B.A. Ponder – Författare

It has been recognized for almost 200 years that certain families seem to inherit cancer. It is only in the past decade, however, that molecular genetics and epidemiology have combined to define the role of inheritance in cancer more clearly, and to identify some of the genes involved. The causative genes can be tracked through cancer-prone families via genetic linkage and positional cloning. Several of the genes discovered have subsequently been proved to play critical roles in normal growth and development. There are also implications for the families themselves in terms of genetic testing with its attendant dilemmas, if it is not clear that useful action will result. The chapters in The Genetics of Cancer illustrate what has already been achieved and take a critical look at the future directions of this research and its potential clinical applications.

Most of the anti-cancer drugs in use today were discovered by happy accident rather than design, yet the rational design of better anti-cancer drugs remains a cherished goal, and one of the most important challenges facing medical science. This book represents a compilation of views and progress reports which illustrate the diversity of approaches to the problem. Recent research has confirmed the belief that critical genetic changes are at work in cancer cells. The genome, then (DNA in biochemical terms), surely represents a critical target for specific chemotherapy of cancer, and several chapters address the issue of attacking DNA, gene targetting, and the like. Others deal with principles of rational design, exploitation of novel modalities and targets, or the nuts and bolts of antitumour drug testing. While no attempt has been made to provide a comprehensive coverage of this wide-ranging and vitally important subject, the present volume in the series will provide much food for thought.

Many of the most effective treatments for disease have been discovered empir­ ically. Nowadays, however, we think that understanding the biology of a disease will lead us to design better treatments, and to improve the application of treatments we already have. To accomplish this, vast sums are expended on cancer research. Even so, to the casual observer of clinical oncology the proliferation of studies and trials of ever-different combinations of therapies looks like empiricism, at the best. In the first part of this book, we have asked practising clinicians in different specialities to assess the contributions of biology and of empiricism to current approaches to treatment. In the second part, we have asked researchers in different areas of biology applied to cancer to assess the present and likely future impact of their type of biology on cancer treatment and control. IX 1 Surgery M.BAUM OBJECTIVES OF CANCER TREATMENT The objectives of cancer treatment can be defined according to population requirements or according to the needs of the individual. As far as the population is concerned, Government authorities are entitled to expect that cancer treatment will lead to mortality reductions and cost containment.