Diagnosis Versus Prognosis and Therapy

As intimated previously, the real value of sophisticated molecular technologies is their potential impact on precise, objective, unambiguous cancer diagnosis. To place this in context, however, it is important to remember that the only reason to establish a diagnosis of cancer in the first place is to determine prognosis and therefore therapy. In the first instance, a diagnosis of any form of cancer (specifically, solid tumors) implies that the tumor must be completely removed and potentially treated systemically with chemotherapy and/or radiotherapy. If benign, or a pseudoneoplastic condition (fibromatosis, for example), these issues do not apply. Function, cosmetic effect, interference with normal bodily function, and similar concerns dominate such diagnoses; life-threatening consequences are rarely part of the dialogue. Thus, the first and paramount issue in cancer diagnosis, whether a tissue is or is not cancerous, relates directly to therapy. However, as cancer therapy has become progressively more sophisticated and multimodal, a simple diagnosis of "cancer" is obviously inadequate. Furthermore, a diagnosis of "high grade" or "grade III" is fraught with some degree of uncertainty. One need only consider the conflicting grading of brain tumors espoused by WHO versus other authors (notably, the existence of three versus four grades of astrocytic brain tumors) to appreciate the conundrum. Clearly, a glioblastoma multiforme is a deadly tumor. But what of a grade II astrocy-toma, and in which diagnostic scheme? This, then, is the sole purpose of diagnosis, and of the methods described herein: to establish the best possible course of action based on the best available diagnostic and prognostic information. The purpose of the diagnostic technologies discussed here is therefore to augment the precision and utility of a cancer diagnosis and its direct relevance to treatment.

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