Watch and wait

Not all cancers are the same. Some cancers grow quickly but many grow very slowly. When you are diagnosed with some types of cancer, you might not need treatment straight away. Doctors monitor you with regular check ups and tests. They sometimes call this 'watch and wait'.

There are different terms for watch and wait. These can sometimes mean slightly different things. The terms include:

• watch and wait
• watchful waiting
• active monitoring
• active surveillance

We use the term ‘watch and wait’ on this page. But this page is also for you if your doctor uses one of the terms above.

It can be hard to hear that you have cancer but not have treatment. You might feel worried that you aren't doing anything to stop the cancer. Or you might feel like the doctors are keeping treatment from you. Waiting for test results and check ups can also be difficult.

It might help to remember that research shows that for some slow growing cancers, it is safe to delay treatment.

What is watch and wait?

Watch and wait means that you have cancer, but you do not need treatment straight away. In some situations, you might never need treatment.

The doctors monitor you at intervals to see if your cancer changes. You have regular check ups. These might include having blood tests and other types of tests. The doctor uses the results to decide if you can continue to wait without treatment. Or if you need to start treatment.

Doctors use different terms for watch and wait. For example, active monitoring. For many cancers such as blood cancers, the different terms mean the same thing. 

For some cancers, such as prostate cancer, the terms mean slightly different things. You might have watchful waiting or active surveillance for prostate cancer. Both have the same aim which is to avoid treatment if you might not need it. But the reasons why and how the doctors monitor you are slightly different.

Why do doctors watch and wait?

Research shows that for some slow growing cancers, it is safe to delay treatment. Having treatment straight away doesn't always mean you are more likely to be cured, or live longer.

Instead, your doctor saves treatment for later on, if you need it. This might mean you have more options when you do need treatment. And you can avoid treatment side effects for as long as possible. 

Sometimes it is less clear whether you should wait or start treatment straight away. Your doctor will discuss the risks and benefits of delaying treatment with you. They will help you make a decision about the best thing to do for you.

When do doctors watch and wait?

Watch and wait is an option for some slow growing cancers that are not causing symptoms.

These include some chronic blood cancers such as:

• chronic lymphocytic leukaemia (CLL)
• some types of Non-Hodgkin lymphoma (NHL)
• hairy cell leukaemia
• myelodysplastic syndromes (MDS)
• smouldering (or asymptomatic) myeloma

Other types of cancer include:

• prostate cancer
• kidney cancer
• brain tumours
• ductal carcinoma in situ (DCIS)
• thyroid cancer

When do you start treatment?

The amount of time you wait before starting treatment varies. Each type of cancer can change and develop at different speeds. And this varies for each person. Your doctor will talk to you about what might happen. 

Some people can wait for a very long time before they need treatment, sometimes years. And some people never need to have any treatment. 

How you might feel

It can be very difficult to find out you have cancer but to not have any treatment. You might feel worried that you aren't doing anything to stop the cancer. And it can be hard to cope with uncertainty when you are waiting for test results and check ups.

You might also worry more than you did about your general health, and any new symptoms you have.

Chronic slow growing cancers can be different to other types of cancer. You often don’t look ill. And people around you might not even know you have cancer. Your doctor might tell you that your illness doesn’t need to affect your day to day life. Although this can be reassuring, some people feel as though they should just carry on as normal. This can be difficult to do. It can make it harder to seek support or tell people about feelings or concerns.

Challenges you might face

You may feel like you have lost control over your life. Some people feel a sense of loss for their old life and long to go back to it.

Being on watch and wait might mean you:

• have frequent trips to the hospital for the rest of your life
• often have to wait for test results which can be worrying
• have to adapt your work and family life
• face uncertainty about your future, making it hard to make plans

Some people find it’s helpful to know what to expect later down the line. There are often lots of different types of treatment, depending on your cancer type. Your doctor might be able to tell you what kind of treatment options you might have in the future. They won't be able to tell you when you will need treatment. But they can share other people's experiences. And tell you what they think might happen in the future months or years.

Tips for coping with your feelings:

• Remember that it's natural to experience different feelings when you are first diagnosed. And these feelings are likely to come and go.
• Try to talk to your friends and family about what is happening and how you feel. This can also help them support you.
• Get in touch with your doctor or specialist nurse if you are worried about any symptoms. They might be able to reassure you. Or they can find out the cause of the symptoms and plan treatment if necessary.
• You might find it easier to talk to someone outside your own friends and family. You could speak to a cancer nurse on a helpline, or to other people with your cancer type. 

You can look at our information about your cancer type to find out how often you will have check ups and what they will involve. Your doctor and nurse will also tell you about this. 

You can also find some useful organisations on the resources and organisations page for your cancer type. This page will be in the 'living with' section for your cancer type. Many of these organisations provide helplines and online forums where you can get support.

We have more information about your feelings, how cancer can affect these and where you can get support. You can read this in our section about mental health and cancer.