Some cancers have “prognostic models,” “scoring systems,” or “nomograms” in which several aspects of the cancer and patient are combined to determine the chances that the disease will return (relapse) after initial therapy. Some of the more commonly used models are for prostate cancer (Partin Tables and several others), kidney cancer (MemorialSloan-Kettering Cancer Center, or MSKCC, criteria), non-Hodgkin’s lymphoma (International Prognostic Index, for diffuse large cell and follicular types), and multiple myeloma (International Scoring System).

“Helpful hint: Ask the oncologist whether a prognostic model exists for the cancer being treated and, if so, how the cancer ranks in the model.”

Perhaps the most advanced and widely used prognostic tool has been developed for early-stage (stages I–III) cancers of the breast, colon, and lung. This tool is a computerized program called Adjuvant! Online, in which the oncologist enters clinical information about the patient (age and overall health) and cancer (tumor size, grade, and number of lymph nodes involved) and obtains a risk profile of that cancer.

The oncologist can then choose a treatment option (such as a particular chemotherapy regimen) and the program will estimate the benefit of that treatment for the patient; the benefit relates to the reduction in the risk or chance that the cancer will return and the survival in years gained from the therapy.

The results can be printed in a patient-friendly graphical format, which the oncologist can share with the patient. The main reason oncologists want to know the risk profile or aggressiveness of a cancer is to guide treatment decisions. If a cancer is deemed to have aggressive features, then stronger treatments would be recommended to try to eradicate it and prevent it from returning; if it has less aggressive features, then strong treatments would not be necessary.

This explains why cancer researchers and practitioners are so focused on identifying the behavior of a cancer before a patient starts treatment. No one wants to subject someone to strong therapies with powerful side effects if they are not truly indicated. If we can identify which cancers need strong therapies and which can be successfully treated with milder therapies, then each patient will receive the optimal and necessary treatment for his or her cancer. This is a central goal of the field of cancer medicine