By: Ross Keller, 2nd year PhD candidate in the Biomedical Sciences Graduate Program
To answer this question, we need to explore what cancer is.
Cancer is described as the uncontrolled growth of our own cells. Normally, cells have a designated number of times then can divide and are genetically programmed when to do so. But when certain genes become “broken” via a mutation, which is a change in the DNA blueprints, the cell is free to divide unchecked.
Interestingly, mutations happen all the time in our cells. There are billions of possible mutations in our genome—but there are also billions and billions of cells. So, why is cancer, overall, rare?
It takes a special combination of mutations for a cell to become cancerous, and every once in a while, a perfect storm of mutations hits one cell. This cell gets the right signals to keep dividing—it becomes the best at passing on its own genetic material. The cell has abandoned the benefit of the organism in favor of passing on its own cellular genetic material. It has evolved in a way its neighbors haven’t, and in true Darwinian fashion, undergoes natural selection. This cell then divides millions of times, and a tumor is the result.
As such, cancer is not a disease in the same sense as a cold or the flu. It can’t be compared to conditions such as heart disease or diabetes. Cancer is in a class all on its own, and it’s actually less like a disease and more like a process—even a natural process depending on how it’s viewed.
To win the war on cancer, we must accomplish three goals: 1.) identify which mutations occur at which times in which cells, 2.) detect these changes quickly, and 3.) develop effective treatments to destroy the cells harboring these changes.
Unfortunately, this is not easy. There are hundreds of cell types in the human body and thousands of mutation combinations capable of creating that perfect storm. There are also many different orders these mutations can be obtained in, and an untold number of timing combinations that may work. One can see how these variables together could create potentially thousands of what could be different cancers. To date, about 200 different cancers have been identified in humans.
Second, we need a means to know if the mutations have happened—a test that says, “Some of my cells are broken.” This can include broad tumor detection methods such as CAT scans, MRIs or even simply feeling for a tumor. Oftentimes, this is not enough.
To win, we need methods that tell us something is wrong before a tumor develops—when a cell first becomes selected to grow. Future methods may use biomarkers, which are biologically relevant substances that individual cells may secrete or display that tell us something is wrong. But again, potentially thousands of different cancers mean potentially thousands of different markers to identify.
Finally, we need a way to treat the cancers. Today, broad cancer treatment options such as surgery, radiation or chemotherapy are used. These can target any cancer, but they also target healthy cells, leading to devastating side effects. Furthermore, these options often fall short of a full cure—some cells are left behind that could grow again. To truly beat cancer, we need methods that target all cancer cells in one’s body. But, with many different cancers, many different treatment methods will be needed.
It’s easy to be pessimistic considering the extent of the challenge we face, but I believe we will win eventually. We’ve come a long way since 1971. More people are living longer after a cancer diagnosis than ever before. But, we still have a long way to go. Major advances still need to be made for all three of the goals.
Currently, most of our scientific energy in the cancer field is being used to try to understand how different cancers happen and how they progress—the first of the three goals. But, that’s okay. The first rule of war is to know your enemy.
Organizations such as Relay for Life and Pink Ribbon charities have raised billions over the years to aid in cancer research. These organizations give a significant portion of their donations to research, and there is no doubt that these contributions are central to the fight. Without them, funding for research would be nowhere near where it needs to be to effectively battle cancer. We will win eventually, but the more resources the public devotes to the war, the faster it will happen.