How we frame and think about subjects clearly has an impact on how we approach and attempt to solve problems. The first image, right or wrong, that comes to my mind is Apple’s “Think Different” campaign back in the mid 1990s. But I’m talking about the importance of perspective in a much bigger sense – we’ve defined and approached some of our biggest problems using techniques and perspectives that were modern 50 years ago. Specifically, I’m thinking about how we diagnose, treat and research cancer.
Today we diagnose a patient’s cancer based on the tissue of origin (i.e. breast cancer, colon cancer, leukemia, etc), what it looks like to the naked eye and under the microscope, and where it has spread in the body. The American Cancer Society has a great description of how cancer is “staged.” Once our doctors have diagnosed the cancer, the treatment is based off of that diagnosis – most often it’s either chemotherapy, radiation, surgery or some combination of the three. The treatment was based on how we diagnosed the cancer, which was defined on the technology we had available to better understand cancer. But, for anyone who’s had experience with a loved one with cancer knows that the current therapies and techniques are certainly lacking – we need to do better. As a side note, the history of cancer chemotherapy is pretty fascinating and also reason for moving beyond current therapies.
Today we finally have better tools that enable us to better understand the core of cancer and will help us get to the root of the disease. Genomics and informatics – the sciences of decoding DNA and then comparing different DNA sequences – are helping to transform not only how we research cancer, but in how we diagnose and ultimately treat cancer. In theory this will lead to better outcomes for cancer patients. If you understand the root of a disease – in the case of cancer, the genetic mutations and internal cellular processes that have gone haywire – you’ll better understand and better treat the disease.
For example, instead of diagnosing breast cancer based on exams, images and pathology slides, we’ll begin to take a sample of the tumor itself, analyze its genome and compare that to cancer genome to your healthy genome (taken from a healthy cell). This is where the recent advances in genomics and informatics come in to play. As we gain the ability to sequence vast amounts of DNA, we’ll greatly increase our knowledge of the genetic make up of cancers.
Specifically, genes today can tell us why the cancer has grown out of control, whether it will metastasize, and we now know it may even help predict where it will metastasize to. But, that technology isn’t ready for clinical medicine just yet – much more research needs to be done to help us better understand the disease process. In the future, though, instead of defining cancer by the staging system or its pathological features, we’ll diagnose a cancer based on its genetic profile. In turn this will help us better understand the best course of treatment, the prognosis and how to prevent the disease from spreading. My guess is that it will even help us be predictive of whether the cancer will metastasize, how fast and to where in the body.
By better understanding the genetic mechanics behind the cancer, we’ll be able to more accurately target our therapies and medications to the specific cancer. This will drastically cut down on unnecessary side effects and ineffective therapies, and potentially lead to better and faster outcomes. We’ll discover new therapies and drugs based upon what we discover through this genomic research. In other words, instead of using cytotoxic agents, like today’s modern chemotherapies, we’ll have drugs that are targeted to the specific genetic make-up of a cancer. This will lead to many fewer side effects, and better patient outcomes.
Taken to the next step, we may even be able to better predict what type of cancers a person may develop based on their genetic make-up. This knowledge will be essential in our fight against cancer. We may even begin to better understand how to harness the power of our own immune system to target cancers. At the foundation of all this knowledge will be genomics and our understandings of the basis of the disease. If we have a better understanding of the genetic mechanics, then we can better define, diagnose and treat the disease. All this advance comes from a shift in how we define and therefore understand the disease in its most basic elements. Maybe it’ll lead to a cure, or maybe improvements in cancer therapy. It’s an exciting time in cancer research.