Posted on Dec 24, 2013 by Ruth Loftus
As cancer continues to take its toll on the population, it is not surprising that we continuously await news of progress in understanding the condition and its treatment. Today, it makes little sense to regard cancer as a single disease anymore but rather a huge network of conditions which all begin in the same way but then progress more individually. Recent research has revealed more of the complexity behind this network therefore creating new questions about some aspects of current treatment methods.
The increasing complexity of cancer means that designing treatments is challenging. Researchers and clinicians are certain though that understanding the fundamentals of the chemistry and mechanics of cancers will lead in due course to much more effective treatments. A better understanding of the way in which specific cancers actually grow and spread through an affected person is now a basic foundation to understanding cancer.
The search for ‘a cure for cancer’ launched many decades ago has laid open the fact that there is no single condition called cancer which can be treated, much less cured, by a single common medical intervention.
Doctors do appear confident however, that cancers do have one thing in common and that this can provide the basis from which treatment for many different cancers might be developed. It has also become fairly clear that although it has previously been common to refer to cancer as being ‘of ‘ specific organs or tissues, this is in fact an oversimplification.
What we typically call ‘cancer’ begins when the normal process of creating new cells in our body and in individual organs somehow malfunctions. This seems to happen because the controls that direct and manage the cell creation process undergo some corruption (or mutation) and begin to send out the wrong instructions. This could mean that a cell continues to grow when it should stop and that the ‘fail safe’ process which exists to ensure that anomalies like this are brought back under control is also overridden.
Cancerous cells grow and tend to displace healthy cells within the body therefore effectively turning the body against itself by diverting energy to their growth. In time, cancerous cells move from the original site and cause this ‘wrong’ growth elsewhere. Much research into cancers has focused in this process of mutation and the development of treatment that might allow the initial fault to be corrected.
However, the latest research now suggests that the notion of a single fault to be corrected may be an oversimplification.
One strand of research has looked in great detail at breast cancer and has suggested that what we have called ‘breast cancer’ can actually be better regarded as perhaps ten different conditions. These different conditions have different survival rates and might be susceptible to quite different therapies as their individual characteristics become more understood.
This deep complexity in the development of cancer has been further explored by other research which suggests that there is a degree of ‘chaos’ in the way that cancers can develop in any one of us and this presents problems for lasting and effective treatment. Researchers have used the analogy of a tree, suggesting that although cancers may have a common trunk they become dispersed and spread through the body in a way that seems as random as the growth of an individual branch of that tree.
With regard to cancer development and treatment, another consequence of this ‘chaos’ theory is that the initial mutation that begins as a cancer may not be the end of the story. A first mutation may lead to further mutations meaning that the development of a tumour may be driven by the consequences of all of these changes. Unravelling the chemistry to switch off the initial change may only partially put a brake on the full process that is underway.
Research looked at a small number of patients with childhood leukaemia and found that the children actually had between two and ten genetically distinct cancers. The research also suggested that the process of random, chaotic mutation means that cancer is unique to an individual, particularly if it is permitted to develop over time. This further explains why advanced cancers are so difficult to treat as they have been able to establish this complexity and consequent resistance to treatment.
In highlighting the complicated nature of the development of cancers, recent research may seem a little disheartening. It does however, stress yet again the importance of early detection of the disease – since treatment is usually more straightforward before complexity has developed. It also highlights the need to avoid those lifestyle choices that for some people, can actually prompt the gene malfunction that is the very beginning of any cancerous condition.