So what are the cancer treatments of the future? They center around overcoming the major limitations we have been dealing with in the past. These are also now possible to overcome with newly developed technology.
A major limitation has been our inability to know what we are doing to the cancer cell with treatment on a moment-to-moment basis. After a treatment is administered we need to know whether most of the cells are dead or dying to know when, or whether, to administer more and what type of treatment. There are two new techniques available in some institutions to do this. One is nuclear magnetic resonance spectroscopy, a variant of MRI scanning. The other is positron emission tomography (PET scanning). Both are highly sophisticated physical tools that can measure the ability of cancer cells to grow while they reside in the body.
Another major limitation is the inability to tell if a cancer cell has developed the ability to metastasize. Since patients die of metastases, it is extremely important to know when metastases are present even when they cannot be seen with the naked eye or a microscope. We now know that the process of metastases is a modification of a process normal cells use to travel to the proper place to form our various organs when we are embryos. Since all these processes are controlled by genes, the abnormal counterparts of these genes in cancer cells can be probed to determine if a cell has executed this program. If cancer cells cannot travel, then we can deal with a cancer at its primary site in the breast, lung, colon and so on by local means alone, such as refined and limited surgery or even laser surgery. There is also computer-driven radiotherapy that shapes the beam precisely to the tumor and avoids the normal tissue (referred to as conformal radiotherapy) now available in a few places in the U.S. If it is known that the cell has already developed the capacity to metastasize, then we need to do more regardless of how favorable the cancer looks to the doctor.
