Timothy J Triche

For more than 100 years, cancer has been diagnosed by empirical, largely subjective means, not unlike clinical medicine itself. A consequence of this is that universal acceptance of a diagnosis, particularly any beyond benign versus malignant, has been an elusive goal. In one published study of rhabdomyosarcoma diagnosis involving more than 800 blinded cases and more than a dozen pathologists working in teams of two at eight institutions, with a 20% resampling, concordance between groups for subclassification (with clinical and therapeutic consequences) was no better than 60%. (The figure for individual reproducibility was marginally better, of the order of 70%.)1 It should be noted that these pathologists were acknowledged to be the world's experts in the diagnosis of this disease at the time. Thus, it is reasonable to conclude that cancer diagnosis is less than a perfectly objective science.

On the other hand, it is also important to note that there is no better alternative, at least until recently. This situation is changing rapidly, as new, relatively objective, and certainly dichotomous or quantitative methods are introduced into practice as diagnostic tools in cancer. This in turn is progressively rendering the diagnosis of cancer more precise, reproducible, and yes, objective. To be clear, the initial diagnosis of cancer of any type remains a histologic diagnosis. That said, all further refinement (and even as a factor in the initial decision of benign versus malignant) increasingly relies on an ever-enlarging panoply of diagnostic tools, most rooted in biotechnology and disparate medical fields such as immunology, biochemistry, molecular genetics, and bioinfor-matics. This chapter describes these methods and illustrates how they augment and clarify the diagnosis of cancer. Of note is the further benefit of these methods: they frequently also provide information about prognosis and potential therapy, as is shown.

10 Ways To Fight Off Cancer

10 Ways To Fight Off Cancer

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