Hacker News Reader

Comment by colordrops | Hacker News Reader

I used to always hear the trope that "cancer isn't one disease, it's 1000, so there will never be a 'cure' for cancer", yet for a while now properties that are shared across a wide variety of cancers are found regularly, increasing hope that we can knock a lot of them out with a single type of treatment. In this case it's 20% of cancers but I recall seeing other findings across a wider swath.

View on HN

PI at a cancer center here. These two ideas are not mutually exclusive. Cancer is indeed not 1 disease but many countless ones. At the same time, cancer diagnoses are based on site of origin and histology (how it looks under a microscope). But often what drives a cell of one tissue toward pathogenesis is the same mutation or other molecular malfunction as a cell of another tissue type. In those cases, we can develop drugs that target that specific component and it may work across both cancer types.

Unfortunately, there are countless ways things can go wrong in cells. There are also rarely drugs that truly span a large swath of cancer types effectively. That's because even though two cancers from different sites may have the same driver, how they respond to treatments can differ. The difference in cell state may allow one of the two cancers to adapt to the treatment, such as by activating an alternative growth pathway, whereas the other cancer type's cell of origin may not have such an easy road to therapeutic escape.

Also, maybe, the fact that what cancer cells have in common, they tend to also have in common with cells that aren't cancer, and therefore make poor targets for therapies.

That's kinda a defining characteristic of cancer. It's your own cells, so your immune system doesn't recognize it as foreign and take care of it. Just about anything that targets cancer targets the non-cancerous cells it started in. Most chemotherapy boils down to "kill it all and hope the cancer dies before the non-cancer, and leaves enough non-cancer behind to keep you alive". There have been a lot of advances in targeted cancer treatments, but even most of them just selectively target the type of cell (healthy or not) that became cancerous, and do less collateral damage to "innocent" cells. It's incredibly hard to target an individual cancer, and so far impossible to target cancers broadly.

So, my question is why isn't fasting a partial solution?

It's kind of the same idea as chemo. (Non-selective cell stress/death)

But won't cancer cells always starve first, as they don't have a way to go dormant?

Or is that a myth?

I'm no expert, but I know cancer cells promote adding blood pathways towards them, so it might be that they have an "uneven share" of the nutrients transported to them, and thus die out later than the healthy tissue.

I don't know anything about cells going dormant as a result of fasting. That sounds questionable to me. There's been some research on fasting and cancer, but there haven't been a lot of studies, and results are inconclusive. Some of the ideas sound sensible. Cancer cells are incredibly greedy and slurp up glucose as they constantly divide. The thinking is that you can starve them and slow progression, in conjunction with chemotherapy and other treatments. It's not widely supported or practiced and more study is warranted. It's hard to find real information on it, because the idea that you can miraculously cure cancer and other diseases by changes in diet is embraced by millions of anti-science crackpots, so there's a ton of disinformation and speculation out there.

> So, my question is why isn't fasting a partial solution?

With a statement like that, it would seem that you know a thing or two!

Care to elaborate?

So what you’re summarizing is that cancer is definitely a single disease with multiple types but there are commonalities. Which makes sense. Which is why I never bought this “we can’t cure it because it’s not one disease”. We can’t cure it because we aren’t smart enough.

> Which is why I never bought this “we can’t cure it because it’s not one disease”.

Really, in an important sense, cancer isn't one disease because cancer isn't a disease at all. It's a mechanical malfunction, kind of like having a cleft palate.

On the other hand, it is more disease-like than most mechanical malfunctions.

Perhaps you have an overly narrow definition of the word disease? Cleft palate is, in my opinion, a congenital disease. A fractured bone is also a disease.

I have a cancer, a basal cell carcinoma. Like other cancers, it's a transformed cell type with dysregulated growth. But, it's likely to be completely excised surgically, unlike pancreatic adenocarcinoma, which would likely kill me in a few months.

> Perhaps you have an overly narrow definition of the word disease?

I'm intentionally highlighting here a definition of 'disease' that is much narrower than the norm, yes.

> A fractured bone is also a disease.

On the other hand, you're trying way too hard to correct that. Nobody considers a broken bone to be a disease. A broken bone in your leg is not fundamentally different from a broken rock outside your leg, and -- more importantly -- this lack of difference is easily understood by everyone.

But while e.g. diabetes is not caused by external agents, it looks from the outside just like other types of problems that are. This leads to both types of problems being called "disease", even though the radical difference in how the problem occurs means that the treatments and ways of thinking that apply to one type are not appropriate for the other type.

Diabetes is purely mechanical, and if you take measures against it, you can suppress its effects. It will never fight back or attempt to circumvent your efforts. Malaria is purely external, and if you take measures against it, it will take countermeasures.

Cancer is an intermediate phenomenon. It is not caused by external agents. But it is alive and may respond to measures taken against it -- it consists of part of yourself 'going rogue' and becoming as malicious as an external agent.

This intermediate status suggests that approaches from either end of the "disease" spectrum might be fruitful. One of the biggest problems we have in dealing with cancer is that we want to treat it as a malign external agent to be removed from the body, as would be appropriate if it were really a disease. But while there are many effective tools to do that for diseases, they all fail badly in a couple of different ways when the "disease" is indistinguishable from the rest of your self.

I think you should maybe come up with a new word. You're heavily overloading terms that have medical definitions with your own meanings, and expounding an alternative philosophy of medicine, which is fine but shouldn't depend on semantics, perhaps.

> and expounding an alternative philosophy of medicine

What?

No, they wrote:

> Cancer is indeed not 1 disease but many countless ones.

No, they do what most cancer researchers do, which is wrap the truth around so much bullshit that you can read it however you please. I’m also not an amateur, I spent most of my PhD studying cancer drugs.

This isn't going to be easy, but an alternative to molecular cures is an organismal-level cure.

Replace the whole body. All the cancerous, pre-cancerous, and worn down, aging and diseased cells wholesale.

Grow monoclonal headless human bodies in a lab. Innervate, artificially supply with hormones, and grow until puberty. No head. (Genetically or surgically stop precursor cells early on in development.) Grow the bodies artificially in pig uteruses at scale. Make it a monoclonal line that is O-, HLA neutral, etc. to avoid transplant rejection and the need for immunosuppressants.

Before these are ready for human use, they can be used for population studies and in situ experiments. They can also be used for organ transplants.

Develop and perfect human head transplantation. Try it on terminal patients, paralyzed patients, et al. Get good at it. Early results won't be good, but given time to develop, we might be able to reattach the spinal system.

Transplant recipients get a new pulmonary, cardiovascular, and circulatory systems. New thymuses with better immune systems. This could be a non-negligible boost to human lifespan.

New bodies can be genetically modified to have higher VO2 max and other stats. You could choose the height, build, and gender of your new body. Literally everything.

This is better than duct taping aging components in place. It's replacing everything but the head and brain, which is where we should be moving as a society anyway.

It won't cure brain, blood cancers, or Alzheimer's. But it'll be useful against heart disease, lung disease, liver disease. Everything else.

> It won't cure brain, blood cancers, or Alzheimer's.

Blood cancers are some of the most successfully-treated cancers. One of the effective--but risky--treatments of last resort is close to this futuristic fantasy you're imagining: there are leukemia/lymphoma patients who've been cured by destroying their bone marrow and then replacing it with healthy bone marrow. It's done using donor marrow, umbilical stem cells, or even the patient's own marrow that's been extracted, treated, and returned to the patient after they wipe everything out. It's pretty close to a full replacement.

Most of what you're suggesting isn't possible with any current or likely near-future technology, but curing blood cancers this way is already mainstream medicine. In some cases, patients that have undergone this treatment have also been cured of AIDS and other "incurable" diseases.

This is unlikely to work, as the brain regulates many bodily functions on a neurohormonal basis, so the headless body won’t develop properly. You can get abnormal heart rhythms from a stroke in certain parts of the brain for example.

Also it has an insurmountable yuck factor.

i could see science getting to a point where you could grow a human body, but I don't think we could surmount the challenge of transplanting a head and successfully integrating the brain from your "old body" onto your "new body".

More specifically, I think even if you could perfectly reattach every nerve from the brain to the spinal cord, your brain might still not know how to control the new body.

(There's my armchair scientist contribution for the month)

Phantom limb syndrome is thought to be caused by the brain adapting to changed signals from the limb's nerves. It means years of pain, itching, false sensation. I can't even begin to imagine what it would take to address phantom body syndrome.

(I'm also a total layman here)

A medication (topomax) once gave me the reverse. My left arm felt like a complete stranger. Was terrified of it. Intellectually I understood it was just the medication screwing with me. Emotionally I wanted to take a chainsaw to that arm.

Was that included in the potential side-effects list you received? That sounds horrible.

Topomax has a lot of insane side effects. Bad reputation.

Trend seems to be it either works great at fixing migraines or makes you really stupid plus weird issues.

Doctors of course want you try it for six months before next medication. Repeat every six months for multiple years.

I have to imagine months or years of physical therapy. Better than the alternative, granted, but wouldn’t seem to scale well.

You should write a screenplay. I’d watch that movie!

It sounds similar to the premise of Altered Carbon. Great book and so-so Netflix show.

There's a bad Arnold movie along these lines - The Sixth Day.

I mean, the end goal there is uploading, growing a new body, and replacing the brain with a computer running the uploaded mind.

Yes, but analogy time:

We are the ancient Greeks, we’ve invented written language and some of our famous philosophers and orators are very upset about how this is changing the human condition.

In the same way the ancient Greeks made the Aeolipile[0] and could probably imagine it doing something useful, we can bioprint tissue and imagine it doing something useful.

If full-body printing is as far off as the industrial revolution, mind uploading is as far off as the internet — while we can detect neuron firing when it happens, AFAIK we don’t have any way to read even a single synaptic connection strength, despite the OpenWorm and Neuralink projects and similar, because nobody has been willing to fund that research.

[0] https://en.m.wikipedia.org/wiki/Aeolipile

Why have a body at that point?

It's just a cost center.

I love how geeks readily fantasize over this "no body" experience when everything we know about how our conscience is shaped is determined by our body.

You can't really separate the two without us turning into something else. Our bodies define the human experience.

I know that we really, really want to be some ethereal beings, but we're not.

I'm not even sure the "no body" situation is superior, we'd probably be psychologically very different and I'm not convinced we'd be better (not feeling pain, for example, is a pretty sure fire way to lose empathy).

Even the upload itself is just a cost center. Just tell people they’ve been uploaded and they can die in peace.

I remember hearing the same things in biology class many years ago, and thinking to myself “but we don’t know what we don’t know, this guy is overly certain about this”. The over-certainty about the present state of knowledge is unfortunate and might slow progress.

Right, and one term one I've heard for this is Overconfident Pessimism [0].

People confidently declare that cancer is "incurable" as a matter of metaphysical principle, the reason being that cancer isn't one thing and that it's really hard. The most celebrated example making this declaration that I know of is this comic from PhD comics [1].

I think you can appreciate that cancer is more than one thing, and that "curing" in all it's variations is really hard, without proceeding, punch drunk on enlightened skepticism, to declare that these mean it can't be cured.

To me it feels like a frustrating philosophy 101 mistake masquerading as profound wisdom.

0. https://www.lesswrong.com/posts/gvdYK8sEFqHqHLRqN/overconfid...

1. https://phdcomics.com/comics.php?f=1162

I'm especially excited about targeted treatments though. It is not just about being shared across cancers, but how specific those properties are to cancers.

Reply on news.ycombinator.com