In the last decade, therapy for specific types of cancer has evolved from a standard treatment for each type of cancer to variable forms therapy, the choice of which is dependent upon the analysis and progression of the individual cancer. Characteristics of the tumor, from its clinical manifestation and stage to the cancer’s molecular and pathologic features are beginning to play a major role in the selection of appropriate care of patients with malignant tumors. The visual pathologic features of tumors have always been the critical parameters in determining tumor type; however, over the last several decades molecular analysis of tumors has played an increasing role in the diagnostic pathology of tumors; thus, “molecular pathology” has gradually emerged as a discipline in pathology which exploits the use of nucleic acid based techniques such as DNA sequencing, fluorescent in-situ hybridization, real time quantitative polymerase chain reaction, nucleic acid microarrays for specialized studies, proteomic based techniques and antibody-based profiling of tissues and cells. Molecular pathology shares some aspects of practice with both anatomic and clinical pathology, and is sometimes considered a crossover discipline. Applications are found in studies of both hereditary and acquired disorders including inheritable genetic diseases, malignant tumors, hematological diseases (leukemias and lymphomas), and infectious diseases. For example, DNA testing is the most common method for identity testing with specific applications such as monitoringbonemarrow engraftment, paternity testing, and forensic identification. The transformation of normal cells to malignant cells involves multiple genetic and epigenetic changes that are currently being studied and defined. Many of these changes have already been defined; however, as these studies proceed, we should take advantage of any identified molecular changes to aid in the early detection of cancer and the corresponding preinvasive neoplastic lesions. Small cancers may be successfully treated and even cured, and treating preinvasive neoplastic lesions may prevent the subsequent development of invasive cancer. Molecular detection offers many advantages in the detection of small tumors or preinvasive neoplastic changes. First, molecularmethodswill permit the identification of very small tumors in their earliest stages of development. These tumors can be treated successfully and cost effectively. Current methods of early detection, such as mammography, endoscopic examination with fine needle aspiration or other techniques of imaging, only detect cancers that have grown to a certain, albeit small size. In many cases, however, aggressive subtypes of small tumors may have already invaded blood and lymphatic vessels or have spread to regional lymph nodes. Secondly, molecular methods will eventually detect field changes especially those that affect broad epithelial areas. Because cancer often arises in fields primed for neoplastic development, in the future, treatments will be directed at field changes rather than at individual lesions. The ultimate objective of early detection, therefore, is the diagnosis of tumor initiation and the use of preventive methods to reverse field effects. A primary goal of using molecular methods should be the ability to separate those preinvasive neoplastic lesions that are destined to progress from those that will not, avoiding the over treatment of harmless lesions. In diagnostic pathology, some lesions are diagnosed as ‘borderline’, ‘atypical’ or dysplastic or of indeterminate malignant potential; such terms reflect
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