Call It Cancer: Letting the Histopathology Determine the Diagnosis

Abstract

The misleading use of terminology in cancer diagnosis is examined.

I read with interest the wise counsel provided by Drs. Chabner and Smith to the National Institutes of Health Consensus Panel on low-grade prostate cancer [1]. The language of cancer is muddled by quasisynonymous terms such as cancer, tumor, neoplasm, growth, mass; the distinction between benign and malignant is, also, often blurred. A profound error was made of the sort that Drs. Chabner and Smith are trying to help us avoid when the clonal cytopenias and oligoblastic myelogenous leukemia were designated myelodysplasia. By using such anachronisms (and euphemisms) as refractory anemia, and illogical terms as “excess blasts”—as if one can have an excess of malignant cells akin to excess fat cells—a neoplasia is thereby mislabeled a dysplasia, thus setting back thinking about the disorders by 50 years [2, 3]. Indeed, it was approximately 75 years from the early descriptions of these syndromes in the 1930s that the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute realized that clonal cytopenias and oligoblastic myelogenous leukemia were neoplasms that should be tracked by the program. The omission greatly underestimated the incidence and prevalence of hematological malignancies. The confusion of students trying to understand why a disease with leukemic blast cells in blood and marrow is not called leukemia and of basic scientists thinking they were studying a preneoplastic condition was entirely unnecessary, if the correct language had been chosen. We are inching our way there by the frequent designation MDS/AML but it should be clarified unequivocally.

A decision not to call low-grade prostatic cancer a cancer would be a very unfortunate step. The act of having a neoplasm diagnosed by biopsy and calling it something else would be a profound mistake. The information available to physicians and patients regarding the matter of low-grade prostate cancer is easily accessible on the World Wide Web and from other sources. The patient given the diagnosis will almost always be in the hands of a physician familiar with the matter and capable of providing understanding and guidance. Of course, it is possible that a patient may not deal with the matter with confidence, but that is likely to be an uncommon event and we should not turn cancer pathobiology upside down on that basis. In addition, one of the problems with modern medicine is the difficulty patients have understanding their disease and making intelligent and informed decisions. We should help them do so, not hide the truth from them with circumlocutions or neologisms. Compassionate care can be delivered with valid information.

See the accompanying editorial in The Oncologist, volume 17, number 2, 2012 .