Cancer Treatment: Present and Future

How can we apply our growing understanding of the biology of cancer to

combat the disease? Prevention is always better than cure, and as we have
already discussed in the first part of this chapter, many cancers can indeed
be preventedfirst and foremost, by avoiding the use of tobacco, a more
important hazard by far than any known carcinogen that is a by-product of
our industrialized society. Moreover, cancers can often be nipped in the bud
by screening: primary tumors can be detected early and removed before they
have metastasized, as we saw for cervical cancers, for example. Many
opportunities for better prevention and screening remain, some using highly
sensitive new molecular assays. Advances in these areas probably offer the
most immediate prospects of reducing the cancer death rate substantially.
But prevention and screening can never be perfectly effective. It is certain
that the full-blown malignant disease will continue to be commonand in
need of treatmentfor many years to come.
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The Search for Cancer Cures Is Difficult but Not Hopeless

The difficulty of curing a cancer is similar to the difficulty of getting rid of

weeds. Cancer cells can be removed surgically or destroyed with toxic
chemicals or radiation; but it is hard to eradicate every single one of them.
Surgery can rarely ferret out every metastasis, and treatments that kill
cancer cells are generally toxic to normal cells as well. If even a few
cancerous cells remain, they can proliferate to produce a resurgence of the
disease; and, unlike the normal cells, they often evolve resistance to the
poisons used against them. In spite of the difficulties, effective cures using
anticancer drugs (alone or in combination with other treatments) have
already been found for some formerly highly lethal cancersnotably
Hodgkin's lymphoma, testicular cancer, choriocarcinoma, and some
leukemias and other cancers of childhood. Even for types of cancer where a
cure at present seems beyond our reach, there are treatments that will
prolong life or at least relieve distress. But what prospect is there of doing
better, and finding cures for the most common forms of cancer?