Genomics in Oncology
A newly diagnosed cancer patient and their family might have barely moved from the first stage to the next of the five stages of grief but, regardless of the course of their emotional journey, their cancer vocabulary begins to grow from day one. Biopsy, staging, chemo, neutropenia,… words that had meant nothing to them before, take on a very tangible meaning invoking thoughts of hospital beds and days spent being sick. As the battle with cancer continuous, their vocabulary continues to evolve as well. Remission, transplant, … relapse, metastasis, morphine, …hospice; relief alternating with despair, a roller coaster ride with too many ups and downs.
In the last few years, a newer set of words are beginning to make their way into the cancer lexicon- whole genome sequencing (WGS), targeted therapies, biomarkers… words that are becoming associated with some recent successes and cautious optimism as we relentlessly search for a cure to cancer. These partial successes, the understanding that cancer is a genetic disease, and the decreasing cost of whole genome sequencing raise important questions about making tumor sequencing an integral part of cancer treatment.
Central to this discussion are several different scientific and social issues. On the scientific side, intratumor heterogeneity, challenges with data interpretation and management, and physician training in genomics dominate the conversation. In the social area, cost and insurance coverage, and ethical issues remain center stage.
Exome sequencing pins down unusual suspects 
