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Dobriner points out that steroid identification is not a good test for early cancer. It is not sure; it takes too long, and it costs too much ($10,000 for a complete job). But he is cutting down the time and cost. As he collects more records, other startling facts are showing up. For instance, people with hypertension (high blood pressure) generally excrete a special steroid. No one knows why, but Dobriner hopes to find out. The mysterious steroids from the glandular orchestra are apparently concerned with all the changes in the body's cells. "If you want to know about cancer," says Dobriner, "you must also know about old age, hypertension and degeneration." Thus, cancer research may discover, as a sort of byproduct, what makes people grow old.
Human Laboratory. The most important of Sloan-Kettering's laboratories is the great hospital next door, including the Strang Prevention Clinic. Dr. Rulon W. Rawson, head of the Division of Clinical Investigation, explains that, after all, human patients are the best source of information about human cancer. Clinical investigation is a two-way street. Observation of patients, especially their reaction to treatment, gives clues for researchers to follow. When the laboratories develop some new method applicable to human beings, the hospital is the only conclusive place to try it out.
A good example of the interaction of research and clinical study is the work of Rawson's group and of Dr. L. D. Marinelli on the treatment of thyroid cancer with radioactive iodine. Since the thyroid gland eagerly absorbs iodine (which it uses to make a hormone), doctors have hoped that a cancerous thyroid would absorb radioactive iodine 131 in sufficient quantity to kill the unruly cells. Unfortunately, this effort was none too successful. The normal thyroid took up nearly all the iodine. The cancerous thyroid cells, particularly the metastases in distant parts of the body, took up so little that they were hardly damaged by the iodine's radioactivity.
Trained Metastases. Dr. Marinelli and his associates worked out a neat method of dealing with this difficulty. First they removed the patient's normal thyroid and with it the original cancer. This left the metastases which, they found, often consisted of cancer cells that retained faint remnants of the normal function of the thyroid. With the normal thyroid gone, the degenerate cells awoke and began to act like thyroids. Stimulated by the proper drugs, they began taking up iodine and making it into thyroid hormones. Then Dr. Marinelli gave radioactive iodine to the patient. The tumors, acting as pinchhitting thyroid glands, absorbed it readily, and were in some cases destroyed by the iodine's radiation.
Some types of thyroid cancer do not respond to this treatment. The cells cannot be trained to take up iodine and kill themselves. But many patients have been helped to some extent. In four of them the disease has been definitely checked, though not wiped out entirely.
More important, Dr. Rawson believes, is the proof this method gives that cancer cells are not "autonomous"; that in some cases, at least, they can be trained to resume some of the functions of the normal cells from which they are descended. If they can be trained, perhaps they can eventually be trained to destroy themselves.