Just about everyone on this planet would dearly love to honor any research scientist who can find a cure for cancer. Despite all the money and time already poured into extensive research efforts in labs and hospitals, the goal of curing this devastating clinical disease still remains elusive; about 589,000 cancer patients are expected to die from cancer in 2015 . A big question thus arises, “What good is all the research and money spent on trying to conquer cancer, if a cure still has not been found after all these years?” The more you know about cancer as a biological phenomenon, the better will you be able to understand why attaining a general cure is so very, very difficult. This brief essay will teach you about the reasons for this frustrating situation that seems to damn the efforts of dedicated researchers in both basic and clinical science.
A brief background of essentials about cancer
At its most fundamental level, the biological phenomenon of cancer takes place in our cells. All cancers are thought to originate from one normal cell that changes into a cancer cell when it becomes “neoplastic”; this term means that the abnormal cell(s) divide independently of the regulatory mechanisms controlling cell growth and division. Multiple causes for development of cancer are recognized (e.g., chemicals, chronic inflammation, genetic heredity, mutagenesis, radiation, viruses). Unrestrained growth of neoplastic cells usually results in a “tumor”; this term specifically means some localized enlargement or swelling filled with the proliferating neoplastic cells. A neoplasm can be benign, meaning that it enlarges but does not spread to distant locations; this is contrasted to malignant neoplasms, where the abnormal cells can metastasize (i.e., spread to other regions of the body and start growing there).
About 1.67 million people are expected to be newly diagnosed with cancer in 2015 . Cancer is not always lethal (i.e., some 14 million cancer survivors now are alive and kicking (see: http://www.cancer.org/ ))! Some cancer patients are being cured (i.e., their neoplastic cells can be removed, caused to die, or to stop proliferating). Cures can be the result of surgical excision, localized exposure to lethal irradiation (i.e., radiotherapy), treatment with chemicals that cause cell death (i.e., chemotherapy), systemic exposure to high tech antibody treatments (i.e., immunotherapy), or, other newly developed experimental therapies. When treated cancer patients retain their disease, therapy can slow its progression and ameliorate their quality of life. Even if no treatments work, the situation for any cancer patient is never absolutely hopeless because there are some spontaneous remissions where the neoplasm miraculously regresses and disappears.
“Cancer” is a very complex and variable entity
Cancer is an extremely complex biological phenomenon showing enormous variability (e.g., age of patient, cell of origin, general health status, genetic background, location in an organ, nutritional status, presence or absence of continued development of neoplasia (i.e., carcinogenesis), presence or absence of enhancers, rate of growth and division, type and dosage of therapy administered, etc.). There are over 200 different types of cells in the human body, many of which can become neoplastic. Neoplastic cells are very similar to normal cells, but show some changes that give rise to aberrant functional activities. In particular, neoplastic cells reproduce without regard to the normal controls that restrict cell growth and division. Almost all the different varieties of cancer cells divide more frequently than do their normal (non-neoplastic) counterparts. In addition, neoplastic cells usually change their normal shape(s) and adhere to each other less strongly.
The enormous complexity and variability of neoplasia are the fundamental factor making the search for a general cure of cancer truly difficult. These features also make it wrong to refer to cancer as a singular term, e.g., “the disease, cancer”, because there are so many different cancers and each shows variability. The term “cancer” thus can be thought of as being analogous to the generic term “paint”; that label says nothing at all about the type of paint, its color, what it is made of, which kinds of surfaces it can be applied to, how it is applied, its durability, etc. The great complexity of cancer is strongly evidenced by the fact that a chemical agent completely curing one type of cancer typically has few effect(s) on many other kinds of neoplasms.
What can laboratory research do for cancer patients?
The most essential reason why cancer can not presently be cured despite therapeutic advances and improved methods for early detection is that this family of neoplastic diseases involves multiple different causes, many different cell types, and numerous variable conditions of human existence (e.g., quality and quantity of nutrition, hygiene, exposure to dangerous environments, screening and early detection, clinical monitoring, availability of expensive therapeutic protocols, etc.). The targets of treatments for cancer are the neoplastic cells; these are dynamic targets that change their status, properties, and metabolism as clinical therapy progresses. Despite tons of research, there still is no accepted general or molecular distinction known between the normal and neoplastic states of each cell type; this essential information will become available later through additional laboratory research studies. The complexity and variability of cancers, along with the absence of full knowledge about many key parts of neoplasia, have even led some to speculate that the long-sought goal of finding a general cure for cancer actually might be impossible.
At present, basic understanding about the whys and wherefores of neoplasia remains very incomplete. Once there will be much greater understanding about the nature of neoplastic versus normal cells, and about the mechanisms for carcinogenesis, then the chance for applied research to develop cures for cancer undoubtedly will increase. The main hope for finding a general cure for cancer therefore is to continue basic research vigorously; in my view, especially needed are development of very new approaches for clinical therapy, and formulation of very innovative concepts or unconventional theories that can be tested experimentally by lab studies. Any proposals that all research grants should be awarded only for cancer research, or that all scientists should work only on studies of cancer, are idiotic and as misguided as are proposals that it is pointless to spend more billions trying to find a general cure for cancer. All of us, and particularly cancer patients, must have great patience while the needed enormous amount of experimental work by both experienced and new investigators progresses.
What can clinical research do for cancer patients?
The fight against cancer now involves current efforts by clinical scientists (i.e., oncologists, who are MDs specializing in treating cancer patients) to find: (1) ways for earlier detection, (2) more effective means to kill cancer cells while leaving neighboring normal cells intact, (3) the genetic and physiological conditions needed to allow cancer cells to proliferate, (4) prevention of metastasis, (5) induced modulation of the immune system for experimental immunotherapy, (6) invention of new and better ways to use chemotherapy, (7) invention of new ways to improve specificity and lethal effects of radiotherapy, (8) identification of anti-neoplastic nutritional effects upon cancer cells, (9) development of new very innovative mechanisms and approaches to target and kill cancer cells, and, (10) development of more effective and less toxic multimodal therapies for cancer patients, etc. All this activity requires the work of doctoral scientists in many labs, and of clinical oncologists in many hospitals. Adjunctive work for the production and research use of very special new materials (e.g., new antibodies and immunomodulators, new genetic strains of cultured cells, new chemicals, new nanostructures as targeting devices and carriers of toxins, new detections of small cancers via advanced imaging assays, etc.) also are needed. Extensive clinical trials must be conducted to determine the efficacy and safety of all newly successful research treatments for human cancer patients.
Is research progress against cancer being made?
All basic or clinical studies of cancer are neither easy nor inexpensive. It is reassuring to know that good progress is being made in the clinical treatment of some previously untreatable cancers. Clinical applied research often is based upon previous basic research findings. Many cancer patients now live longer and more actively due to their new clinical treatment(s). Research progress indeed is being made; all the money and time spent with cancer research is having some very good effects for cancer patients, even though the final victory has not yet been accomplished.
Many scientists and clinicians working with cancer have the feeling that if there was a much greater fundamental understanding of neoplasia at the cellular, molecular, and genetic levels, then improved therapies and better preventive measures could and would be developed. Current research is looking closely at the interactions of different gene expressions and protein networks, within normal versus neoplastic cells. Further progress towards the goal of curing cancer undoubtedly will involve tackling difficult questions in both very basic science (e.g., exactly how does the metabolism of neoplastic cells differ from that of their pre-neoplastic or normal counterparts?) and applied clinical science (e.g., how can oncologists cause repression or expression of certain target genes in a safe manner within human cancer patients?). The road to a cure will be long, hard, and not straight; thereby it will take great determination, long persistence, and very creative experiments before success eventually can be obtained.
The materials presented above should enable all readers to have a basic idea of the nature of cancer, and to recognize why cancer in human patients is a very difficult disease to understand and to cure. Although the ultimate goal has not been reached yet, cancer research continues to progress slowly and incrementally. In my view, this will be made speedier by (1) more emphasis on cancer prevention, (2) evaluating completely new ideas for clinical treatment of cancer patients, and (3) development of innovative concepts about the fundamental nature of neoplasia. Patience with the progress of cancer research now is needed more than is additional support money. Cancer research requires intense dedication and long efforts by laboratory scientists, clinical oncologists, and cancer patients. These efforts necessitate spending additional enormous sums of money to support the hospital and lab work. Research results that do not produce a general cure for cancer still are valuable since the new facts acquired can be used subsequently for the generation of better experimental studies and of advanced clinical treatments.
A postscript from Dr.M
For those seeking further information or news about cancer, treatments for cancer patients, incidence, clinical cures and new trials, cancer research, costs, etc., I recommend that you visit the excellent websites of the Americal Cancer Society (see: http://www.cancer.org/ ) and the National Cancer Institute (see: http://www.cancer.gov ).
 Simon, S., for the American Cancer Society, 2014. Facts and figures report: 1.5 million cancer deaths avoided in 2 decades. See: http://www.cancer.org/cancer/news/news/facts-figures-report-cancer-deaths-avoided-in-2-decades .
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