If you hear the words “watchful waiting” or “active surveillance” after you’ve been diagnosed with cancer, you might be confused. You may have expected cancer care to start immediately. But in some cases, not treating cancer right away may be the safest, most effective path.
Watchful waiting in cancer care means your care team closely follows your cancer and does not start treatment unless the cancer or symptoms change. It may be an option if:
- Your cancer is growing slowly
- Treatment side effects outweigh the benefits
- Your overall health means immediate treatment might be less helpful
“This strategy can help some people avoid or delay treatment side effects while maintaining their quality of life,” said Vishangi Dave, MD, an oncologist with Banner MD Anderson Cancer Center. “Many people assume that every cancer diagnosis requires urgent treatment. However, sometimes choosing not to treat immediately can be the best medical decision.”
Watchful waiting vs. active surveillance: What’s the difference?
These terms are often used interchangeably but the meaning can vary depending on your cancer type, provider and treatment plan. You should ask your care team which approach is recommended and what the follow-up schedule includes.
Watchful waiting
Watchful waiting usually means monitoring cancer without treatment right away. It’s more focused on symptoms, comfort and quality of life, compared to active surveillance.
Your care team may recommend watchful waiting if you have other serious health conditions or cancers that are unlikely to cause problems during your lifetime or when treatment risks outweigh the likely benefits. If you condition changes or symptoms develop, and you do need treatment, it may focus on relieving your symptoms.
Active surveillance
Active surveillance means closely monitoring cancer with regular tests and exams and starting treatment if the cancer changes or becomes more active. It’s usually more structured than watchful waiting and may include more testing.
Your care team may suggest active surveillance if you have a low risk or slow growing cancer, since it can help you avoid or delay treatment side effects while still watching closely.
Why wouldn’t cancer be treated right away?
“Some cancers grow very slowly and may never cause problems during your lifetime. In those situations, the risks and side effects of the treatment may outweigh the benefits of treating immediately,” Dr. Dave said.
Waiting is only recommended when your care team believes monitoring is safe and appropriate. Your age, health, cancer type and personal priorities all matter.
Conditions where watchful waiting or active surveillance may be used
The decision depends on cancer type, grade, stage, symptoms, test results, overall health and your preferences.
Low-risk prostate cancer
Low-risk prostate cancer is one of the most common cancers where active surveillance may be used. That’s because some prostate cancers grow slowly and may not need treatment right away.
Monitoring may include PSA tests, physical exams, MRI, biopsy or other testing depending on the plan. Treatment may begin if the cancer changes.
Certain blood cancers or chronic blood conditions
Some slow-growing blood cancers may be monitored with blood tests, exams and symptom checks. Your care team may recommend starting treatment if blood counts change, you develop symptoms or the disease becomes more active.
Some thyroid cancers or small tumors
Some very small, low risk thyroid cancers may be monitored with ultrasound and exams and treated if the tumor grows or risk changes.
Precancerous or abnormal cell changes
Some precancerous conditions may be monitored for changes rather than treated right away.
What happens during active surveillance?
During active surveillance, your care team may monitor cancer with:
- Regular visits with your oncology team
- Physical exams
- Blood tests
- Tumor marker tests
- Imaging, such as ultrasound, CT, MRI or PET scans
- Biopsies
- Symptom tracking
The schedule depends on cancer type and risk level. Treatment can start if test results or symptoms show the cancer is changing.
What signs might mean treatment is needed?
Treatment may begin during watchful waiting or active surveillance if:
- The cancer grows
- Test results change
- A biopsy shows more aggressive cells
- Symptoms develop or get worse
- Imaging shows spread or progression
- Tumor markers rise
- Your goals or preferences change
- The risks of treatment become lower than the risks of continuing to monitor
What are the benefits of watchful waiting or active surveillance?
“For some cancers, studies have shown that careful monitoring can provide outcomes that are just as good as immediate treatment while avoiding unnecessary side effects,” Dr. Dave said.
Benefits may include:
- Preserving quality of life
- Avoiding unnecessary surgery, radiation or medication
- Giving the care team time to understand cancer behavior better
- Keeping treatment available if the cancer changes
- Matching care to your goals and overall health
What are the risks or challenges?
The challenges of watchful waiting or active surveillance may include:
- Anxiety about living with cancer
- Need for repeated follow-up visits and tests
- Small risk that cancer may grow or change between visits
- Uncertainty about the need to switch to treatment later
How to cope with anxiety during watchful waiting
Feeling anxious is common. To cope with watchful waiting anxiety:
- Understand your risk level and monitoring plan
- Keep your appointments
- Know when to call your doctor
- Bring a loved one to your appointments
- Ask for mental health support if worry is affecting your daily life
- Avoid overchecking symptoms or searching online
- Focus on what is in your control, like appointments, health habits and communication
Questions to ask your cancer care team
- Are you recommending watchful waiting or active surveillance?
- Why is treatment not recommended right now?
- What makes my cancer low-risk or slow-growing?
- What tests will I need and how often?
- What changes would trigger treatment?
- What symptoms should I report right away?
- What are the risks of waiting?
- What are the risks of treatment now?
- How will this plan affect my quality of life?
- Can I change my mind and choose treatment later?
- Who should I call between appointments?
- Should I get a second opinion?
When to call your doctor between visits
Call your care team if you notice:
- New pain or pain that’s getting worse
- Unexplained weight loss
- New lumps, swelling or masses
- Changes in urination, bowel habits or bleeding
- New fatigue
- Fevers or night sweats
- Repeated infections
- New shortness of breath
- Persistent cough
- New neurologic symptoms, such as weakness, numbness, headaches or vision changes
- Symptoms your team told you to watch for
- Anxiety that feels hard to manage
Monitoring is still cancer care
“If your doctor recommends observation, it does not mean lack of treatment,” Dr. Dave said. Watchful waiting is still cancer care. It means your care team is following the cancer over time and will adjust the plan if symptoms, tests or cancer behavior change.
Bottom line
Watchful waiting and active surveillance can be safe, planned approaches for some cancers and precancerous conditions. They are not the same as ignoring cancer. Instead, your care team monitors the condition and starts treatment if signs show the cancer is changing or becoming more active.
Choosing watchful waiting or active surveillance can feel emotional but you don’t have to navigate it alone. A Banner MD Anderson Cancer Center specialist can explain your diagnosis, review your options and help you understand whether close monitoring or treatment is right for you.
Frequently asked questions about watchful waiting in cancer care
Is watchful waiting the same as doing nothing?
No. Watchful waiting is a planned approach where your care team monitors your condition and starts treatment if symptoms or test results change.
What is the difference between watchful waiting and active surveillance?
Active surveillance usually involves more structured testing, such as blood tests, imaging or biopsies. Watchful waiting may involve less intensive monitoring and more focus on symptoms and quality of life.
Why would doctors wait to treat cancer?
Doctors may wait when cancer is slow-growing, low-risk or unlikely to cause harm right away and when treatment side effects may outweigh the benefits.
Can I choose treatment later?
In many cases, yes. The goal of active surveillance is to monitor closely and start treatment if the cancer changes or if you and your care team decide treatment is the better next step.
What cancers can be managed with active surveillance?
Active surveillance may be used for some low-risk prostate cancers, certain slow-growing blood cancers, small low-risk tumors and some precancerous changes. It depends on the diagnosis and risk level.
How often will I need follow-up tests?
The schedule depends on your cancer type, risk level and care plan. Your oncology team should explain how often you need visits, labs, imaging or biopsies.
What if I feel anxious about waiting?
Anxiety is common. Ask your care team to explain your plan, bring support to visits and seek counseling or support groups if worry affects your sleep, work or daily life.
When should I call my doctor during watchful waiting?
Call your doctor for new or worsening symptoms, unexpected weight loss, pain, bleeding, lumps, breathing changes, fevers, night sweats or any symptoms your care team told you to report.
