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ISBN: 0-8247-0650-1

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 To Mary

Julie and Beth

Anita
Jeanne
Cathy
Henry
Michelle
Lisa
Patrice

Mom, Dad, and Big Anita

 I am a cancer cell.
Of my earliest ancestry no evidence remains.
When the earth’s first creatures stirred the
ancient seas, when the Pharaohs wrought
the pyramids, when the medieval scribes
laboriously recorded their philosophies, I was
there. The ingenious Virchow, who recognized
my stamp, marshaled the forces of science
against me. Malicious, relentless, insidious I
am, full of destruction, ripe for carnage, yet in
my enduring frame I carry the secret of life.
Study me, and you will bring into the light of
day precious urns of wisdom long buried in
the tomb of ignorance. For you I shall tell a
wondrous tale of the beginning of things that
are and are to be. Study me, know me, and
you will hold the world in fief. Neglect me, and
as surely as the fingers of the dawn grasp first
the temples of the East, I will strike you dead.
Preface to the Fourth Edition

It has been some 15 years since the third edition of this text was published. The original purpose
of the book was to replace notes in a course, “Introduction to Experimental Oncology,” which
has been given in the Department of Oncology at the University of Wisconsin–Madison for more
than 25 years. The course has evolved from being primarily directed towards graduate students
to one that includes more than 80% undergraduates, usually juniors and seniors in various sci-
ences. The course has always been offered for two credits, but with the enormous increase in
information in the field of oncology, it will likely be increased to three credits.
In this revision, four new chapters have been added and the other chapters significantly
expanded. The genetics of neoplasia is now covered in two chapters, as is the stage of progres-
sion. Discussion of carcinogenesis in humans has also been expanded to two full chapters in
addition to the chapter on the evaluation of risk of carcinogenic environmental agents. Finally,
another chapter has been added in the area of host–tumor relationships, covering endocrine and
stromal responses. Of necessity, the glossary has been somewhat expanded, as have the number
of figures and tables. (We are very grateful to the authors and publishers who gave us permission
to incorporate their work in this text. In addition, for instructors wishing to use this text in
classes in oncology, we have developed an extended series of slide illustrations that may be
found at our web site: http://mcardle.oncology.wisc.edu/pitot.+ Click on “Courses” and scroll
down to “Oncology 401.”)
As in the third edition, I have again cited references in the text. Although some of the third
edition’s references have been retained because of their usefulness, a larger number of new refer-
ences have been added since the last edition than were in the third edition itself. Still, this funda-
mental text is not exhaustive in its treatment of the literature (although some students may think
it is), but it presents reasonably representative samples of each of the topics and areas covered.
My sincere apologies are extended to any colleagues whose work was not specifically cited. If
there are other subjects in the field of oncology that should be covered in a basic text such as
this, I would certainly appreciate receiving such information.
I would like to express my sincere appreciation to my colleague Dr. Daniel Loeb, who,
after some arm-twisting, agreed to write the vast majority of Chapter 4, on viruses and cancer.
This field has become much more complex since the third edition, and I felt need of an expert in
the area. I am also grateful to other colleagues who read and made critical comments on the
manuscript, especially Drs. Norman Drinkwater, the late Dr. James Miller, and Bill Sugden of
the McArdle Laboratory; Dr. Lynn Allen-Hoffmann of the Department of Pathology at the Uni-
v
vi Preface to the Fourth Edition

versity of Wisconsin–Madison; my son, Dr. Henry C. Pitot IV, and his colleagues in the Depart-
ment of Oncology of the Mayo Clinic, Rochester, Minnesota; and Dr. Peter Duesberg of the
University of California, Berkeley. In particular, I express my deepest thanks to Dr. Ilse Riegel
for her invaluable help in editing and correcting the manuscript throughout all its stages. Our
special appreciation and thanks go to Mrs. Mary Jo Markham and Mrs. Kristen Adler for their
patient, enduring, and expert transcribing and typing of the manuscript and indexing the entire
book. A special thanks is given to my colleague Dr. Yi-hua Xu, who aided us immensely in
developing and digitizing figures.
Perhaps the greatest debt of gratitude in developing the fourth edition of this text is owed
my wife and our children, who have endured the constant “working on the book” that kept me
from spending more time with them. As the final corrections were being made to the text, our
oldest daughter was diagnosed with metastatic breast cancer. Several years ago she gave me a
small blackboard on which was written, “A teacher affects eternity; they can never tell where
their influence stops.” I can only hope and pray that these words are prophetic and that this text
may play a small role in the ultimate control of cancer.

Henry C. Pitot
Preface to the Third Edition

Since the manuscript for the second edition of this text was completed, information regarding
the science of oncology, in the human and the experimental animal as well as in the plant king-
dom, has expanded in an astounding manner. The prediction of an earlier reviewer that this test
would require constant updating has proven true many times over. Furthermore, for the sake of
our students—the prime motivation for writing this text—a reasonably succinct survey of the
field of experimental oncology and its applications to humans continues to be of primary impor-
tance in our basic instructional program.
In this revision of the text, a number of new chapters have been added. A new Chapter 5,
concerned with hereditary factors in the causation of cancer, has been included. The discussion
of human cancer has been divided into two chapters: Chapter 9 is concerned with the direct
known causes and Chapter 10 with the scientific and societal considerations of human cancer.
Finally, the chapter on the biochemistry of neoplasia (Chapter 10 in the second edition) has also
been divided into two chapters, one dealing with the biochemistry of the neoplastic transforma-
tion in vivo (Chapter 12), the other with the biochemistry and molecular biology of the neoplas-
tic transformation in vitro (Chapter 13).
At the suggestion of one of the reviewers of the second edition, we have cited the refer-
ences in the text for the convenience of the reader. This has the disadvantage of a somewhat
more formal presentation, but we hope that it will be useful to the student who wishes to study
the field of experimental oncology in greater depth. This fundamental text is not exhaustive in its
treatment of the literature but presents representative examples of each of the topics and areas
covered. My apologies to any colleagues whose work was not specifically cited. If anyone feels
strongly that additional references are needed, please communicate your suggestions to the
author.
Again I would like to express my sincere appreciation to my colleagues at the McArdle
Laboratory who read and made critical comments on the manuscript, especially Doctors Nor-
man Drinkwater, Janet Mertz, James and Elizabeth Miller, Gerald C. Mueller, Van R Potter, Rex
Risser, Jeffrey Ross, Bill Sugden, and Howard M. Temin, and to Dr. Paul Carbone of the

vii
viii Preface to the Third Edition

Wisconsin Clinical Cancer Center. In particular I would like to express my thanks to Dr. Ilse
Riegel and Bette Sheehan for their invaluable help in editing and correcting the manuscript
throughout all of its stages and my appreciation to Mary Jo Markham and Karen Denk for their
patient and expert transcribing and typing. Finally, my thanks are extended to Carol Dizack for
her expert artistry in drawing the figures added to this edition of the text and to Terrill P. Stewart
for his photographic skills.

Henry C. Pitot
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Preface to the Second Edition

In the few short years since the publication of the first edition of this text, a number of signifi-
cant facts have been uncovered in the science of oncology. Many of these findings have been
incorporated into the teaching of our basic course in experimental oncology through additional
notes and lectures, and the revision of this text became a clear necessity.
In this revision we have maintained the same format as in the first edition but have altered
the contents of most of the chapters, adding both figures and tables. In addition, the pathogenesis
of cancer and the natural history of cancer in vivo have been divided into Chapters 6 and 8 re-
spectively. Finally, Chapter 13 has been added to present some aspects of the basis for cancer
chemotherapy. Although this chapter is not an attempt to discuss the various treatment modali-
ties used in cancer therapy, the subject matter does introduce the student to the experimental
basis for chemotherapy and also briefly discusses the methodology and rationale for the chemi-
cal therapies used today.
We have continued to utilize illustrative slides to supplement the lectures and text. Lec-
tures by several of my clinical colleagues on the diagnosis, therapy, and psychosocial aspects of
cancer continue to be significant components of our course.
Again I would like to express my sincere appreciation to a number of my colleagues at the
McArdle Laboratory, especially Doctors Roswell Boutwell, James and Elizabeth Miller, Van R.
Potter, Rex Risser, Bill Sugden, and Howard Temin, as well as others who have read and made
critical comments on the manuscript. In particular, I would like to express my thanks to Dr. Ilse
Riegel and Ms. Bette Sheehan for their invaluable help in collating, editing, and correcting the
manuscript throughout all of its stages, and my appreciation to Ms. Karen Denk for her patient
and expert typing. Finally, my thanks are again extended to Mr. John L. Shane for his continued
artistic aid in drawing the new figures for this text.

Henry C. Pitot

ix
Preface to the First Edition

The sensationalism and publicity directed toward the investigation, diagnosis, and treatment of
cancer as a disease in the human being have reached a dramatic level in the United States. In part
this is a result of the decision by the political administration of Richard M. Nixon to make the
conquest of cancer a major goal of his office. Although it is not my desire nor is this the place to
consider the ramifications of this decision and the subsequent difficulties that have arisen in its
implementation, it is clear that cancer research received a “shot in the arm” of international pro-
portions by political decisions at the beginning of this decade. The U.S. public, who have sup-
ported the National Cancer Plan through their taxes, have been repeatedly apprised of its
existence and progress since its inception in 1970. Much has been written on the subject of can-
cer in the scientific literature as a direct result of the financial impetus given to research in oncol-
ogy over the past decade. A variety of books and monographs on the general subject of cancer in
humans and animals for both the scientist and the layman have appeared during this same
period.
This text is not meant to be a popular account of the cancer problem. More than two de-
cades ago, the Department of Oncology, which comprises the McArdle Laboratory for Cancer
Research of the University of Wisconsin at Madison, initiated a graduate course in oncology.
This course consisted of a series of lectures covering a variety of aspects of experimental oncol-
ogy including chemical and biological carcinogenesis, host-tumor relationships, the natural his-
tory of cancer, and the biochemistry of cancer. In addition, within a few years of its inception,
several lectures were given on the diagnosis and therapy of cancer in the human patient. The
course was and always has been oriented primarily toward the graduate student in oncology
rather than specifically for the medical student or postgraduate physician. In part as a result of
the increased interest in cancer research by both graduate and undergraduate students and as part
of the mechanism of self-evaluation of teaching programs, several years ago the McArdle Labo-
ratory expanded its original course into three separate courses in experimental oncology. The
first course in this series is open to all students and fellows at the University of Wisconsin, and
the notes given to the students comprise the basis for this short text on the fundamentals of
oncology.
During the course period, these notes are supplemented by several sessions in which slides
are shown depicting a variety of examples both from human and animal neoplasms to illustrate
many of the specific points presented in the text. A list of these slides can be made available to
anyone interested, on written request to the author. In addition, at the end of the course several
x
Preface to the First Edition xi

lectures are given to the students on the diagnosis and therapy of human cancer as well as on the
psychosocial aspects and bioethics of human oncology.
It is the hope of those of us in the McArdle Laboratory involved in the teaching of this
course that we can instill in our students the basic concepts of the science of this disease and
thereby interest them in learning more about the mechanisms of neoplastic disease and the use
of such knowledge toward the ultimate control of cancer in the human patient.
In particular, I would like to express my appreciation to my colleagues in the McArdle
Laboratory, especially Drs. James and Elizabeth Miller, Van R. Potter, Ilse L. Riegel, Bill Sug-
den, Howard M. Temin, and others who have read and made critical comments on this manu-
script at its earlier stages. My thanks also go to the several outside reviewers of the manuscript
whose suggestions resulted in an increased number of illustrations and the addition of the epi-
logue, and to Mr. John L. Shane, whose artistic skill produced the drawings of the figures.

Henry C. Pitot
Contents

Preface to the Fourth Edition v

Preface to the Third Edition vii
Preface to the Second Edition ix
Preface to the First Edition x

1. Cancer: Yesterday and Today 1

2. The Language of Oncology 27
3. The Etiology of Cancer: Chemical and Physical Agents 41
4. The Etiology of Cancer as an Infectious Disease 107
5. The Etiology of Cancer: Germline Genetic Factors 133
6. The Etiology of Cancer: Somatic Cell Genetics 189
7. The Natural History of Neoplastic Development: Initiation and Promotion 223
8. The Natural History of Neoplastic Development: Host Effects During
Carcinogenesis 273
9. The Natural History of Neoplastic Development: Progression 335
10. Consequences of the Stage of Progression 373
11. Environmental Factors in the Etiology of Human Cancer—Chemical Agents
and Processes 423
12. Environmental Factors in the Etiology of Human Cancer—Physical and
Biological Agents 491
13. Evaluation of Toxic and Carcinogenic Environmental Agents: Scientific and
Societal Considerations and Their Role in Cancer Prevention 547
14. The Natural History of the Development of Neoplasia in Cultured Cells
and Tissues 593
15. The Cellular and Molecular Biology of Neoplasia in Vivo 643
16. Cellular and Molecular Biology of Neoplastic Transformation in Vitro 697
17. The Host–Tumor Relationship—Nutritional Factors and Biomarkers 743
18. The Host–Tumor Relationship—Endocrine Factors and Stromal Reaction 783
19. Immunobiology of the Host–Tumor Relationship 817
20. Some Basic and Applied Principles of Cancer Chemotherapy 901

Epilogue: Cancer: Tomorrow and the Future 947

Glossary 951
Index 963
xiii
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