on tissue sections also remains the best way to assess tumor : stromal cell interactions, such as angiogenesis and host immune responses; the latter may have an increasingly important role in guiding therapeutic interventions that are designed to counteract immune evasion by tumors. Thus, what lies ahead is not the replacement of one set of techniques by another. On the contrary, for the foreseeable future the most accurate diagnosis and assessment of prognosis in cancer patients will be arrived at by a combination of morphologic and molecular techniques.
With all of the advances in genomic analyses and targeted therapies, one can safely predict that we are on the cusp of the golden age of tumor diagnosis and treatment. Those of you who are in medical school now can safely assume that the expectations for rapid advances in cancer diagnosis and therapy will be realized while you are still in practice. Get ready!
Several sampling approaches exist for the diagnosis of tumors, including excision, biopsy, fine-needle aspiration, and cytologicsmears.
Immunohistochemistry and flow cytometry studies help in thediagnosis and classification of tumors, because distinct proteinexpression patterns define different entities.
Proteins released by tumors into the serum, such as PSA, canbe used to screen populations for cancer and to monitor forrecurrence after treatment.
Molecular analyses are used to determine diagnosis and prognosis, to detect minimal residual disease, and to diagnosepatients with a hereditary predisposition to cancer.
Molecular profiling of tumors by RNA expression profiling, DNA sequencing, and DNA copy number arrays are useful inmolecular stratification of otherwise identical tumors or thoseof distinct histogenesis that share a mutation for the purposeof targeted treatment and prognostication.
Assays of circulating tumor cells and of DNA shed into blood, stool, sputum, and urine are under development.
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