Cancer: Will We Ever Cure it, And How Long Will That Take? A Scientific and Humanitarian Perspective.

Abstract

Cancer, by definition, is a disease caused by the uncontrollable cell division of mutated cells (Rosenbaum, 2011). This arises from both genetic and spontaneous causes but can be influenced by the use of carcinogens (i.e., smoking) and unhealthy lifestyles. Cancer will affect half of the population of the UK (Anon, 2019) in their lives. This sorrowing statistic, along with the knowledge that cancer is now the most threatening disease alive, means that the future of medical advances in this field seems bleak. However, there are positives. For example, there were 1,112 trials in 2018 alone towards improving those odds (Blazynski and Runkel, 2019). It encouraged me to pursue this topic knowing there is a balanced argument. Even as new pioneering discoveries are made in medicine every day, it is difficult to quantify their success with the bigger picture.

What is cancer?

Before discussing how cancer is treated, it is important to understand how cancer can develop in the human body in a bit more detail. Cancer is either inherited or sporadic (Divan and Royds, 2020). If inherited, the chance of cancer being onset is much greater and much more imminent, but sadly there is no real way to know or prevent it. However, sporadic cancers caused by random mutations of cells can be prevented by reducing the risk factors, including smoking, exposure to UV light, and eating unhealthily (Divan and Royds, 2020). More cancers are sporadic than hereditary.

Background knowledge & History of treatments

Amongst all the discoveries over the past century to eradicate or treat the virus, chemotherapy and radiation rank amongst the greatest discoveries to date in widespread treatment for most cancers, whether in the early or late stage. Before this time, only surgical resection was available for those with cancer, along with a relatively low success rate overall. The statistics could not be included because of the variegated nature of cancer regarding the type and stage of advancement.

One of the most common treatments available in today’s world, chemotherapy, was first developed during World War II in the US. It was known to kill all living cells and took the name of nitrogen mustard. Back then, no one knew just how important this discovery would be in the journey to eradicating cancer. As time passed, Sidney Farber, a pioneering oncologist, discovered a new drug called aminopterin, which redefined treating leukaemia in children (Anon, 2012). This stemmed to the creation of toxic cell-killing drugs, which later developed into chemotherapy. Of course, to this day, many adaptations have been developed to fine-tune the treatment of cancer, including using cancer stem cells to reduce the possibility of drug resistance (Anon, 2012).?

Radiation also lists amongst the most beneficial discoveries in the fight for cancer within the past century. It originated in 1896 when a German physics professor named Wilhelm Conrad Roentgen discovered the X-Ray, which could diagnose patients unlike ever before. From there, he shaped this into radiation for cancer and soon won the Nobel Prize in Physics. Unfortunately, the course of its discovery was interfered with when it was discovered that radiation could also cause cancer (particularly blood cancers) (Anon, 2014). However, it did not stop scientists from continuing to make advances in the field: shortly into the 20th century, a type of therapy known as conformal radiation therapy (from CT scans) was a more precise method of locating cancer. Additionally, intraoperative radiation therapy was a treatment to particularly combat abdominal and pelvic cancer by minimising the amount of tissue when exposed to radiation (Anon, 2014).

It is not unusual for any cancer patient to experience effects from chemotherapy, and indeed radiation presents very harshly: nausea, tiredness, distress, and infection are inevitable effects caused by chemotherapy due to the harsh course it takes to remove almost every functioning cell from the body. This has been combated over the years with antiemetics to reduce nausea and vomiting (Divan and Royds, 2020) as well as several other clinical trials. However, it was made clear that in addition to chemotherapy and radiation, some major advances were required in order to improve the success rate of cancer treatment. Thus, oncologists are struggling to keep up with the modern-day to develop more targeted and cutting-edge therapies in this day and age. However, be rest assured that oncological trials are the number one ranking in the number of trials carried out (as of 2018), standing at a grand total of 1,112 in 2018 (Blazynski and Runkel, 2019) alone. These statistics go to show we are making progress towards the end goal: total eradication.

More modern targeted therapy and clinical trials

One group of scientists made a particularly groundbreaking discovery in reducing metastasis (cancer recurring after treatment) by inserting a drug called BBI608. This is a particularly significant exploration because ‘current cancer treatments ultimately fail owing to metastasis and relapse.’ Overall, the trial was largely successful in killing most cancer stem cells without affecting stem cells from dying. They concluded that BBI608 was a ‘novel approach’ to this issue (Rogoff, Keates, Gao, Murikipudi, Mikule, Leggett, Li, Pardee, Li, 2015).

Bone marrow transplants and stem cell research are two life-saving methods that are fast arising in cancer. In the past, bone marrow transplants were poor in terms of success rate and were about to be terminated. Even today, stem cell and bone marrow transplants result in a success rate of around 50-60% (Carrier and Kelvin, 2004), which is alarming considering the importance of these surgeries. Unfortunately, in addition to this low success rate, there is a lot of controversy towards Stem Cell research. For example, questions like ‘is it right to test animals?’ and ‘is it right ethically to clone someone?’ have arisen throughout the process. In addition, there are some serious scientific flaws to the process, which include the tumour growing somewhere else, stem cells forming tumours, and the knowledge that we are still in the clinical trial phase (Thomas, 2012). This means that stem cells are a novelty for us. Stem cells are the parts of our body that contain unspecialised cells. This means replacing it would create completely new cells that are not cancerous and potentially lead us to defeat cancer cells 100% of the time. Therefore, it has certain potential in the eradication of cancer.

Targeted therapies interfere with and block signals of cancerous cells, which reduce the amount of cell division that takes place. Whilst some trials have been extremely successful, dosing and cost (for example, the fact that it costs over $30,000 for eight weeks of treatment) hinder its progress. This is why some clinical trials are fatal in the future of therapy (Khahil, Smith, Brentjens, Wolchock, 2016). But, if finance was not a problem, this would have great potential in the fight to cure cancer.

Finally, one more clinical trial was carried out in the early days of 2007 and concluded in 2009, looking at GSK46134, a potential drug for curing advanced-stage cancers. Some side effects from this drug at higher doses included a decline in blood cells and some blood clots, which unfortunately ended the trial (De Bono, 2015).

In conclusion, it can be said that there is a mixed number of successful and unsuccessful trials around in the current day. Whilst the efforts of a team of scientists to create the BBI608 drug paid off, other trials and stem cell research are still seriously dragging behind. This puts us in a tricky situation, moving forward, as the treatment element of cancer continues to be difficult. This is mostly due to the aggressive and clever progression and metastasis of cancer, which is seriously limiting possibilities.

There are unscientific and scientific reasons why cancer has a very limited future. Some of which are purely permanent and cannot be ‘eradicated.’ Other reasons are the very peril of scientists and medics today, who are scrambling to create a cure to this awful disease.

Scientific barriers

According to scientists, there are a few main scientific reasons that have led the treatment and eradication of cancer into turmoil. The first of which is that targeting stem cells is hard (Chakraborty and Rahaman, 2012). When we target cells, all cells have originated from the stem cells, meaning the cancerous stem cells are never killed off. With this in mind, it is difficult to completely kill cancer because the cancer stem cells have the ability to ‘self-renew’ and put the body into what is known as cancer relapse (i.e., cancer comes back) (Chakraborty and Rahaman, 2012). Additionally, they could grow resistant to the drugs being given as a result of epigenetics. Prostate cancers, Esophageal cancers, and Pancreatic cancers, all extremely aggressive cancers, are challenging to diagnose for two main reasons: firstly, they are what is known as latent cancers (meaning the patient could have cancer but be asymptomatic), and the tumours start very small, giving no ‘tell-tale’ signs. Finally, metastasis is a huge problem for most cancer patients. Tumours, once killed, can still re-grow in other parts of the body, either spreading locally through the blood or through the lymphatic system (Chakraborty and Rahaman, 2012). This can happen easily, and so significantly limits the progress that can be made to eradicate it.

Financial and discriminative barriers

There are also racial and discriminative reasons why cancer treatment and eradication have been limited. These are issues that can easily be fixed, but if not, they also significantly reduce the number of possible outcomes available. The first of which is a lack of follow-up care. The average African-American cancer patient has a concerningly higher 32% chance of mortality than a white male cancer patient (Jabson and Bowen, 2013). This blatantly tells us that your race decides whether you will be treated or if cancer can be eradicated; it’s simple – if race determines your healthcare, and BIPOC people continue to get cancer, we can never fully eradicate this disease.

Additionally, cancer is missed every day in elderly patients. An interesting biopsy study was held on diseased patients over 65, and a staggering 32.5% of these patients had one or more cancer, most of which would have been fatal if their additional health issues had been dealt with (Suen, Lau and Yermakov, 1974).

Clinical trials are an extremely vital system that lead scientists to get a better understanding and idea of the kind of drugs and therapies that can cure diseases. Clinical trials in oncology are no exception. A reminder that over 1000 clinical trials in oncology took place in 2018 alone (Blazinsky and Runkel, 2019). With this in mind, it is no celebration that patients of Arizona (and indeed many other states of the US) are not receiving these possibly life-saving studies. About 20 years ago, a law was put in place in Arizona and other states that both the patient and staff had to fund these trials. Insurers also refused to cover this care, causing most of the clinical trials (which were imperative for life-saving care and advances in medicine) to be under-enrolled. As a result, a very poor and ‘flawed product’ (Olson-Garewal and Hessler, 2001) was produced, leaving much of the US without the cutting-edge possibility to make advances in cancer eradication.

These ideas show that our lack of care and discrimination is severely affecting this long and troublesome road to eradicating cancer; we forget that science does not have the only thing to do with that. Finance, race, and age are important factors but should never affect healthcare.

Conclusion

Cancer, by definition, is a disease caused by the uncontrollable cell division of mutated cells (Rosenbaum, 2011). Taking the lives of thousands of people, this disease ruins many lives and takes the lives of innocent and healthy communities. Without the quick action to find treatment and cure this disease, we are looking at a rather dim future, with around 4 million people living with cancer by the year 2040 (Anon, 2016); this is a shocking yet very real 13% of the population. Thus, cancer is the most deadly disease in the world.

But even with a cure, my question is, can we ever ‘fully eradicate’ cancer? When we look at this question carefully, we really mean ‘can we ever look at this world and not remember that cancer ever existed’? The answer is yes, we can. But what is the time frame? Is it in all countries? Is it in all cities? Is it to all species? The answers to these questions, alas, are unknown. But, due to the overwhelming scientific evidence stating that mutations are extremely hard to control and cancer stem cells are extremely aggressive, the time frame looks rather grim. In addition, the financial, racial, and age issues encompassing this disease inexplicably increase the deadline of defeating cancer. Unfortunately, this project is starting to look much more long-term than we hoped.

Cameron Davies, Youth Medical Journal 2021

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