Cancer research includes a wide range of projects, from identifying carcinogens to developing improved anticancer drugs. Advances in some areas have raised hopes of finding better methods of treatment and prevention. Scientists have made especially rapid progress in the fields of genetics and molecular medicine. These fields involve the development of treatments to target the specific abnormal gene or abnormal function of the gene that is associated with a particular type of cancer. New cancer treatments are tested in clinical trials.

Genetics. Scientists are working to better understand the role of oncogenes and suppressor genes in the development of cancer. This knowledge could lead to new ways of controlling cancer cells. Scientists have developed tests that show if individuals have certain defective genes. But experts disagree about when such tests should be offered. In most cases, doctors cannot yet use these tests to treat or prevent cancer. Some experts question the value of telling people that they have a damaged gene when this knowledge carries little benefit. But researchers hope that genetic tests may one day make it possible to prevent cancer or to detect the disease in its earliest stages.

Molecular medicine involves the development of specific treatments or medicines to interfere with a specific abnormal gene or abnormal function of a gene. Highly targeted molecular medicine can be directed at killing cancer cells without harming healthy cells.

Biologists are investigating a process called apoptosis (pronounced ap uh TOH sihs). Apoptosis is also known as programmed cell death or "cell suicide." In apoptosis, various genes activate mechanisms of self-destruction when cells become damaged or are no longer needed. Techniques that bring on apoptosis in cancer cells may one day offer new treatments. Another active area of research focuses on preventing blood vessels from growing to nourish cancers. In order to grow beyond a small, harmless size, every cancer must develop its own blood supply. Development of blood vessels is called angiogenesis (pronounced an jee oh JEHN uh sihs). Many experts feel that substances that prevent angiogenesis, called angiogenesis inhibitors, can be developed into cancer-fighting drugs.

Researcher are also working to develop drugs that interfere with signal transduction, the process by which growth signals are transmitted to cells. Several types of cancer secrete too much growth factor. These factors act on nearby cells but also drive proliferation of the cells that produced them. Drugs that interfere with signal transduction would stop the uncontrolled cell growth characteristic of cancer cells.

Clinical trials. Despite many advances in cancer treatment, many cancers are not fully curable. Scientists continue to develop new treatments that are tested through clinical trials. In a clinical trial, a group of cancer patients is treated with standard available treatments while another group with the same disease receives a new treatment that is being evaluated. Unfortunately, only a small number of patients who are eligible to participate in clinical trials actually enter these programs. Patients who are interested in participating in a clinical trial should discuss the possibility with their physician.

Marc B. Garnick, M.D., Clinical Professor of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School.