Is cured early cancer truly cancer?
Is cured early cancer truly cancer? is a question that characterizes th dilemma created by pathologists who diagnose cancer while it is still microscopic. This question may be asked by those who hold the diagnosis of cancer valid if the individual patient succumbs, and may even accept a reduction in the mortality rate as a result of therapy; but the ultimate obviation of all deaths by therapeutic interdiction impugns the diagnosis. Both experimental and clinical data can help to explicate the rationale for the answer to the question. In experimental systems of neoplastically transformed cells, fully committed cancer cells are readily characterized biochemically, physiologically, and morphologically; and these cellular observations are the foundation for our understanding of the biology of cancer. We know that biologic neoplastic transformation can precede morphologic evidence of the change and that morphologic evidence of transformation does not always forbode inevitable lethal progression. Human in situ and minimal carcinoma are the earliest microscopic evidences of highly curable cancer. The spectrum considered also includes clinically indolent cancers which may be locally invasive but ordinarily have a low lethal potential, and those hopelessly disseminated cancers which spontaneously regress. Should these latter not be considered real cancers because they did not kill? The relative risk for fatal termination generally increases as the cancer becomes more clinically obvious. Although the minute microscopic cancers have a lethal potential, there is much still to be learned about the probability of their progression. The pathologist and therapist must ascertain and integrate all available data and make their best estimate of the clinical significance of the microscopic findings, giving due consideration to whether therapy is indicated, the extent of therapy required, the potential for physical and psychological disability, and cost. This information should be presented to and discussed with the patient, who must then decide, with the physician(s), what is best in these particular circumstances.
D002471:Cell Transformation, Neoplastic / Q000473:pathology; D006801:Humans; D009361:Neoplasm Invasiveness / Q000175:diagnosis*; D009369:Neoplasms / Q000473:pathology / Q000628:therapy*; D013997:Time Factors