Medicine: Early & Operable

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It is often said that early cancer is curable. Yet almost every doctor knows patients who discovered a tiny mass, had prompt treatment, but soon died from fast-spreading disease. Why? Main reason, says the University of Chicago's Pathologist Paul E. Steiner, is that "early" means many different things.

It may mean early 1) in the sense that it has only just begun to produce signs and symptoms; 2) in the anatomical sense of being small; 3) in the topographical sense of being localized; 4) in the technical (histological) sense of not having invaded other tissues; 5) in the sense of still being susceptible to treatment or of offering a high probability of cure. "These attributes may coincide in some instances," says Dr. Steiner in Cancer Research, "but frequently they do not . . . Early-disseminating tumors, in many sites in the body, are incurable almost from the start and before they are diagnosable. In the biological sense, they are already late in their youth."

It is fortunate, Dr. Steiner notes, that most tumors arise at sites which he calls "expendable." These, if detected early, meaning before they have spread, are indeed often curable. But they may soon spread to vital parts. "The surgeon is constantly reducing the number of anatomical structures that are essential to life, but at this time there appears to be a limit beyond which he cannot hope to go. The brain, heart, some lung tissue, and other organs will probably be indispensable for some time. The [cancers] involving these parts are threats to life from the time of their origin."

One way to detect many early cancers which otherwise defy diagnosis is by studying the cells in a minute quantity of fluid taken from the bone marrow (usually breastbone) through a large-bore needle, reported researchers at Ontario's Hamilton General Hospital. Even when cancer is not directly suspected, and when the symptoms are such common ones as anemia, fatigue, loss of weight, or changes in the white blood-cell count, they often find telltale cancer cells in the marrow. After running the tests on 4,100 patients, they now make them routinely in all cases where diagnosis is in doubt, the researchers reported in the Annals of Internal Medicine.