The Jeremiah Metzger Lecture Cancer in the Twenty-First Century: An Inside View from an Outsider

Cancer is not a single disease. The term refers to literally hundreds of illnesses sharing common features: inappropriate proliferation of imperfectly differentiated cell types, invasion of nearby vital structures, and spread to distant sites (metastasis). Invasiveness and metastasis distinguish cancers from benign tumors such as fibroids and meningiomas. Yet, each type is distinct, possessed of defining morphologic, histologic, biochemical, and genomic features that have allowed oncologists to develop a nosology that guides diagnosis and therapy. Cancer is thus a complex collection of disorders. That complexity is increasing exponentially as modern technologies allow us to dissect each form in ever greater detail. The notion of curing cancer with a "magic bullet" like the polio vaccine is no more realistic than using the same wrench to fix a bicycle, a car, and an airliner just because they are all vehicles.