We have found ways to edit genetic material, cloned sheep, and mapped the entirety of the human genome. But there is one single anomaly completely unphased by the billions of dollars invested in decades of research and still upholds its position as one of the leading causes of death around the globe. What is it about this fascinating phenomenon that makes it so hard to eradicate cancer?
Cells do a lot of things well. Neurons allow the world around your body to be accessible to you via electrical impulses, epithelial cells in the gut harvest material for energy and growth, and stem cells can literally become anything they want – almost. But there is one common aspect of cells that is particularly fundamental: your cells divide. They divide to grow you; they divide to repair you.
There are billions and billions of biochemical reactions happening in your body this second, via trillions of reaction pathways. With these numbers taken into account, it is not a matter of ‘if’ there is a mistake – but ‘when’. It is inevitable that something will go wrong.
Cancer is exactly that; it is uncontrolled cell division of normal cells as a result of a mutation in the cell’s genetic material. I prefer to see it as corrupted division – the ability of the body to regenerate hijacked. It’s sobering how something whose purpose is to give you life and keep you alive can turn into something that is the death of you.
When cancer cells grow unchecked, they become tumours, where they can metastasize (spread to other sites in the body by metastasis) to distant organs. This is where it gets bad, because when cancers are metastasized, they become almost incurable – with the incredible rate at which these divisions occur, there is a fine, fragile line holding the cancer from getting to a point where it can no longer be controlled.
Usually, your immune system is brilliant at recognising these mutated cells and getting rid of them. The mutated cells themselves undergo apoptosis (controlled self-destruction) in order to eliminate the issue. But sometimes, these defence mechanisms just can’t keep up.
Cancers are incredibly complex, which mainly accounts for why there has been no definitive cure found over decades and decades of research. The main reason, though, is something called clonal heterogeneity. This happens when different, random genetic mutations accumulate in different, equally random parts of the tumour, which results in even more random, unique subclones being made. Imagine having a balloon that’s constantly inflating, while also growing different shaped bumps at completely random places, with no means of predictability – such as a star and a square on the top and a heart next to the star, with a doughnut shape in between. Your job is to get rid of this balloon without popping it. That’s cancer.
The thing about clonal heterogeneity is that a drug that works on one subclone may have no effect on another – just like how the same antibiotic doesn’t work on a new mutated strain of the same bacteria.
Another remarkable aspect to note is that tumours are, essentially, ecosystems of their own. Complex, entangled cancer cells communicate with each other and with healthy body cells all the time. Siddhartha Mukherjee, author of The Emperor of All Maladies: A Biography of Cancer, describes this occurrence as ‘Cancer’s life is a recapitulation of the body’s life, its existence is a pathological mirror of our own.’
They can manipulate or coax healthy cells to form networks of blood vessels to and around the tumour to feed it. These lines of communication also allow cancerous cells to suppress the immune system to prevent getting recognised and, eventually, destroyed. Genius. So, needless to say, in order to find a cure to eradicate cancer from its roots, we first need to find a way to shut down these lines of communication within cells.
And, let’s say that we did in fact find a way to solve all these problems. We all know that cancer is a master of adaptations; there is no doubt that it will be firing newer, unique, and so much more difficult challenges our way. It truly is a the survival of the fittest. In the words of Siddhartha Mukherjee, ‘History repeats, but science reverberates.’
But there is no room for pessimism during the golden age of science and innovation. According to the statistics published by Science-Based Medicine, the overall death rate from cancer has been steadily declining by 1.5% per year since 1991, resulting in a decrease of the cancer death rate by 26%. That is an incredible number. Keep in mind that our technology gets better and better, and more and more scientists practise researching this area with time. Who knows what number we will see in another twenty years!
I could write paragraphs after paragraphs, pages after pages discussing the ‘how’s and ‘why’s of this fascinating phenomenon – the way that it has no definitive conclusion almost makes it a philosophical matter. I would like to leave a quote with you, one of my favourites, that really highlights the fragility of life. I hope that you will be kinder to yourself in this life where so many things – like mutations – are completely random and out of our control, for your body has always tried its best to be kind to you.
‘We are fragile creatures, and it is from this weakness, not despite it, that we discover the possibility of true joy.’ – Desmond Tutu, The Book of Joy: Lasting Happiness in a Changing World
