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Cancer is classified according to stages, numbered as zero and I through IV. It's based on tumor size (T), regional metastases or spread to lymph nodes (N), and distant metastases (M). The staging process is called the TNM Cancer Staging system and describes the anatomic extent of the disease. It is used to help the physician plan the patient’s treatment and estimate the prognosis of the treatment. Stage 0 The cancer is still in situ, present only in the layer of cells where it began Stages I - III The higher the stage number, the more extensive the disease. Increasingly greater tumor size, and/or spread of the cancer to nearby lymph nodes or organs adjacent to the primary tumor. Stage IV The cancer has spread to another organ or organs. Histologic GradingIn conjunction to the TNM staging system, there is a histologic grading system numbered 1 through 4. It is a biologic, not anatomic, system performed by a pathologist looking at the cancer tissue through a microscope. The check points are the degree of differentiation, degree of cellular pleiomorphism that assesses how much the cells have degraded to differing sizes and shapes, the nuclear grade that subjectively describes how ugly the cell nucleus looks, the number of mitoses (cell divisions) and degree of lymphatic and vascular invasion. Why Stage and Grading MattersA cursory look at a graph showing five year survival rates as a percentage for people diagnosed in each of the four stages show that the survival rate drops off dramatically at each successive stage. For example, lung cancer patients diagnosed in stage I have a 60% to 100% of surviving five years. A Stage II diagnosis gives a 40% to 60% chance, by stage III it's down to 20% to 40% and a stage IV diagnosis gives a zero to 10% chance of surviving five years. Lung cancer is problematic in that many of its malignancies are detected in stage IV where the survival rate is lowest. The graph is extremely bleak for pancreatic cancer since 80% to 100% of all cases are only detected in Stage IV. Due to more frequent and better screening technology, most prostate cancers are found in the first three stages and survival rates remain high, but that is due to the slow growth rate of prostate cancers. In stage IV diagnoses, the survival rate drops off quickly. The survival graph of ovarian cancer patients shows a steady decline as the diagnosis moves through the stages. Between 75% and 100% of all ovarian cancers are found in stage IV where the five year survival rate is 20% or less. The result of all these late stage diagnoses is that the bulk of cancer research funds go to finding late stage cures where only 10% of patients will survive. Stage I cancers are the most difficult to detect and late stages are the easiest. By stage III and certainly in stage IV, the patient has started to exhibit the signs and symptoms of their cancer even though the cancer may have been growing for decades. A Review of LiteratureOne of the best ways to assess the state and focus of any scientific research is to examine the publications of its representative associations. Want to know what's going on in neurology...visit the American Neurological Association. How about Astronomy? Check out what the American Astronomical Society is doing. So in that vein, if someone wanted to know where cancer reseach is going, what better place to visit than the American Association for Cancer Research (AACR). Checking into the AACR website shows that six scientific, medical journals are published by the American Association for Cancer Research, Inc. that covers all aspects of cancer research. A quick review of their publications gave an incredible insight into the amount and type of work being done to beat this dreaded disease once and for all. The first is "Cancer Research" published twice a month. It reports on significant original papers of topical areas of cell and tumor biology; clinical research; endocrinology; epidemiology; experimental therapeutics, molecular targets and chemical biology; immunology; molecular biology, pathobiology and genetics; prevention. The second journal is "Molecular Cancer Research", published monthly, and covering basic research that has implications for cancer therapeutics in Angiogenesis, Metastasis, and the Cellular Microenvironment; Cancer Genes and Genomics; Cell Cycle, Cell Death, and Senescence; DNA Damage and Cellular Stress Responses; Model Organisms; and Signaling and Regulation. The third is "Clinical Cancer Research" which twice a month, publishes original articles describing clinical research on the cellular and molecular characterization, prevention, diagnosis, and therapy of human cancer. Its focus is on innovative clinical research and translational research which bridges the laboratory and the clinic. The fourth is "Cancer Epidemiology Biomarkers and Prevention" which publishes monthly, original, peer-reviewed research on cancer causes, mechanisms of carcinogenesis, prevention, and survival outlook. Topics include descriptive, analytical, biochemical, and molecular epidemiology; the use of biomarkers to study the neoplastic and preneoplastic processes in humans; chemoprevention and other types of prevention trials; and the role of behavioral factors in cancer etiology (study of why diseases occur) and prevention. The fifth is "Cancer Prevention Research". It is the newest of the Association's journals, published monthly, and focuses exclusively on cancer prevention. It carries important original studies, reviews, and perspectives within the major topic areas of oncogenesis, risk factors and risk assessment, early detection research, and chemopreventive and other interventions, including the basic science behind them. It also deals with preclinical, clinical and translational research, with special attention given to molecular discoveries and an emphasis on building a translational bridge between the basic and clinical sciences. The sixth journal is "Molecular Cancer Therapeutics", a monthly publication focusing on basic research that has implications for cancer therapeutics in several areas. Included are: Experimental Cancer Therapeutics, Identification of Molecular Targets, Targets for Chemoprevention, New Models, Cancer Chemistry and Drug Discovery, Molecular and Cellular Pharmacology, Molecular Classification of Tumors, and Bioinformatics and Computational Molecular Biology. It is apparent that a huge amount of effort is going into cancer research and much of it now being properly focused on prevention and early detection. The question is whether or not prevention and early detection will be able to attract adequate funding in the face of competition for money that is flowing into research for new drug development and late stage cures. With that we dovetail nicely into the funding question. Cancer Research FundingThe National Cancer Institute (NCI), a component of the National Institutes of Health, is the Nation’s principal agency for cancer research. As a Federal Government research agency, the Institute receives its funds from the U.S. Congress and uses the money to support research at the Institute’s headquarters in Bethesda, Maryland and in labs and medical centers throughout the U.S. The Institute coordinates a national research program on cancer causes and prevention, detection and diagnosis, and treatment through various research projects and clinical trials. The NCI’s total budget for fiscal year 2005 was $4.83 billion, $4.79 billion for fiscal 2006 and $4.75 billion for fiscal year 2007. Why is the budget trending down? Ask you congressman. According to an article on cancer in Wired Magazine, the NCI spent 8% of its 2007 budget, less than $400 million, on detection and diagnostic research. NCI has a 2009 budget of $6.028 billion and if the same percentage for detection and prevention holds, they will spend about $482 million in this area. Other Federal agencies, state and local governments, voluntary organizations, industry, and private institutions also spend money on cancer-related research and services, although their efforts pale in comparison to the drug companies. Hey Big Spender!The pharmaceutical industry spends $8 billion on cancer research, most on drug development and late stage treatments, according to the International Union Against Cancer. This is about 33% more than the entire NCI budget for 2009. Do we think the pharmaceutical industry is interested in curing cancer and preventing future cases? Not likely! In the next page on cancer treatments, we will see what the pharmaceutical industry makes off of cancer patients and their insurers. In comparison, the Susan G. Komen Breast Cancer Foundation spent $180 million on cures in 2007 and the Michael Milken Prostate Cancer Foundation spends $14 million a year chasing a cure for prostate cancer. Both are noble causes but much more funding is needed and, for real progress, the focus should be on finding a way to keep people from getting breast cancer and prostate cancer in the first place. Charitable Services FundsThere are numerous charitable services funds set up under IRS provision 501(c)3 to raise money for research or assistance to people with catastrophic illnesses. The 501(c)3 provision applies to corporations, funds, or foundations, organized and operated exclusively for religious, charitable, scientific, testing for public safety, literary, or educational purposes. AIDS, heart disease, diabetes and the like have all fostered the formation of such organizations. One representative 501(c)3 specifically set up to fight cancer is SU2C. Stand Up to Cancer (SU2C)Stand Up To Cancer (SU2C) was established by the Entertainment Industry Foundation to speed up cancer research by raising philanthropic dollars and developing unique mechanisms to utilize these funds.
The end result is intended to be more rapid advances in the treatment of patients and the prevention of cancer in those individuals who are at risk. SU2C funds will support research projects conducted by interdisciplinary, multi-institutional translational and clinical research Dream Teams and high-risk Innovative research grants from which ideas for new Dream Teams may arise.The funds will be administered through the American Association for Cancer Research (mentioned above), since they have the existing infrastructure to focus on every aspect of high-quality, innovative cancer research. The Canary Foundation... |
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