The recognition that cancer is fundamentally a genetic disease has opened enormous new opportunities for preventing and treating the disease. Carcinogens can now be assessed for their effects on known steps in cell-cycle control. Genetic defects in the checkpoint controls for detecting damaged DNA and in the systems for repairing it can be readily recognized and used to explore the mechanisms of cancer. The multiple changes that must occur for a cell to grow into a dangerous tumor present multiple opportunities for intervention. Identifying mutated genes associated with cancer points directly to proteins at which drugs can be targeted.
Diagnostic medicine is being transformed by our newfound ability to monitor large numbers of cell characteristics. The traditional methods of assessing possible tumor cells, mainly microscopy of stained cells, will be augmented or replaced by techniques for measuring the expression of tens of thousands of genes, focusing particularly on genes whose activities are identified as powerful indicators of the cell's growth properties and the patient's prognosis. Currently, DNA microarray analysis permits measurement of gene transcription. In the future, techniques for systematically measuring protein production, modification, and localization, all important measures of cell states, will give us even more refined portraits of cells. Tumors now viewed as identical or very similar will instead be recognized as distinctly different and given appropriately different treatments. Earlier detection of tumors, based on better monitoring of cell properties, should allow more successful treatment. A focus on that particularly destructive process, metastasis, should be successful in identifying more of the mechanisms used by cells to migrate, attach, and invade. Manipulation of angiogenesis continues to look hopeful as a means of suffocating tumors.
The molecular cell biology of cancer provides avenues for new therapies, but prevention remains crucial and preferable to therapy. Avoidance of obvious carcinogens, in particular cigarette smoke, can significantly reduce the incidence of lung cancer and perhaps other kinds as well. Beyond minimizing exposure to carcinogens such as smoke or sunlight, certain specific approaches are now feasible. New knowledge of the involvement of human papillomavirus 16 in most cases of cervical cancer holds promise for developing a cancer vaccine that will prevent viral action. Antibodies against cell surface markers that distinguish cancer cells are a source of great hope, especially after successes with the clinical use of monoclonal antibodies against human EGF receptor 2 (Her2), a protein involved in some cases of human breast cancer. Further steps must involve medicine and science. Understanding the cell biology of cancer is a critical first step toward prevention and cure, but the next steps are hard. The success with Gleevec (STI-571) against leukemia is exceptional; many cancers remain difficult to treat and cause enormous suffering. Since cancer is a term for a group of highly diverse diseases, interventions that are successful for one type may not be useful for others. Despite these daunting realities, we are beginning to reap the benefits of decades of research exploring the molecular biology of the cell. We hope that many of the readers of this book will help to overcome the obstacles that remain.
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