Friday, September 26, 2008

Tumor Speciation in Neoplasms book

My latest book, Neoplasms: Principles of Development and Diversity, has just been published and is available from the Publisher's (Jones & Bartlett) web site.

The two categories of fundamental questions discussed in Neoplasms are:

1. Is cancer a single disease process that is manifested in many different types of tumors, or is cancer many different diseases, all related by excessive cell growth? If all cancer can be characterized by a single disease process, why haven't we isolated the process and cured cancer? If cancer is thousands of different diseases, how can we ever hope to cure all of the different kinds of cancer?

2. If cancer is characterized by the progressive accumulation of genetic abnormalities, and if every tumor specimen is genetically unique and distinct from every other tumor specimen, why do tumors fit into precisely named types? Worded another way, why does every unique tumor fall into one of the diagnostic entities (e.g., Warthin tumor, melanoma, lobular carcinoma of breast, and so on) that pathologists are taught to recognize?

Believe it or not, by tackling these two questions, it is possible to develop a practical strategy to eradicate cancer. Though there are thousands of distinct named neoplasms, all neoplasms can be sensibly grouped into biological classes, and these biological classes can be characterized by shared developmental pathways (including precancer/cancer transitions), shared functional pathways (including genetic and epigenetic features), and shared restraints (determined by the cell lineage of the neoplasm).

The book is divided into three major parts. The first part, Speciation, covers the causes of cancer, and why we see the kinds of restricted cancers that occur in man and animals. The concept of tumor speciation is key to building a classification of cancer, and it has been a constant wonder to me that the people who write cancer textbooks always accept the extant species of cancer as a "given" condition that does not require any deep thought or explanation. It is very important to understand why we see the species of tumors that we see. We cannot start thinking about how to classify cancers until we understand tumor speciation. The lack of any serious attention to the subject manifests itself in the popular classifications of cancer, which are basically just lists of tumors that occur in an anatomic region (e.g. tumors of head and neck).

The second part of the book is Classification. This section describes the different ways that cancers can be classified. In this section, I used a variety of informatics methods to build a classification of neoplasms. The classification can be downloaded by readers as an ontology (in RDF format), or as a plain-text file, or as an XML file. The supplementary materials are available.

None of this effort (i.e., understanding tumor speciation and constructing a neoplasm classification) has any value if it does not lead to the reduction of deaths from cancer. The last part of the book explains how a biologically relevant classification reduces the perceived complexity of cancer by assigning each tumor to one of several dozen classes of tumors that may be amenable to class-specific prevention, diagnosis, and treatment. This is the most important part of the book, because it suggests practical ways of eradicating cancer by applying pre-existing approaches (designed for individual cancers) to classes of cancer, using an available neoplasm classification.

The complete Table of Contents of Neoplasms: Principles of Development and Diversity is now available for review.

-© 2008 Jules Berman

No comments: