Whither the solid tumors. James Ewing lecture.

Improvement in survival rates for solid tumors, the cancers of greatest concern to the surgeon, has lagged far behind the dramatic advances that have been made in the treatment of leukemias, lymphomas, and certain childhood tumors. The application of new technical procedures and an aggressive approach to certain metastatic lesions offer chances for improving operative results, but the greatest contribution to curing cancer that can be made by surgeons at this time is the complete removal of the small localized primary tumor. By more active participation in "early detection programs" surgeons can increase their opportunities to treat cancer at this stage. The American College of Surgeons, in consultation with the National Cancer Institute, has conducted a detailed survey that analyzes the lack of surgical participation in clinical trials with a view toward developing a more active surgical interest in evaluating new methods of treatment for the solid tumors. One of the current efforts to improve the outcome of these recalcitrant cancers involves increasing the number of trained surgical scientists in the field of cancer.