Dr. Len's Cancer Blog

When I started my oncology career many years ago my research focus was on the immunology and immunotherapy of cancer.  Our goal was to solve the puzzle as to why our bodies allowed cancer to develop in the first place, and what we could do to improve our own natural response to cancer cells in an effort to help treat the disease.

The basic question that we tried to answer early on in the development of the field of cancer immunotherapy was fairly simple: If cancer cells are abnormal, why don’t our bodies recognize them as such and destroy them, much like our bodies respond to infectious agents such as viruses and bacteria?

Unfortunately, our success was limited.

Now, we may actually have a tool that helps us put theory into practice, one that may enable our bodies to recognize the cancer cell as foreign, and destroy it.

Last night I found myself on the horns of a dilemma.

I am accompanying my wife on a trip to Kansas City as she gives a course for a medical professional organization.

Being the barbecue aficionados that we are, it isn’t particularly surprising that we would find our way to a local barbecue restaurant for our dinner last evening.

So there I sat, looking at the menu, and struggling with the question of what I should have for dinner.  After all, life is about choices: good vs. evil, pork, beef, chicken or—yes—fish (even barbecue restaurants these days make grilled fish available on their menus).

Maybe if I had read the articles and editorial that appeared in this week’s New England Journal of Medicine discussing the risks of premature death in relationship to body mass index, I would have made a better choice. 

But, I had not done my reading until this morning. 

The beef ribs won.

One of the most common questions I am asked is whether we are really making progress in our efforts to reduce the suffering and death from cancer.

There are many ways of saying “yes” in response to this question. 

Probably the simplest answer is to comment on the increase in the 5 year survival of people diagnosed with invasive cancers from 50% in 1974-76 to 65% for those folks diagnosed between 1995 and 2001.

However a better and more detailed examination of how effective our cancer control and treatment efforts have been over the past 15 years or so recently appeared in an article and accompanying editorial in the American Cancer Society’s journal Cancer.

The net result of the discussion was not a simple pat on the back.  The authors concluded that we have made progress; but we could do much better.

We spend a good deal of time discussing targeted therapies in cancer treatment, but don’t pay as much attention to what I am going to call “targeted diagnostics.” 

Yet, this is probably as important a part of the current revolution in cancer treatment since diagnostic and prognostic tests will play an increasing role in helping us improve our ability to decide which cancer patients will need treatment in which circumstances, as well as help us to more accurately provide prognostic information for patients and their physicians.

Two articles and an editorial in today’s New England Journal of Medicine point out how important these types of tests are becoming in cancer treatment.

I returned from vacation on Monday, and started the process of catching up on the emails and voice mails that had accumulated over the past 10 days.

One of the voice mails was from a lady I did not know.  I returned the call and spoke with the woman. 

I have been replaying the conversation in my mind ever since, because it reminded me of how difficult it can be for families and doctors alike when situations are not going well.  And it reminded me of how important it is for doctors and patients to communicate in times of crisis and in times of need.