Does “Cancer” – The Word – Properly Explain “Cancer” – the Disease?

Does “Cancer” – The Word – Properly Explain “Cancer” – the Disease?:
by Jonathan Klein, MD
Often times, after explaining a diagnosis and treatment plan to a patient, physicians hear some variation on “my brother/sister/parent/friend/co-worker had cancer and received radiation/surgery/phase I clinical trial medication. Why am I not receiving this?” The answer may revolve around the idea that different cancers, even different cancers arising from the same part of the body, can be wildly different in biology, treatment, and prognosis. We obviously want to ensure that patients understand their options so that they can make informed decisions about their own care, but couldn’t the medical community do a better job of conveying this concept to the public even before people end up in our clinics?

We use the catch-all term “cancer” to refer to diseases within the body arising from uncontrollably dividing cells. It is a term familiar to everyone, and a diagnosis of cancer is a useful shorthand – it’s concise, easy to understand, and conveys a sense of seriousness around what lies ahead. But beyond that initial purpose, it’s largely insufficient.


There is no more homogeneity within this broad disease category than there is among the different manifestations of mental illnesses caused by various chemical imbalances in the brain or heart disease leading to defective heart pumping. In fact, there may even be less similarity. And for patients to better understand their specific disease and the options before them, medical professionals should make this concept more widely understood to the lay public.

The most basic division among cancers refers to the cell type of origin of the disease – carcinomas from epithelial cells, sarcomas from mesenchymal cells, leukemia from blood, lymphomas from lymph, and melanomas from melanocytes. Beyond that, we distinguish types of cancer by disease site – lung, prostate, breast, bone, etc. – and further by histology – subtypes among the carcinomas including adenocarcinoma, squamous cell carcinoma and others. But even these divisions don’t differentiate the most important factors for patients, namely prognosis and treatment options. So we add staging techniques based on the extent of the primary disease and the presence of lymph node or distant metastases. This is a lot of information for a patient to assimilate and comprehend – it’s even a lot for an oncology resident to comprehend, and this is our chosen profession.

After the above classifications have been made, treatment options can still vary between seemingly similar patients. Take breast cancer, for example. Even if a diagnosis of a 2cm node negative ductal carcinoma is made, patient age, receptor status and genetic testing results can lead to widely divergence prognoses and treatment recommendations from the number of radiation fractions to be given, appropriateness of systemic hormone therapy, surgical options.

And molecular/genetic testing for breast cancer is probably the best understood at present among all the disease sites. Over the coming years, we can expect the age of so-called “personalized medicine” to sweep through all areas of oncology and make minute differentiations even more important than they are today in dictating treatment recommendations and outcomes.

Oncology is a complex field, but it’s also a young field. Barely more than 60 years old from the time that Sidney Farber produced the first (temporary) remissions of acute leukemia at Boston Children’s Hospital. The advances made in the past few years alone with respect to genetic and pathologic markers, targeted treatments and prognostic indicators are merely the tip of the iceberg. I don’t expect all patients to be fully aware of all the nuances in diagnosis, treatment, and prognosis for every malignant variation (if they were, they wouldn’t need to see an oncologist), but a greater understanding among the general public that a diagnosis of cancer for one patient can have hugely different implications than for another will go a long way to allowing more time and resources to be focused on discussing an individual patient’s needs.

Professional organizations’ awareness and outreach efforts should include education campaigns focused on the general public describing that a diagnosis of cancer doesn’t mean the same thing for everyone. One person’s experience can vary widely from another’s, even if their cancers were the same size and in the same site.

Oncology organizations make great efforts to promote educational, support, and survivorship initiatives to patients once they have been diagnosed with cancer and after their treatment. But patient education should not be limited to those who have already developed the disease. Having an understanding of the very basics of cancer biology (such as outlined above) and the differences that exist even between seemingly similar manifestations of cancer can go a long way to enhancing individual and public understanding of treatment options and how to navigate through the cancer-care system. Such an understanding in advance of diagnosis can ease patients’ concerns and anxieties and relieve some pressure from busy health care professionals.