Indolent vs Malignant Tumors

This concept continues to crop up and in a way it is tied to a concept that continually pops-up in science.

How can an observer tell the difference between dangerous and non-dangerous lab results when they both look the same early on?

As our ability to see into the human body improves with each technological step, we often find ourselves at the fork in the road. We can see that there is clearly a physical change, perhaps a small tumor, or a polyp, or perhaps a constellation of genes, or altered genes. That change could lead to a malignant tumor, a parasite, an amalgam of broken cells, that now wage a single-sided war with their host.

Then again; it might be nothing…

Dennis Normile tackles this in his March 4, 2016 article in Science “Epidemic of Fear”. In fact Sarah Fallon has a great perspective piece in Wired (Wired’s science journalism continues to get better and better).

Normile presents a very nice case for care when evaluating new screening data against past norms. In a case study that follows Fukushima related pediatric thyroid screenings, he presents both the initial driver of fear, in the form of screening results that suggested elevated rates of thyroid nodules in children. Further studies of a “normal” or “unexposed” population describe similar elevated rates of nodule detection in the thyroid, a result that suggests better detection, but not higher risk.

Fallon puts this in perspective, and provides the title of this post, indolent vs. malignant tumors. With each technological leap, we are better able to identify smaller and smaller clusters of cells within the human body. But these advances require further study to provide clues (read as markers) as to whether these clusters of cells will go on to become a malignant monster or perhaps lie dormant for the lifetime of the host. This is in no way an insignificant question. One path takes the patient into the world of invasive treatment, while the second suggests that no further treatment is warranted, while the cluster is small and treatable.

There are many ways forward that were not available to clinicians previously. One of the more promising are gene expression profiles that will be used to classify these early clusters of cells as taking an indolent path over a malignant one. This data has been collected for more than a decade now, and is already being used to assist with these decisions.

Hopefully it will continue so.