Alexis Devaney was unaware of the large tumor growing in her body until a friend of the family pointed out a peculiar lump in her back during a visit. A few scans and biopsies later, she was informed that she had thyroid cancer. She was 12-years-old at the time.

“Not too long after, I had a total thyroidectomy,” said the now 24-year-old Devaney, a Brooklyn-based wedding photographer, in an interview with Mashable. 

“And they took out two parathyroid [glands] and a bunch of lymph nodes.” 

Following the surgery, she also received radiation treatment.

For the next five years, Devaney received regular check-ups — every few months for a while, eventually graduating to once a year — until she reached the five-year mark, which was supposed to be the point at which she could stop coming in for examinations so frequently. But the exam did not go as expected.

“At my five-year check-up, they found cancer cells in my neck,” said Devaney, who had just turned 18 by that point and was preparing to head off to her dream college, the Hallmark Institute of Photography in Massachusetts.

She recalls considering deferring treatment so she could go away to school immediately — but ultimately opted for a procedure known as a “radical neck dissection,” which involved the removal of essentially all of the lymph nodes on the right side of her neck. A week after the procedure, she went in for a check-up and was cleared to leave for college.

Today, Devaney is unable to say for sure whether she’s truly cancer-free. Several years ago, scans revealed another mass in her body — but the scar tissue and other physical consequences of her surgeries and radiation have made it difficult to access for a biopsy.

So far, the mass hasn’t grown since 2009, so doctors are content to watch and wait for the time being — but they still can’t say definitively what it is. One theory is that the mass is another cancerous tumor, but it’s being kept in check by medications Devaney takes, and could be kept at bay indefinitely.

“Technically, I’m in remission,” Devaney said. “I used to say that I was cancer-free, and I don’t say that anymore.”

“I used to say that I was cancer-free, and I don’t say that anymore.”

What does a cure look like?

Devaney’s nebulous status exemplifies some difficult questions about the future of cancer treatment — namely, what exactly it means to “cure” cancer, or if it’s even possible. 

It’s an issue that’s come to the surface of discussions about cancer research in recent weeks with the creation of the new White House Cancer Moonshot Task Force, which was announced by President Obama during his final State of the Union address in January and formally kicked off in a White House meeting that took place on Feb. 1. 

Vice President Joe Biden, who lost his son Beau to brain cancer on May 30 at the age of 46, is heading up the effort.

In his address, Obama declared his intent to “make America the country that cures cancer once and for all.” The new memorandum establishing the task force listed accelerated progress toward “prevention, treatment and a cure” as a primary objective.

The problem is that many experts agree that striving for a single cure for cancer is a simplistic and likely impossible goal. After all, there are dozens of known types of cancers in existence, many of which respond differently to different types of treatments. 

It’s more reasonable to assume that many different cures may exist, depending on the kind of cancer being treated.

And some experts believe that the idea of a “cure,” in and of itself, might not even be so straightforward — an idea that’s made apparent in cases like Devaney’s.

“The reality is we can already ‘cure’ some cancers,” said Otis Brawley, chief medical officer for the American Cancer Society, in an interview. 

Breast, lung and colon cancers are all commonly cured at certain stages, he pointed out — that is, the patient goes into a state of permanent remission and there is no more sign of cancer in the body.

Coexisting with cancer

For other types of cancers, Brawley suggested that a more realistic approach would be to model our expectations of a cure after the attitudes commonly adopted toward conditions such as diabetes — that is, “people being able to live for a prolonged period of time in peaceful coexistence with their disease,” he said.

This is not a “cure” in the traditional sense — coexistence implies lifelong treatment and maintenance in order to keep the disease under control — but the idea does push toward a similar outcome for the patient: a long, high-quality life in which the disease continues to exist but remains permanently under control.

This is the scenario that Devaney may be experiencing now, although she and her doctors still aren’t sure. Devaney also pointed out living under such conditions still keeps the patient in a constant state of worry that their maintenance treatments and medications may fail and that their cancer may resurface.

“I feel like if I was ‘cured’ I wouldn’t have to worry about it,” she said.

So, as Devaney pointed out, there’s clear incentive to keep searching for more absolute types of cures. But even these are likely to be heavily dependent on the type of cancer in question, as well as a number of other factors, including the root cause of the cancer or the patient’s genetic history, experts say — and they may require a great deal of tailoring to individual patients.

“I think there will be multiple approaches applied that are really personalized to each person’s cancer,” said Joanne Weidhaas, professor of radiation oncology and member of UCLA’s Jonsson Comprehensive Cancer Center, in an interview. 

“It won’t be the same because people have different cancer biologies.”

“There won’t be a single approach, a single drug, that works for everybody.”

On the other hand, many experts are optimistic about promising new therapies that have shown potential to be used in the treatment of a range of different conditions.

“There will not be a single cure, but there may be many cancers that can be cured using similar mechanistic approaches — for example, harnessing the power of our immune system to fight cancer,” said Gary Gilliland, president and director of the Fred Hutchinson Cancer Research Center in Seattle, in an email to Mashable.

The type of treatment Gilliland referred to is known as immunotherapy, and it’s been rapidly gaining traction among cancer researchers. 

The idea is to develop therapies that help the immune system eradicate cancer cells on its own, rather than using drugs or radiation to target tumors.

It’s a “game-changing” concept, according to Ronald DePinho, president of the University of Texas MD Anderson Cancer Center. MD Anderson has it’s own Moon Shots program, which was established in 2012 and aims to reduce cancer mortality and suffering. The program places a high emphasis on the study of immunotherapy and has launched more than a hundred clinical trials so far.

It’s been suggested that immunotherapy is a target area for Biden’s new initiative as well. In January, the vice president chose to formally launch the moonshot at the University of Pennsylvania’s Abramson Cancer Center, in a nod to the institute’s pioneering research into immunotherapy.

But there are other research areas to consider as well. 

Brawley, of the American Cancer Society, suggested that another focus area should be prevention —- in other words, “curing” cancer by finding better ways to prevent people from getting it in the first place. This is another part of the MD Anderson Moon Shots program, according to DePinho.

For the time being, the direction that the new White House task force takes still remains to be seen, and its progress toward a cure, or cures — whatever they may look like — has yet to unfold. But the overall mood surrounding the initiative is one of optimism.

In an outline of the initiative’s intentions published in Medium on Jan. 12, Biden pointed to the revolutionary new therapies (immunotherapy included) that have begun to emerge in recent years and noted that cancer research appears to be at an “inflection point.”

With the launching of the Moonshot initiative, he wrote, he plans to “solidify a genuine global commitment to end cancer as we know it today.” 

And while it’s still unclear what exactly the end of cancer will look like, the future — according to the experts — is bright.