The recent developments in understanding abnormalities that result in cancerous growth like the expression of oncogenes, the status of tumour suppressor genes (anti-oncogenes), genetic instability or deficient programmed cell death (apoptosis) established ‘tumour prognostic factors’. Analyzing such prognostic factors would pave the way toward proper planning for management of any individual cancer case. This can now be done by means of molecular techniques, which became more safe, reliable and user-friendly at present. In fact, oncologists all over the world do believe in and depend on such techniques because they are essential for knowing ‘what is going on’ inside malignancies before selecting the type of management.

Conventional histopathology provides a static description of the anatomical extent of tumor spread within a surgical specimen. Tumor stage is predictive for populations of patients within a stage but, because it does not answer the question of how far the tumor has spread in the patient, it can not determine those individuals that will relapse. Histopathological staging can not identify the patients that are likely to experience treatment failure after putatively curative surgery. This limitation has resulted in the extensive evaluation of polymerase chain reaction (PCR)-based assays as routine clinical tools in cancer diagnosis. Their aim is to use the sensitivity and specificity of PCR to provide an accurate prognosis for an individual cancer patient.

Now, it is time to say that administering a cytotoxic chemotherapy, which is a very narrow-spectrum antibiotic, without a prior analysis of prognostic factors would be like ‘administering a narrow spectrum antibiotic for treating a bacterial infection without a prior sensitivity test’!!. Someone would argue that such molecular analysis would need a long time. However, the recent advancement in automation of such techniques shortened the time of analysis significantly. Moreover, the desire to reduce the chance of relapse of cases would keep the idea of waiting for couple of days very permissible.

Bibliography

 

Molecular Oncology

Molecular Oncology

Why we are slow with predictors?

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