Understanding the biology of cancer: has this any impact on treatment?

Abstract

Rapid advances in laboratory techniques in the last two decades and, what is more important, in the last 5-7 years have significantly increased our knowledge and understanding on many fronts. We have learned much about (a) the basic biological processes of growth control and its aberrations, (b) the possible mechanisms involved in genetic initiation, progression and suppression, (c) the complexity of the multistep carcinogenesis induced by viruses, chemicals, hormones and other iatrogenic factors, (d) the secrets of immunological defence mechanisms and a host of other fundamental processes, (e) the application of molecular biology techniques to clinical problems, etc. The list is unending and often leads the uninitiated clinician to believe that the resolution of the mystery of the cancer cell and its successful control and cure are almost at hand. He or she often comes to believe that conventional principles in cancer treatment have radically changed from the 1960 and 1970 and that a new era in cancer treatment, based on our recent biological understanding, has already arrived. There is little doubt that the treatment scenario has changed significantly and that there is more hope for a cancer patient today than ever before-especially in certain types of paediatric and lymphoproliferative disorders; however, the unfortunate fact is that this cautiously optimistic therapeutic scenario has come about not because of any great understanding of the biological processes, which continue to confound us, but because of the intense interaction of various therapeutic disciplines and sophisticated technology now available for early diagnosis and more efficient therapeutic procedures in radiotherapy, chemotherapy and surgery. The author presents evidence and data here to show that, while treatment results have improved, we have a long way to go in understanding the biological processes before our knowledge can have a significant impact on the overall treatment methods in current use. The principles of cancer treatment, though modified have not changed. In fact, in the light of our current knowledge, they have been re-emphasized.