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Minimally invasive surgical techniques have reduced the size of the incisions necessary to remove many tumors from "less than a foot" to "less than an inch." Stereotactic radiosurgery allows the delivery of powerful beams of cancer-killing gamma rays to an area the size of a pencil eraser, leaving healthy surrounding tissue unharmed. Now, thanks to the continual evolution of molecular therapies, clinical oncologists at New York Methodist Hospital (NYM) can attack cancer cells on a scale so precise that an electron microscope would be needed to watch the fight.

"Every type of cancer—the uncontrolled division of abnormal cells within a part of the body—is associated with interactions that take place at the molecular level," said Hani Ashamalla, M.D., chairman of NYM's Department of Radiation Oncology. "These interactions include aberrations in an individual's gene sequences and protein functions, as well as specific 'markers' in cancer cells. As scientists continue to map the human genome, new discoveries are made about the molecular mechanisms of cancer, allowing for the advent of therapies and treatments that can target cancer at its microscopic source."

With laboratory tests that determine the molecular structure of an individual patient's cancer, oncologists can target and interrupt many specific cellular processes that cause cancer tumors to grow. Targeted cancer therapies are often used in conjunction with other treatments, such as radiation, chemotherapy and surgery.

"Today's cancer therapy does not mean a one-size-fits-all treatment," said Rabia Mir, M.D., chief of pathology at the Hospital. "For example, molecular targeting has been valuable in treating adenocarcinoma, an extremely deadly form of cancer that develops in glandular tissue cells in major organs such as the lungs, breast and colon. Adenocarcinoma is the most common cause of lung cancer, and accounts for the vast majority of lung cancer cases among non-smokers."

In the case of adenocarcinoma of the lung, a mutation in the gene for a protein called epidermal growth factor receptor (EGFR) can cause that protein to be found at abnormally high levels on the surface of the cancer cells, which may cause those cells to divide excessively. Molecular testing can be used to identify this mutation. Clinical oncologists can then incorporate specific drugs into a patient's treatment regimen to inhibit EGFR function, which can help slow or stop the growth of that patient's cancer. And if a patient is found not to have this particular gene mutation, tests can be performed for rarer molecular abnormalities, and different therapies may be used for those.

"Organ-by-organ, gene-by-gene molecular evaluation and treatment is at the core of personalized cancer therapy," said Dr. Ashamalla. "And it will only grow more sophisticated in the years to come. Sometimes, the 'next big thing' in cancer treatment can be quite small."

To find a physician affiliated with New York Methodist Hospital's Institute for Cancer Care, call 866-411-ONCO (866-411-6626).