A Discourse on Warfare: Why We Still Haven't Defeated Cancer
Cancer -- the familiar phonetics of the word sends shivers down our spine and vandalizes our core. The disease ignites sensations of somber, leaving friends and family of the affected in disarray -- despondent, anguished, and heartbroken. In angst and in desperation for comfort, we euphemize the term: she fought cancer. Maybe she was victorious, we would hope; or perhaps she lost, we mourn. Because in the end, this most enigmatic aspect of the human condition is viewed as a war to be fought, a battle to be won.
As a species, we have landed man on the moon, learned to communicate across continents at the touch of a button, and, not too long ago, sequenced our own genome in its entirety. Similarly, we have discovered the simple, yet astonishing drug penicillin -- a life-saving antibiotic. And, in an incredibly unlikely turn of events, we have uncovered the notion that small doses of a virus, such as chicken pox, for example, can protect against the full fledged disease itself. Technology, science, and medicine have come a long way. Cancer, however, despite its seemingly simple pathology, continues its campaign, striking deep into our creative arsenal. In a brief moment of digression, unencumbered by the ethotic nature of the disease, the question is undoubtedly asked: why have we not yet cured cancer?
In a few words, it is because we are asking the wrong question. Cancer does not have a single cure because it is not a single disease. Rather, the group of conditions we call cancer only displays a common base pathological mechanism.
Normally, our 30 trillion body tissue cells are constantly dividing and replacing those which have already expired. This division is tightly regulated by specific “checkpoints” along the cycle, which signal the cell to replicate, divide, and stop at specific times. However, the cellular division stop sign, if you will, may become faulty, leading to the uncontrollable formation of clumped cells in a specific body tissue. We call this colony of cells a tumor. The name of a specific cancer is dictated by the location of the tumor: if it's in the breast, breast cancer; the prostate, prostate cancer. The rarity of heart cancer as emphasized by Lewis Cantley, a biophysical chemist, helps illustrate this point: cardiac cells, which develop primarily in utero, offer little chance to become cancerous into adulthood “because they have reduced abilities to divide”. In other tissues, however, these rapidly dividing cells can cause tumors which interfere with body functions, and, if spread to other areas of the body, are said to have metastasized.
Surprisingly, this process of tumor formation happens quite often. Our immensely clever immune systems, however, typically recognize the problem before it becomes pathologic, targeting the rogue cells with an elegantly planned search and destroy mission. But what happens to those mischievous cells that slip through the defenses? More specifically, how is cancer currently treated and what does the future of this interesting field hold?
To begin speaking of potential treatments, we must focus on an unfortunate reality: large variation exists in how tumors develop, and, along with a multitude of other factors, this is why we have not yet “cured” cancer.
By extension, the disease comes in five main varieties according to the Cancer Treatment Centers of America: carcinomas, sarcomas, leukemias, lymphomas, and central nervous system cancers. These diseases differ in their primary developmental mechanism -- namely, those beginning in the skin, connective tissues, blood, immune system, and brain and spinal cord, respectively. What’s more, the pathology of tumor development often diverges in different body tissues: colorectal cancer formation demonstrates a distinct mechanism from that of skin cancer. A large body of research, including a study on breast cancer performed in conjunction with the University of Cambridge, showed that even the same cancer within different individuals must be treated distinctly.
Currently, according to the National Cancer Institute, we have three main options for cancer treatment depending on its type, stage, and the general health of the individual. In no particular order, we have surgery, radiation, and chemotherapy. The surgical option, or resection, is fairly straightforward (but not always feasible) and mandates the manual removal of the tumor -- the “go in and take it out” approach. Radiation therapy involves aiming specific energy filled photons at the tumor in an attempt to kill or even shrink it -- the “laser it away” approach. Lastly, the group of drugs we categorize as chemotherapy agents can be utilized to kill not only cancer cells, but, unfortunately, many of their healthy counterparts as well -- the true “carpet bomb” approach. However, as many may be aware, these treatment options are far from perfect and often carry unduly adverse effects.
In an attempt to extinguish such tumors while minimizing potential side effects, researchers continue to develop targeted treatments to individualized cancers, which have, in recent years, become a reality. One such targeted therapy, according to the National Cancer Institute, is a type of immunotherapy which involves the use of monoclonal antibodies, which essentially assist the immune system in its search and destroy mission by “tagging” cancer cells for destruction. Another such targeted technique, hormone therapy (which works particularly well on breast and prostate cancers), takes advantage of one of the cells’ primary growth factors, hormones, and regulates them in order to starve these rogue biologics of their food. Just as well, some therapies can cut off cancer cell nutrient supply by harming their blood vessels. Such an approach is similar to shutting the oxygen vents in a sealed room, thereby suffocating its contents -- in the case of uncontrollable cells, a sensible biological weapon.
These are just a few of the many potential cancer treatments. Thus, left with a myriad of complex, interplaying options, how are we to choose? While oncologists may be experts in their field, treatment plans are becoming increasingly reinforced with a robotic mind. The International Business Machine Corporation (IBM), in 2011, released Watson, a computer program that can help synthesize a patient's medical records in order to grant an evidence based treatment plan grounded in thousands of research studies. Various studies, such as a 2017 study from the Manipal Comprehensive Cancer Centre in India, have cited Watson’s accuracy as defined by its congruent opinions with doctors, specifically when it comes to lung, rectal, and colon cancers. The researchers concluded Watson’s treatment plan to be “highly concordant in the cancers examined”. Of course, while Watson has, in many instances, sufficiently demonstrated its capabilities, the program does contain limitations. Moreover, many experts -- including one of the physicians heading the project -- are in agreement that Watson will require improvements before claiming itself as a breakthrough device in cancer treatment. The physician commented: “It’s still in testing and not quite ready for the mainstream yet, but it has the infrastructure to potentially revolutionize oncology research”.
In consideration of our predicament, what are we left with? As a society, we are in an ongoing war with an enemy that is constantly adapting. As a countermeasure, we search in the test tubes and computer databases for our weapon. Yet, as we have seen, a single weapon does not likely exist. Rather, multiple weapons are required for multiple enemies. The various cancers, therefore, will need to be treated one at a time. However, to those who have become despondent, anguished, and heartbroken, know that progress is being made everyday and that staunch optimism should remain in your blood.