"Scientia potentia est" - Sir Francis Bacon

What is Cancer?

The word cancer is used to describe many diseases that are distinct from one another but share a few properties. The Swiss Cancer League, for example, lists 33 of the more common cancers on their info pages. The American Cancer Society lists over 70 on their "all cancer types" page.

The common properties of cancers are:

• One cell mutates in its genetic material in such a way that it is instructed to grow, or rather multiply, without an off-switch. This is a series of genetic mutations, not only a single switch that is toggled. In multiplying, the cell passes on this "grow" instruction to its offspring.
• The mechanism that corrects damaged DNA is suppressed, allowing the cells with altered genetic material to live and reproduce with the mutation.
• This cell and its offspring then proceed to multiply and invade surrounding healthy tissue. As the growth proceeds, the cancerous cells supplant and destroy the surrounding healthy cells.
• As time proceeds, these cancerous cells gain mobility, that is the ability to peel off from the initial growth and start new colonies elsewhere in the body. Each of these outposts is called a metastasis.
• Mobile cancer cells can and in advanced stages do hide away in parts of the body that are difficult to get to chemically. They come out of hiding later when its safe, after chemotherapy ends, to grow once again.

(Leukemia may be considered an exception, as it does not have a single concentrated growth or tumour. This type of cancer is never in situ or at stasis, but prolific throughout blood. Still, the general common characteristics above hold true if one considers the entire volume of blood in the body to be one organ.)

One Name, Different Diseases

A treatment that is successful against one type of cancer has no relevance to other types. The chemotherapy or targeted medication that is used against one cancer type does not significantly affect other cancers.

In general, successfully treating one type of cancer does not reduce the chances of another type occurring. So, if you survive colorectal cancer treatment, your chances of getting lung cancer are not diminished. Obviously, though, if your prostate is removed during surgery for colorectal cancer, you're not going to get prostate cancer in future.

Cancer can be treated quite successfully for many people, especially in stages 1 and 2, and more cancer survivors do live full lives than ever before. Me included!

Cancer Staging

When diagnosed, a cancer is assigned a stage from one to four. Generally, the lower number means that the cancer is not much progressed, has not spread, is very treatable. Knowing at what stage your cancer is, is essential for doctors to decide both the form and the method of treatment. It is very important to you too, as it allows you to manage your expectations.

The stage of your cancer, together with your access to medical treatment, allow you to get the statistical probability of your survival. Try to match your stage to your own country's statistics. If this is impossible, use the American Cancer Society stats. Understand that this survival rate is statistically calculated from the past, so there were people who survived your diagnosis. Also, new and future treatments can shift your survival chances higher.

The American Cancer Society, at the time of this writing, published excellent graphs showing the change in survival rate of patients for the various cancer types. This is indispensable information and I wish the other cancer societies would do the same. It allows you to see that, where your particular stage of a specific cancer may have had a survival rate of only about 50% in 1990, today it has improved to over 65%.

Get the best treatment that you can access and live as if you will survive!

Causes

Asking "why me?" has no relevance, don't do it.

Aside from a few clear causality lines that have been established by empirical evidence (for example, repeatedly inhaling asbestos fibres causes lung cancer by a mechanism properly understood and published in 2010), the exact causes of your cancer are unknown. Actually, for the most part doctors don't really know what causes cancer.

Only recently has the mechanism by which cancer starts, carcinogenesis, been understood at a genetic level. Not all cancer types have had their genetic instruction set analysed and described.

Furthermore, there is not one theory for carcinogenesis. Rather, there is one leading theory enjoying broad acceptance, and several competing theories that are being actively pursued at institutes of medicine and science. When we finally understand carcinogenesis completely it will almost certainly be as a complex model with various factors assigned varying statistical probability for the cause of each cancer type.

So, really, don't ask "why me?". No-one knows what caused your cancer.

Cancer Treatment

Sadly, there is no such thing as "a cure for cancer", nor will there be. Medicine is, however, able to treat and cure specific variants of individual types of cancer. Perhaps one day it will be possible to reliably detect virtually all cancers early enough to be able to cure each in its own specific way.

Cancer is usually treated by a combination of radiation (radiotherapy), chemotherapy and surgery.

Chemotherapy, the treatment of cancer with chemicals, is a bit more complicated these days. It's not just some chemical that attacks rapidly growing cells in the hope that cancer cells die before the healthy cells do (until recently, that's more or less what chemo was). Nowadays there is a differentiation between chemotherapy, targeted therapy, immunotherapy, and hormone therapy.

Each of these involve the programmed and carefully monitored administration of pharmaceuticals, often in combination with radiotherapy, in an attempt to inhibit the growth of cancer cells and/or explicitly attack the cancer cells.

For example, there are some newer medications that are targeted to a specific receptor on a protein in an attempt to interfere with the "grow" instruction that causes the cancer (a gross simplification), and the future will surely include many more such pharmaceuticals.

There are even a few new biological medications that are created using viruses to attack and alter specific DNA in a person's genes. These individual "living" medications are still experimental, I think, and have only been successful against a very few types of cancer. The future will, no doubt, include more such genetic cancer treatments.

The classical standard remedy continues its proliferation:

Blood Tests

Tumour markers in the blood, urine or stool are used to detect cancer and to track the effectiveness of a treatment. These markers, usually specific proteins, are not completely reliable for various reasons. The presence of a given tumour marker may be indicative of one or more types of cancer, the absence does not necessarily mean that cancer is non-existent.

Scans

CT, MRI and PET scanners are used to plot the shape of the tumour in three dimensions and to find any infected lymph nodes. These scanners are also used throughout the cancer treatment to monitor the tumour's reaction to the treatment. The patient continues having scans after treatment concludes, to monitor the body for any unexpected cellular activity that may be a sign of recurrence or metastasis.

These radiology technologies are absolutely essential in the fight against cancer, as they are in all of medicine. They are very expensive, though, and the radiologists who interpret and transform the scans into knowledge and intelligence are highly specialised. For this reason, access to good radiology scans is still limited to people who are well insured and countries that can afford it.

Radiotherapy

Radiation is used to shrink tumours and to boost the effectiveness of chemotherapy.

The patient lies on a ledge alongside a machine that moves around the patient's body directing a shaped beam of high energy protons. The radiation is targeted to an approximate accuracy of 1mm, allowing the therapy to attack specific cells while leaving neighbouring cells mostly unscathed. The treatment usually only takes a couple of minutes (my own was about 90 seconds) and is repeated daily, five days per week for several weeks.

It works by damaging the DNA of cells. The damaged cells don’t reproduce, die and are absorbed by the body. Cancer cells weakened by radiation also become easier to attack and kill with chemotherapy, so radiotherapy and chemotherapy are synergistic.

There are other types of radiotherapy, each with its own uses. The one described here is the most common today, but it can not be applied to all cancers or in all cases.

Chemotherapy and other Medications

Chemotherapy, targeted therapy, immunotherapy, or hormone therapy is administered in an attempt to inhibit the growth of the cancer cells or to provoke an immune reaction directly attacking the cancer cells.

Chemotherapy, as the word is used today, is the administration of chemicals that attack fast-growing cells of a particular type. Although there are some chemo medicines today that are taken independently in pill form, mostly chemo is still administered intravenously at a clinic.

The hoped-for effect is that the radiotherapy and the chemo increase one another's potency, ultimately resulting in the reduction or eradication of the tumour. This is the result achieved in many cases today.

Since about the year 2000 specific targeted therapies have been available that bind to specific molecules and so treat individual cancers. These are specialized medications, each for a particular type of cancer, like Herceptin® for HER2 positive breast cancer. Herceptin® works by binding to the HER2 receptor on breast cancer cells and blocks it so that it no longer reacts to growth signals, slowing or even stopping the growth of this type of cancer.

Thus Herceptin® may be described as a targeted hormonal cancer medication.

Hormonal therapy is used in types of cancers where hormones are causing the cells to grow, for example breast or prostate cancers. Typically hormonal therapies interfere with the hormonal signals that are causing the cell growth, thus slowing or even stopping the growth of the tumour. Sometimes hormone therapy is used to control the symptoms of cancer, and sometimes to reduce the risk of a cancer recurrence after the primary treatment.

Immunotherapy is the injection of a chemical or bacillus that provokes the patient's own immune system into attacking the cancer cells. Several specific immunotherapy treatments were generally available since the early 1990s. There is even a newer type of immunotherapy called adoptive cell transfer, in which the patient's own white blood cells are extracted, genetically engineered, then grown in large numbers in a lab, and re-injected into the patient to fight the cancer (see "CAR T-cell therapy"). This is very new stuff, with the first two medication approvals in the USA in 2017. Adoptive cell transfer, specifically, seems to hold some promise for the future of fighting cancers.

Surgery

Once the tumour has been reduced in size, surgery is used to remove it and any other affected tissue or organs. Sometimes the cancer is caught so early that it can be removed surgically without the prior use of chemo or radiation.

Even when the tumour disappears completely during chemoradiotherapy, surgery is still commonly used to remove the tissue from the affected and surrounding areas.

Adjuvant Chemotherapy

Chemo is also sometimes administered after surgery in an attempt to kill any remaining undetected cancer cells left in the body or, indeed, an attempt to prolong the patient's life. This is called adjuvant chemotherapy.

Clinical Trials or Studies

Sometimes a cancer patient will get the opportunity to take part in a clinical trial. Often the trial is between two alternative treatment regimes or medications. In these cases it is beneficial to take part in the clinical trial or study because of the increased and intensified monitoring of trial patients. No matter if a patient is part of the control or the test group, they are subjected to more intensive and longer monitoring and they often get the personal attention of a trial nurse. This intensive attention is paid for by the trial, not by the patient or the patient's medical insurance.

Absolutely get yourself into a clinical trial if you can!

Your Own Treatment

There are many types of cancer, most with several variants. Each variant of each type of cancer is treated differently, and differently again depending on how early it is detected and to which stage it has progressed. A person's treatment of a cancer is fine-tuned to the specific situation.

Typically, a tumour board made up of several cancer specialists discuss each case and decide together on every person's treatment. Your oncologist will advise you in quite a lot of detail and guide you in making the very hard decisions necessary as a newly diagnosed cancer patient.

Remember that your treatment is individual, it is your own. Just because some other guy was successfully treated with some chemical may not have any relevance to your case. Trust your oncologist or find one who you can trust.