There are different types of cancer, and the prognosis depends on a number of factors, including the exact type of cancer we are dealing with, how advanced it is, and also the age, health status, lifestyle and diet of the patient, to name only a few.
Statistically speaking, for some types of cancers, the chances of cure and patient survival rates are as high as 95%.
However, for other types of cancer, and particularly for advanced stages of the disease, the situation is completely different, the most difficult to cure being methastatic solid tumors. Advanced cancer is one of the major problems in oncology as currently, despite the recent technological and scientific advancements, the mortality of metastatic disease remains very high at 70–90%.
I think that one of the main reasons behind the high incidence and mortality of advanced cancer is the lack of understanding of the cancer process itself. You can’t cure what you don’t understand, and the simplest question regarding cancer is also the most difficult to answer. And that question is “What Is Cancer?”.
There are a number of theories; in 180 A.D., Galen defined cancer as “an abormal growth”. In modern times, different scientists offered different definitions, such as: “Cancer is random genetic mutations” (Hanahan & Weinberg); “Cancer is an energetic disease” (Warburg); “Cancer is a disease of the stroma” (Soto & Sonnenschein); “Cancer is accelerated evolution” (Heng); “Cancer is a return to a primitive life form” (Udriste); “Cancer is a new life form” (Liu); “Cancer is a cellular program that went wrong” (Israel & Schwarz), … and so on.
However, while defining precisely what cancer is still remains a puzzling question to scientists, we do know that cancer cells have a number of characteristics that are different from normal cells. These characteristics have been described by Hanahan & Weinberg, who coined them “The Hallmarks of Cancer”. They include, among others, the ability of cancer cells to multiply uncontrolled, to invade tissues and to metastasize (that is, to create new tumors in others parts of the body), to create new blood vessels and to avoid the death of cells which occurs as part of the normal cellular life cycle.
In my opinion, besides being a disease, cancer is also a form of life, and this frame of reference may provide a fresh look on this complex process.
In recent years we have seen significant progress in the development of new medication for specific types of cancers, in genetics and targeted therapies, in the development of radiation equipment, immunotherapies and so on. The science of oncollogy is rapidly evolving, but at the same time, the treatment decision pathway is getting more and more complex, and, to be able to provide optimal treatment to all their patients, doctors need to master a lot of information, as currently the treatment is often based on genetic data about the type of cancer cells involved.
In complex cases, we decide on the therapy to follow in multidisciplinary teams (comprising a medical oncologist, a surgeon, a radiation therapist, a pathologist and sometimes a nutritionist) called tumor boards, each member of the team bringing his or her specialized knowledge and experience to help us find together the best medical solution for that particular patient in that particular moment of the disease. Here at Weill Cornell University Hospital I participate in tumor boards every day.
For more information about cancer, you can read the pages in the Cancers section and also listen to my postcasts.