Cancer’s origin story features predictable plot line, researchers find
med.stanford.edu
med.stanford.edu
(Disclaimer, I’m not an expert, I was just pretty amazed by how the whole process was customized and targeted for her specific case.)
I’m sure this isn’t a catch-all, and it’s bad to put hope in “one thing to solve it all”, but this sure is exciting.
She’s doing better, only about a year off treatment currently. It was originally found at stage 3 but it seems that surgery + 2 radiation rounds + 2 chemo rounds has worked alright.
Cancer is like a bacterial infection, but with cells from the host. Of course if your lung has an infection of colon cells those don’t suddenly become lung cells.
I don’t see how that makes it different diseases. It is only treated that way because we aren’t attacking the root cause (i.e. the actual broken replication inhibitor in whatever line of cells).
For the cancer to not get killed immediately several things have to get broken, not just the replication inhibitor. Once they get to that state is not far fetched to think that they can have or get in the future different mutations, not specifically required to get cancer in the first place.
The comments below us talk about the folate receptor mutation that not all cancers have.
https://www.nature.com/articles/s41586-020-1969-6
Figure 2 shows the different mutations present in cells in a variety of cancers carry. These genes have a variety of functions. The DNA of cancer cells from different tumor types is different, and TP53, the gene featured in OP, is never mutated in some cancer types. In the end the discussion is a little semantic (what defines a different disease), but if the prognosis, treatment, and molecular mechanisms behind different types of cancers are different, I would consider it fair to consider them different diseases.
As for if this cancer screening process from the root post is available, I’m not sure.
> Conclusions: Among younger Canadian cancer patients in the lowest SES group, greater access to health care may have resulted in higher cancer survival, while higher screening prevalence and access to health insurance (Medicare) among older Americans during the period of this study may have resulted in higher survival for some screen-detected cancers. Higher survival in the highest SES group for stomach and liver may relate to treatment differences. [1]
This study breaks it down by type, and socioeconomic status too, if you're curious.
This is just one more recent study, but there's a lot of evidence to support this.
[edit] Note that 5-year survival rate comparisons tend to benefit the US because the US does more aggressive testing. Studies show that this testing often doesn't actually reduce mortality, but it does start the 5-year survival clock earlier. So odds are this data overstates the outcomes in the US, particularly in the older demographic as the conclusion calls out. But that's a conversation for another time.
[1] https://www.naaccr.org/wp-content/uploads/2022/07/NCRA-Sprin...
For prostate cancer specifically, that's likely due to higher screening rate guidelines in the US leading to earlier detection, not lower mortality. Prostate cancer comes up a lot because it's often used as a stalking horse, and it's generally a disease of the elderly. [1]
Specifically it came up in re: Guiliani and the UK:
> For one thing, according to the American Cancer Society, many more men are screened for prostate cancer in the U.S. than in Britain. This leads to more cases being diagnosed. And many who have prostate cancer live for years, without treatment, whether they are diagnosed or not. Thus, a higher number of diagnoses leads to a higher official survival rate. But this tells us nothing about the quality of treatment available to those who have the disease. A spokesman for the ACS told us that comparing rates in the two countries is “misleading.”
There have been evaluations of this between the US and Canada [2]
> US and Canadian differences in screening due to guidelines can potentially explain cross-country differences in breast cancer mortality and affect interpretation of international comparisons of cancer statistics.
The outcomes really are very comparable in the two systems, despite them trading top spots in different categories.
[1] https://www.factcheck.org/2007/10/a-bogus-cancer-statistic/
[2] https://academic.oup.com/intqhc/article/23/6/611/1819867
I had testicular cancer in 2006 in Chile. I was a teenager so I went with the public system (AUGE back then). My parents friends were giving the condolences for my soon to occur death. The doctors had a laugh as in the last 10 years (by then) my chances of dying of it became basically nil.
Last year we hired a new guy at $JOB that 1 week after being hired was diagnosed with testicular cancer too. He really thought he was gonna die. He was at stage 4 (which is a highly zone specific metric). Last time I saw him he is still coding and more bald. It was more difficult to sort payments than the treatment as he is in the US.
Cancer sucks.
IF we catch the cancer early, we are much better at treatments.
What we are getting good at is treatment with early detection because we can just cut it out with surgery. What we are only marginally better at is treatment with late detection.
For cancers that we don't have early detection, the success rates are far, far lower and the treatments are far more limited.
For example, a significant fraction of women get diagnose with lobular breast cancer--it doesn't form lumps. So by the time you detect it, you are almost always already Stage 3 or worse.
Radiation, in particular, is much better thanks to computing. The only advance in surgery I have seen since the 1970s is that they use a radioctive marker to trace where the lymph nodes are--it helps with lympedema but not the cancer. Chemotherapy is only marginally better than 20 years ago--they're a little better at managing side effects but chemo is still horrible.
Medicine does well on things that can be fixed by physical means--cutting things out or sewing things together. Medicine still doesn't do all that well from a chemical standpoint.
Didn't realize myself until I was diagnosed with a sarcoma (1% of adult cancer diagnoses), MPNST (a single digit percentage of sarcomas).
Doctors scrambled to figure out what to do - first we should just cut it out, then, well maybe we should do chemo + radiation. A day before getting a port put in receive a phone call that "oops, chemo doesn't work, just cut it out and radiation afterwards."
Luckily I was in a good position to get multiple opinions and read the data myself.
Almost 2 years cancer free now and am so grateful, but looking at the data, it's all seems like a toss up unless you can just cut it out with clean margins.
I really can't help but think modern medicine is really missing the mark with the reactionary approach to disease in general, but of course I have no clue what to do about it.
There are two hard problems here:
1) Medicine doesn't always have anything good to actually do
As you point out, there was nothing other than cut it out and do radiation for your case. Those are very physical processes. Chemical processes that either do something directly to problematic cells or cause the body to do something to problematic cells are very lacking. We don't have very many knobs that do something to diseased cells that don't also do horrible things to the patient.
2) The source of being "reactionary" is that statistically rare diseases show up as false positives way more often than real positives without some Bayesian prior.
Medical testing is a balance between causing too much harm in testing and not enough detection.
Lobular breast cancer only shows up on MRI. So, women should get an MRI with their mammogram, right? Well, except that the MRI requires a gadolinium contrast which bioaccumulates. And you needed an IV for the contrast which can get infected. And, you will find a lump of something with a modern MRI. Now what? You really should leave it alone and watch it, but some women will be unable to deal with the anxiety so you will need to biopsy it. Biopsies have their own problems. etc.
Testing for infrequent events is hard.
I guess the only people that have access to them are people in stage 4 cancer where all treatment options have run out. And even this group is small.
https://en.wikipedia.org/wiki/The_Emperor_of_All_Maladies
It really helped me appreciate how we went from treating people with anything that'd kill their cells to highly specific drugs that target genetic pathways.
I have lung cancer, stage 4.
My cancer has a mutation that is uncommon in lung cancers (< 2%), but common in breast cancers (> 25%). All of the treatments for my mutation are breast cancer treatments. It has been alternately not too bad and hellish getting insurance to agree to give me medications that could be saving my life. That plus a previous steroid-treated pneumonitis disqualifies me from about 90% of clinical trials, so the tip-of-the-spear treatments (CRISPR-T, CRISPR-NK) are unavailable to me.
So yes, lots of advancements are being made...in common cancers. Uncommon cancers, we have to wait and take the older stuff, or stuff that's just been approved.
And even through all of that, it's a crap shoot as to whether it will work or not. I took 2 conjugates, in the same class of medication - each had a slightly different chemo med. One worked fabulously, about halved the size of my main tumor. The other did nothing, and ended up giving me neuropathy in my feet (it can be numbness, but in my case it felt like my feet were on fire, 24/7. I am on a medication now to fix that, and my feet feel totally normal). Fun fact - the neuropathy chances for that med were stated as 0%. I guess someone rounded down from 0.1%, because I got it.
Genetic engineering where evolution failed us :).
It's not clear.
The last time I looked at these data (about a decade ago), we were catching more cancers than ever and people were living longer. But really we were screening earlier so time from detection->death was longer.
Some of these cancers didn't matter. The studies I refer to above were for breast cancer. In the case of prostate cancer, most men have it when they get old. It develops slowly and most patients "die with it but not of it", i.e. it had nothing to do with their death. For those cases intervention is unnecessary pain and misery. And indeed, I believe the treatment regime in the US is now "watchful waiting" with rare intervention.
There has been a revolution (several, actually) in cancer treatment over the past decade and the prognoses for several are much more promising. So this comment is specifically about your general hypothesis, not to criticise your aim in commenting with it.