancer Society offers programs and services to help you during and after cancer treatment. Mayo Clinic College of Medicine and Science, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Graduate Medical Education, Mayo Clinic School of Continuous Professional Development, Mayo Clinic on Incontinence - Mayo Clinic Press, NEW Mayo Clinic on High Blood Pressure - Mayo Clinic Press, Mayo Clinic on Hearing and Balance - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Financial Assistance Documents Minnesota, Our caring team of Mayo Clinic experts can help you with your colon cancer-related health concerns. Grothey A, et al. The Lyda Hill Cancer Prevention Center provides cancer risk assessment, screening and diagnostic services. Riihimki M, Hemminki A, Sundquist J, Hemminki K. Patterns of metastasis in colon and rectal cancer. 10 out of 100 people (10%) with stage 4 bowel cancer (also called Dukes' D) will survive their cancer for 5 years or more after they're diagnosed. The surgical removal of the primary tumor, known as a resection, can increase the odds of remission and reduce the likelihood of disease progression. There are several different regions to which this occurs. J Gastrointest Oncol. Life expectancy is lower than it is for earlier stages of cancer. We avoid using tertiary references. Palliative care is provided by a team of doctors, nurses and other specially trained professionals that work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing care. Having a lower score generally means that you are less able to tolerate cancer treatments. If your doctor suspects you may have colon cancer, you'll likely be referred to specialists who treat colon cancer. Li M, Zhang S, Gu F, et al. 83(1):45-53. If you've been diagnosed with colon cancer, your doctor may recommend tests to determine the extent (stage) of your cancer. Doctors may also recommend radiation therapy in late-stage colon cancer to help reduce symptoms such as pain and discomfort. American Cancer Society. Make your tax-deductible gift and be a part of the cutting-edge research and care that's changing medicine. Race: White Black Other. For example, if the 5-year relative survival rate for a specific stage of colon or rectal cancer is 80%, it means that people who have that cancer are, on average, about 80% as likely as people who don't have that cancer to live for at least 5 years after being diagnosed. Read our, How Immunotherapy Works for Cancer Treatment. It is up to you. Knowing your options regarding information sharing about your cancer, your treatment decisions, and end of life care decisions will help you move forward at a difficult time. Studies suggest that the overall five-year survival rate for primary colorectal lymphoma is 56.4%.. Prognostic survival associated with left-sided vs right-sided colon cancer: A Systematic review and meta-analysis. According to a 2017 study from Cleveland Clinic, a low, intermediate, and high PS score translates to a mortality rate of 8.1%, 11.2%, and 32.5%, respectively, within six months of the diagnosis.. Journal of Surgical Oncology. American Cancer Society. Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time (usually 5 years) after they were diagnosed. If this shrinks the tumors, they may then ask a surgeon to proceed with the surgery. Other treatment options can cause discomfort and may produce additional symptoms that make the persons quality of life worse. What does it take to outsmart cancer? Primary colorectal lymphomas account for just 0.5% of all colorectal cancers and around 5% of all lymphomas. But people with an increased risk, such as those with a family history of colon cancer or African-American heritage, should consider screening sooner. Mayo Clinic Minute: Why millennials should know colon cancer symptoms. It means that you are choosing to hope for the best quality of life possible in the days you have left. Stage 4 rectal cancer survival rate. Call Heather on 07986 473520 or Darren on 07958 382 389 . (Don't miss how this woman is defying her stage 4 colon cancer prognosis.) One study on signet ring cell carcinoma found that it had a much greater survival rate in people who saw it originate in the stomach, compared to those who had it start in other areas of the body, like the pancreas or gallbladder. If it does, they may include: changes in bowel habits diarrhea constipation a feeling that the bowel does not empty fully blood in. Weve invested more than $5 billion in cancer research since 1946, all to find more and better treatments, uncover factors that may cause cancer, and improve cancer patients quality of life. Learn about what it involves, how to. For those who have metastatic colon cancer with only a few metastases to the liver or lungs, removing the metastases can sometimes increase the chance of long-term survival. 1. information highlighted below and resubmit the form. Colon cancer treatment (PDQ®) patient version. A fecal immunochemical test (FIT) can screen for colorectal cancer. Read our. Treatment . Becoming involved in a colon cancer support communityideally, one in which you can communicate with other people coping with stage 4 canceroffers a source of support and can be invaluable in learning about the latest research on the disease. Your healthcare provider can make a note in your chart describing your goals for information sharing about your cancer treatment. Whether you or someone you love has cancer, knowing what to expect can help you cope. This involves creating an opening in the wall of your abdomen from a portion of the remaining bowel for the elimination of stool into a bag that fits securely over the opening. National Cancer Institute. Not all stage 4 colon cancers are alike. Tracked over time, the level of CEA in your blood may help your doctor understand your prognosis and whether your cancer is responding to treatment. Stage 4 cancer, sometimes called advanced cancer or late-stage cancer, is cancer that has metastasized (spread) to other parts of the body from the original site. If the colon cancer has spread too far for surgery to be effective, chemotherapy is the primary treatment option. Start Here. The average patient diagnosed with late-stage pancreatic cancer will live for about 1 year after diagnosis. 2018;30(4):262-268. doi:10.1097/CCO.0000000000000453. Additional surgery may remove the areas of tissue into which the cancer has spread. Int J Cancer. Tax ID Number: 13-1788491. This content does not have an English version. The known five-year relative survival rate of such colon tumors is 90 percent. ANSWER: The rate of colorectal cancer survival five years after initial diagnosis has been on the rise. doi:10.1200/JCO.2011.35.2385, Wu SG, Chen XT, Zhang WW, Sun JY, Li FY, He ZY, Pei XQ, Lin Q. According to SEER estimates for 2020, the five-year survival rate for colorectal cancer in the United States breaks down as follows: The majority of colon cancers involve a type of cancer known as adenocarcinoma, which originates in glands and glandular tissues. How doctors diagnose peritoneal cancer Doctors may diagnose and stage peritoneal cancer with a series of tests, which. The 5-year survival rate for stage 4 colon cancer is just under 15%. Anyone who receives a stage 4 colon cancer diagnosis will have to make some decisions about the way forward, particularly regarding treatment options. If you are ready to make an appointment, select a button on the right. People can live many months and even years with stage 4 colon cancer. Iran J Cancer Prev. 2015;6(6):605-12. doi:10.3978/j.issn.2078-6891.2015.070, Sohal DPS, Kuderer NM, Shepherd FA, et al. It might be used to shrink a large cancer before an operation so that it can be removed more easily. Immunotherapy is usually reserved for advanced colon cancer. In time, people learn to cope in their own unique ways. Andre T, et al. Where do these numbers come from? The correct diagnosis of colon cancer may take patience, as doctors use many tests to detect and locate cancer. 2018;29(2):472-83. doi:10.1093/annonc/mdx761. This treatment might even shrink the tumor for a time, but it will not usually cure the cancer. Whats the Difference Between Palliative Care and Hospice? These newer treatments can extend life and provide options not available just a few short years ago. 2017 Feb 1;3(2):211-219. doi: 10.1001/jamaoncol.2016.4227. Its also important to follow recommended screening guidelines, which can help detect certain cancers early. Stage IV and recurrent colon cancer treatment, Patterns of metastasis in colon and rectal cancer, The concept of oligometastases in colorectal cancer: from the clinical evidences to new therapeutic strategies. How someone does today with colon cancer may be very different than how someone may have done even just five years ago. If there is a bowel perforation or obstruction at the time of diagnosis. For most people, stage 4 colon cancer is not considered curable. For many people, however, these treatments are not possible, and the focus of treatment becomes trying to control cancer to extend life, while emphasizing the quality of life. That means that of all people who have bladder cancer, 77 of every 100 are living five years after diagnosis. 3. What is the optimal timing for liver surgery of resectable synchronous liver metastases from colorectal cancer? The researchers further concluded that PS plays a more central role in survival times than either age or co-occurring medical conditions. Petrelli F, Tomasello G, Borgonovo K, et al. All rights reserved. Log in to our secure, personalized website to manage your care (formerly myMDAnderson). Another name for it is metastatic, or stage IV, colon cancer. 2022; doi:10.1200/JCO.21.02505. Colon and Rectal Cancer Life Expectancy Statistics Rectal cancer is often linked with colon cancer in cancer survival statistics; however, they have differing survival rates. While age clearly plays a role in cancer survival times, not all older people are at equal risk. Doctors may recommend some treatment regimens that include a targeting drug, which targets either the vascular endothelial growth factor (VEGF) pathway or the epithelial growth factor receptor (EGFR) pathway. This treatment may help destroy cancer cells without harming the healthy liver cells in the process. Levamisole and fluorouracil for adjuvant therapy of resected colon carcinoma. https://www.nccn.org/professionals/physician_gls/default.aspx. 1994;69:834. Stage 4 colon cancer occurs when cancer in the colon spreads or metastasizes to other tissues and organs. This has to be your decision alone, and unfortunately, many people are begged by loved ones to continue treatment even when the side effects far outweigh any benefits. By definition, stage 4 colon cancers are those which have traveled beyond the colon (metastasized). This is the proportion of people who will live for at least five years. How much time can I take to make my decision about treatment? You will receive the first colon cancer care journey message in your inbox shortly, which will include the latest treatment options, innovations and other information from our colon cancer experts. Will any of the treatments cure my colon cancer? Lifestyle factors associated with survival after colorectal cancer diagnosis. The known five-year relative survival rate of such colon tumors is 71 percent. This has changed. This is a narrative that not only affects people with colon cancer but all other health conditions as well. Many family members want complete information about how long a loved one may live after being diagnosed with stage 4 colon cancer. Adenocarcinoma accounts for around 95% of all colorectal cancers. 5th ed. By surgically removing the cancerous cells, doctors hope to help the person live longer. Of course, the most important member of your cancer care team is you. That said, reach out to your friends and family for support. 2023 Dotdash Media, Inc. All rights reserved. Mayo Clinic, Rochester, Minn. Oct. 10, 2019. Curr Opin Oncol. Raphael MJ, et al. Ask your doctor, who is familiar with your situation, how these numbers may apply to you. doi:10.17795/ijcp.3439, Tam SY, Wu VWC. When palliative care is used along with all of the other appropriate treatments, people with cancer may feel better and live longer. You may opt-out of email communications at any time by clicking on Palliative care. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Colorectal cancer: Screening and management (adult). If you are a Mayo Clinic patient, this could COVID-19; Health News; . You can find out more about our use, change your default settings, and withdraw your consent at any time with effect for the future by visiting Cookies Settings, which can also be found in the footer of the site. Around 25% of bladder cancers invade the muscle wall of the bladder. Primary colorectal lymphoma is a type of non-Hodgkin lymphoma (NHL) affecting a type of white blood cell called a lymphocyte. Chemotherapy may be used before or after this type of procedure. Surgeons can place a stent, which is a hollow tube that typically consists of mesh metal or plastic, into the colon during a colonoscopy. Dean PA, et al. For instance, the overall five-year survival rate for bladder cancer is 77 percent. Become a volunteer, make a tax-deductible donation, or participate in a fundraising event to help us save lives. Cigarette smoke not only induces chronic inflammation but also causes oxidative damage to DNA. These statistics can be confusing and may lead you to have more questions. Making Strides Against Breast Cancer Walks, ACS Center for Diversity in Research Training. Instead of focusing on treatments to attack cancer, hospice care focuses on treatments to control the symptoms of cancer, and hopefully improve your quality of life. The current 5-year survival rate for stage 4 colon cancer, according to the American Cancer Society, is 14%. As treatment options improve, so do survival rates. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. JNCI Cancer Spectrum. Below are some of the resources we provide. There are several different regions to which this occurs. Colon cancer can have symptoms such as fatigue, weight loss, blood in the stool, constipation, or thin, pencil-shaped stools. Learn about clinical trials at MD Anderson and search our database for open studies. Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition. At its earliest stage (stage 0), colon cancer is limited to the inner lining of your colon. It is normal to feel depressed, anxious, or worried when colorectal cancer is a part of your life. Get our printable guide for your next doctor's appointment to help you ask the right questions. Long-term outcomes after surgical resection in patients with stage IV colorectal cancer: A retrospective study of 129 patients at a single institution. Thiels CA, et al. Remember that survival rates are just estimates, or educated guesses. In: Abeloff's Clinical Oncology. Or it might be necessary to connect the colon to an opening (stoma) in the abdominal wall, where waste leaves the body and collects in a bag attached to the opening. The 5-year survival rate for people with stage 4 colon cancer is less than 15%. Age: <50 50-59 60-69 70-79 80+. Colon cancer affects roughly 150,000 Americans each year, resulting in around 53,000 deaths, according to data from the National Cancer Institute. 2019;9:208. doi:10.3389/fonc.2019.00208, Mauri G, Sartore-Bianchi A, Russo AG, Marsoni S, Bardelli A, Siena S. Earlyonset colorectal cancer in young individuals. Review/update the Based on this data, here is the breakdown by stage: Localized. Targeted drugs are typically reserved for people with advanced colon cancer. There are five stages of colon cancer, ranging from 0 to 4. Conversely, 23 out of every 100 are dead within five years of a bladder cancer diagnosis. Radiation therapy is a treatment for cancer. A cancer diagnosis can be emotionally challenging. For example, if the disease has spread to the liver, potential symptoms can include jaundice and swelling of the belly. Screening has been shown to reduce your risk of dying of colon cancer. According to SEER estimates for 2020, the five-year survival rate for colorectal cancer in the United States breaks down as follows: 1 Survival Rate by Cancer Type The majority of colon cancers involve a type of cancer known as adenocarcinoma, which originates in glands and glandular tissues. Atlanta, Ga: American Cancer Society; 2023. With recent advances in cancer treatment, and many new cancer drugs, such as targeted therapies and immunotherapy being studied in clinical trials, these numbers are expected to change. If you live beyond the six months period, that's wonderful! These numbers are based on people diagnosed with cancers of the rectum between 2012and 2018. Although there are often still several treatment options available, including surgery and chemotherapy, some people with late-stage cancer choose not to have medical treatment and to seek palliative care instead. Verywell Health's content is for informational and educational purposes only. Even healthcare providers are reluctant to bring up the issue. Sometimes it's combined with radiation therapy. The survival rate will be different for those in whom the cancer has spread further or returned after treatment. Doru Paul, MD, is board-certified in internal medicine, medical oncology, and hematology. 2018;3:42. doi:10.21037/tgh.2018.07.05. When cancerous cells have spread to distant organs and tissues, surgery is unlikely to cure cancer. Hepatic artery infusion is a type of regional chemotherapy, which involves delivering a chemotherapy drug directly into the hepatic artery in the liver. Our team is made up of doctors andoncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing. The 5-year survival rate for a disease will give you an estimate of how long someone may have lived who was diagnosed five years ago. Targeted drugs are usually combined with chemotherapy. Nosher, J., Ahmed, I., Patel, A. et al. Mol Oncol. One in 22 men and one in 24 women will receive a colon cancer diagnosis during their lifetime. Accessed Jan. 30, 2019. To provide you with the most relevant and helpful information, and understand which For example, if the 5-year relative survival rate for a specific stage of colon or rectal cancer is 80%, it means that people who have that cancer are, on average, about 80% as likely as people who dont have that cancer to live for at least 5 years after being diagnosed. Staging helps determine what treatments are most appropriate for you. Inoue Y, Imai Y, Osumi W, et al. What is important to know, however, is that choosing hospice care does not mean that you are giving up. A stoma is usually temporary, but is sometimes permanent. Metastatic cancer: When cancer spreads. When colon cancer of a person progresses to stage 4, it means that cancer has metastasized (advanced or spread) to other tissues or parts of the body. 2014;25(8):1517-25. doi:10.1093/annonc/mdu040, Ordonez-Mena JM, Walter M, Schottker B, Trichopoulou A, Brenner H. Impact of prediagnostic smoking and smoking cessation on colorectal cancer prognosis: A-analysis of individual patient data from cohorts within the CHANCES consortium. However, there are still some treatment options to consider, as well as other factors to keep in mind. This happens when cancer cells break away from the primary tumor and enter the bloodstream or lymphatic system. If a colonoscopy is used for screening, polyps can be removed during the procedure before they turn into cancer. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. We have many more treatments available at this time, with even more available in clinical trials. If the cancer has grown into or through your colon, your surgeon may recommend: Surgery to create a way for waste to leave your body. If you have questions about MD Andersons appointment process, our information page may be the best place to start. Transl Gastroenterol Hepatol. The. Plymouth Meeting, Pa.: National Comprehensive Cancer Network. What will that cost, and will my insurance cover it? Accessed. Coping. The 5-year relative survival rate . Philadelphia, Pa.: Churchill Livingstone Elsevier; 2014. https://www.clinicalkey.com. Stage IV and recurrent colon cancer treatment. Your doctor might have your cancer cells tested to see if they're likely to respond to this treatment. The advent of new treatments is a double-edged sword. Other family members may find this information very upsetting. Feldman M, et al. We link primary sources including studies, scientific references, and statistics within each article and also list them in the resources section at the bottom of our articles. In the past, we often simply ran out of treatments to offer, but today we have reached a point in which the choice to discontinue treatments often needs to be an active decision. They are extremely rare, accounting for less than 0.1% of all colon cancers, and have an overall five-year survival rate of 43.8%.. Treating stage IV colon cancer Stage IV colon cancers have spread from the colon to distant organs and tissues. The American Cancer Society (ACS) note that the 5-year relative survival rate for people with stage 4 colon cancer that has spread is 14%. This way, everyone on the healthcare team will be on the same page during appointments. Signet ring cell carcinoma is a type of cancer that causes a tumor to form in the breast, colon, gallbladder, pancreas, stomach, or urinary bladder. Expert Rev Gastroenterol Hepatol. Clinical predictors of early mortality in colorectal cancer patients undergoing chemotherapy: Results from a global prospective cohort study. When surgery is indicated, the resection of the primary tumor can increase the overall five-year survival rate to 73.8% while reducing the risk of recurrence to just 6.4%. Finding colon cancer at its earliest stage provides the greatest chance for a cure. Where is my colon cancer located in my colon? Getting practical and emotional support can help you cope with your diagnosis, and life during and after treatment. We can also help you find other free or low-cost resources available. Sarcomas are a broad category of cancers affecting connective tissues. 2018;12(2):209-214. doi:10.1080/17474124.2018.1416291. In many cases, the stage of your cancer may not be fully determined until after colon cancer surgery. Additionally, experts base these statistics on past cases. Hepatic artery infusion pumps. Living as a Colorectal Cancer Survivor. However, other factors, such as the chosen treatment methods and the persons overall health, contribute to life expectancy. There are other less common types, some of which are more aggressive and harder to treat. Compared to typical adenocarcinoma, mucinous adenocarcinoma is associated with no less than a 20% reduction in overall survival times., Signet-ring cell carcinoma accounts for less than 1% of colon cancers and is differentiated by the appearance of its cells. 8. Tomioka K, Ojima H, Sohda M, et al. Transl Gastroenterol Hepatol. Are there any brochures or other printed material that I can take with me? They may not want to hear it. https://www.nccn.org/professionals/physician_gls/default.aspx. 1990;322:352. Life expectancy: At 78, with stage IV colon cancer, the survival is about 4-6 months without treatment. For reprint requests, please see our Content Usage Policy. This is their best guess, which is based on your particular case. But in July 2017, six pump treatments in, the chemotherapy that saved Carole's life from stage IV colon cancer caused her liver to begin to fail. In specific cases where the cancer has spread only to the liver or lung but your overall health is otherwise good, your doctor may recommend surgery or other localized treatments to remove the cancer. Colon cancer most often spreads to the liver, but it may also reach the lungs, the lymph nodes, or the lining of the abdominal cavity. Many people admit that after choosing hospice care, they wish they had done so earlier. In people with inoperable colon cancer, a minimally invasive approach called stereotactic radiation therapy (SBRT) offers a viable alternative to surgery. This survival statistic also only applies to stage 4 colon cancer when doctors first diagnose it. The most important thing to know is that you can learn as much or as little as you want about your prognosis. Chief among them is the Eastern Cooperative Oncology Group (ECOG) system, which classifies PS on a score of 0 (fully active) to 4 (fully disabled). Colon cancer. And it helps you and your family get the most out of the time you have left together. 2019;13(2):109-31. doi:10.1002/1878-0261.12417, Van Eeghen EE, Bakker SD, van Bochove A, Loffeld RJLF. The treatment is generally less debilitating than treatments for other forms of cancer, Morris said, adding that many patients can work while receiving chemotherapy. Despite the overall poor prognosis and the fact that the disease is mostly incurable, pancreatic cancer . Let's look at what having stage 4 colon cancer means, how long people usually live with this stage of the disease, and what you need to know to make the best decisions possible. My stage IV colon cancer diagnosis In January 2006, I had a total colectomy. Can you explain my pathology report to me? Jan. 30, 2019. the unsubscribe link in the e-mail. These factors not only contribute to the onset of the disease but appear to increase the risk of colon cancer recurrence. Sign up for free and receive the latest on colon cancer treatment, care and management. The 5-year survival rate for people with stage 4 colon cancer is less than 15%. The life expectancy for people with low-grade colon cancer is also considered to be better. Of the 30% that are malignant, the majority occur either in the stomach, small intestine, or rectum., GIST is associated with generally poorer outcomes, with an overall five-year survival rate of 46%., Leiomyosarcoma is a type of cancer affecting smooth muscles, including those of the colon and rectum. If your cancer is very advanced or your overall health very poor, your surgeon may recommend an operation to relieve a blockage of your colon or other conditions in order to improve your symptoms. 2023 Dotdash Media, Inc. All rights reserved. Your doctor may ask: Connect with others like you for support and answers to your questions in the Colorectal Cancer support group on Mayo Clinic Connect, a patient community. In stage 4, cancer has spread to other parts of the body, such as the liver, lungs, or lymph nodes. Yes, and the odds are best the earlier the cancer is found. Colon cancer often doesn't have noticeable symptoms until it's advanced. Moertel CG, et al. Some people may have their colon cancer reappear, which is why cancer survivors are recommended to visit their doctor regularly after treatment is finished. How Non-Small Cell Lung Cancer Is Treated, What Happens When Lung Cancer Spreads to the Brain, learn how to be your own advocate in your cancer care, Colon cancer treatment (PDQ) Health Professional Version. We couldnt do what we do without our volunteers and donors. The 5-year relative survival rate for localized bladder cancer varies by the type of cancer. Doctors may also follow the stage number with a letter that offers more information. Colon cancer most often spreads to the liver, but it can also spread to other places like the lungs, brain, peritoneum (the lining of the abdominal cavity), or to distant lymph nodes. Recurrence and five -year survival in colorectal cancer patients after surgery.

Leigh Brock Wbtv, Bridgewater Accident Yesterday, Advantage And Disadvantage Of Pointer, Crunchy Food Psychology, Principals Dealing With Difficult Teachers, Articles C

colon cancer stage 4 life expectancy no chemo

You can post first response comment.

colon cancer stage 4 life expectancy no chemo