Cancer: Let’s talk about the “C”

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Second of two parts

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Why is it so Hard to Treat Cancer?

A Cure for cancer has been widely sought for decades since its discovery. While popular and entertainment media usually play on “evil big pharma” tropes in their stories saying cancer cure has always been here and it has always been hidden, the truth is not actually that simple.

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For one, there have been people “cured” of cancer – So basically there is a “cancer cure”. However, this is not a cure all for every type of cancer, not even a cure all for one type of cancer, and may not even be a cure all for the individual person who has been tailored for this treatment.

"Diagram showing how cancer cells keep on reproducing to form a tumour." by Cancer Research UK is licensed under CC BY-SA 4.0
“Diagram showing how cancer cells keep on reproducing to form a tumour.” by Cancer Research UK is licensed under CC BY-SA 4.0

This is because of how cancer behaves.

When a cell mutates and it turns into a cancer cell, the cancer cell still has high chances of mutating into a slightly varied version of itself. That is why when a brain tumor gets treated by a combination of therapies like surgery, radiotherapy and chemotherapy, months or years later, another tumor may take its place. This may not be because the treatment was ineffective – the treatment may have effectively neutralized the cancer cells it needed to, but this may be because the initial treatment have only targeted a specific type of cancer cell, yet those cancer cells, with whatever time they had, have “given birth” to multiple different strains of themselves with slightly different variations of the mutation. Thus the initial treatment may have been less effective to these “new” types of cells, leaving them unaffected and they eventually grew and become a new tumor, owing for another round, perhaps a different set of individualized / unique treatments specific for these new strains. (READ also: Cancer: Let’s talk about the “C” – Part 1)

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Once, “cured” of cancer, it does not necessarily mean one cannot get cancer again. Research is still ongoing in looking for a true preventive measure for cancer, or true immunity once cured of it – specifically in immunotherapy studies. The body’s immune system can actually detect cancer cells and combat them, however due to cancer’s ability to mutate, it has always been known to evade the immune system, that’s why it’s not enough. Immunotherapy research may one day be able to tune the body’s immune system to fight cancer no matter its mutations and evasions. It may be the future of cancer treatment.

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Cancer is usually treated with a combination of treatment regiments. Cancer is first determined in the individual, its size, characteristics, extent of involvement, etc. Some cancers often go together with other diseases, some may have been triggered by a disease, complicating treatment options. No two cancers are the same – that is why there is yet to be a “cancer cure all”. Someone’s Breast Cancer treatment might not work for another’s Breast Cancer. A patient’s previous Breast cancer treatment may also not be viable as treatment if that same patient got Breast cancer again.

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Cancer treatments that are available are as follows (covering only the basics as they are large topics to talk about on their own)

Surgery

In theory, non-hematological cancers can be cured if entirely removed by surgery, but this is not always possible. When the cancer has metastasized to other sites in the body prior to surgery, complete surgical excision is usually impossible. Surgery is also done for cancer staging, so it’s both therapeutic and diagnostic. Surgery may come before or after chemotherapy treatment depending on the nature of cancer.

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Radiation Therapy

The effects of this therapy are localised and confined to the region being treated. This method injures or destroys cells in the treatment area – called the “target tissue” by damaging their genetic material, making it impossible for these cells to continue to grow and divide. Unfortunately radiation therapy may be harmful to normal cells in the vicinity as well.

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Chemotherapy and Targeted Chemotherapy

These are the “anticancer drugs” and are often used in combination. Generally these drugs target rapidly multiplying / dividing cells which are the basic nature of cancer cells. Research is still ongoing on trying to give chemotherapy drugs the ability to specifically target cancer cells only (Targeted Therapy / Chemotherapy) This is because chemotherapy drugs may also target rapidly diving normal cells of the body – like the cells of the bone marrow (causing myelosuppression – which suppresses the immune system), the cells of the digestive tract causing mucocytis or ulceration, and commonly it causes hair loss as well. That’s why most cancer patients being treated by chemo may be bald, nauseous, anemic and immunocompromised.

Immunotherapy

As was stated above cancer immunotherapy refers to a diverse set of therapeutic strategies designed to induce the patient’s own immune system to fight the tumor.

Hormonal Therapy

Some cancers can be inhibited by providing or blocking certain hormones. Common examples of hormone-sensitive tumors include certain types of breast and prostate cancers that rely on estrogen or testosterone.

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Supportive Treatments are also done in conjunction to these treatments, as most cancer patients have relatively lost a significant amount of quality of life. With chemotherapy-induced nausea and vomiting, diarrhea, hemorrhage and other common problems in cancer patients, the multidisciplinary specialty of palliative / supportive care has arisen specifically in response to the symptom control needs of this group.

Psychiatric Treatments are also done as cancer patients are prone to depression and anxiety, a diagnosis of cancer itself has been known to increase the risk of suicide, owing to the looming fear of mortality and the cost of treatment.

An indian-born American physician and oncologist, Siddhartha Mukherjee, wrote a book that won the 2011 Pulitzer Prize for General Non-Fiction. “The Emperor of All Maladies: A Biography of Cancer”.

It is aptly titled, as cancer in all its glory and horror, remains emperor, and will likely remain so.

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