WHAT EVERYONE WANTS TO KNOW
ABOUT CANCER
Patients
During my career as a cancer scientist, I have
frequently received calls from individuals who
recently heard a physician tell them the ominous
words ‘‘You have cancer,’’ or from people who
have heard that statement about a family member
or close friend. The first question usually is
‘‘What can you tell me about this kind of cancer?’’
They may have already visited several
Internet sites and have some information, not always
accurate or scientifically based. If the patient
is a child and the inquiry comes from
parents, they frequently have a great feeling of
guilt and want to know what they did wrong, or
they may lash out at some perceived environmental
agent that they think is the cause, such as
water pollutants or electromagnetic fields from
high-power lines in their neighborhood. Individuals
or their family members then want to
know what caused the cancer, what the meaning
of the test results is, what the treatment options
are, and, if the tumor has spread, if there are any
preventive measures that can be taken to stop
further spread of the cancer. If cancer is in the
family, they may ask what their chances are of
getting cancer. These are questions that are always
difficult to answer. One of the goals of this
book is to try to provide the scientific basis for
approaching these questions.
Physicians and Health Care
Professionals
The members of the health care team who take
care of cancer patients have a different set of
questions. Thesemay include the following:What
are the most appropriate diagnostic tests with low
false negatives and false positives? What are the
differential diagnoses that need to be ruled out?
And once the diagnosis is made, what is the stage
and histological grade? Is the disease local, regional,
or metastatic? What is the likely prognosis
and the best therapeutic approach? How often is
follow-up of the patient required and for how
long? If the disease progresses, how may the
treatment approaches change? Some of the data
that relate to answering these questions will also
be discussed in the book.
Cancer Researchers
Basic scientists and clinicians working in the field
of cancer research, by contrast, have yet another
set of fundamental questions: What are the basic
mechanisms of malignant transformation of cells?
What causes of cancer can be identified? Knowing
that, what preventive measures can be taken?
Are there genetic profiles, hereditary or induced
by spontaneous mutations, that correlate with
susceptibility or progression of cancer? Can the
gene expression patterns of cancer cells be used
to identify targets for cancer diagnosis or therapy?
What proof-of-principle studies are needed
3
to verify these targets?What type of clinical trials
is needed to determine the toxicity and efficacy of
a new therapeutic modality? These questions will
also be addressed.
ABOUT CANCER
Patients
During my career as a cancer scientist, I have
frequently received calls from individuals who
recently heard a physician tell them the ominous
words ‘‘You have cancer,’’ or from people who
have heard that statement about a family member
or close friend. The first question usually is
‘‘What can you tell me about this kind of cancer?’’
They may have already visited several
Internet sites and have some information, not always
accurate or scientifically based. If the patient
is a child and the inquiry comes from
parents, they frequently have a great feeling of
guilt and want to know what they did wrong, or
they may lash out at some perceived environmental
agent that they think is the cause, such as
water pollutants or electromagnetic fields from
high-power lines in their neighborhood. Individuals
or their family members then want to
know what caused the cancer, what the meaning
of the test results is, what the treatment options
are, and, if the tumor has spread, if there are any
preventive measures that can be taken to stop
further spread of the cancer. If cancer is in the
family, they may ask what their chances are of
getting cancer. These are questions that are always
difficult to answer. One of the goals of this
book is to try to provide the scientific basis for
approaching these questions.
Physicians and Health Care
Professionals
The members of the health care team who take
care of cancer patients have a different set of
questions. Thesemay include the following:What
are the most appropriate diagnostic tests with low
false negatives and false positives? What are the
differential diagnoses that need to be ruled out?
And once the diagnosis is made, what is the stage
and histological grade? Is the disease local, regional,
or metastatic? What is the likely prognosis
and the best therapeutic approach? How often is
follow-up of the patient required and for how
long? If the disease progresses, how may the
treatment approaches change? Some of the data
that relate to answering these questions will also
be discussed in the book.
Cancer Researchers
Basic scientists and clinicians working in the field
of cancer research, by contrast, have yet another
set of fundamental questions: What are the basic
mechanisms of malignant transformation of cells?
What causes of cancer can be identified? Knowing
that, what preventive measures can be taken?
Are there genetic profiles, hereditary or induced
by spontaneous mutations, that correlate with
susceptibility or progression of cancer? Can the
gene expression patterns of cancer cells be used
to identify targets for cancer diagnosis or therapy?
What proof-of-principle studies are needed
3
to verify these targets?What type of clinical trials
is needed to determine the toxicity and efficacy of
a new therapeutic modality? These questions will
also be addressed.
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