Monday, October 24, 2011

The way of the future

My non-medical opinion of cancer treatment is that there are a lot of assumptions built it. If you have a tumor,they should take it out. If they think you need chemotherapy, they guess at the dose based on your body weight. If you need radiation, they try to hit only where the tumor was, this is a change from hitting the entire area of the body. They assume you will respond as well as everyone else who had the same treatment protocol but realize that not everyone does and they don't necessarily understand why. It is realized that many cancer patients are either under treated or over treated because they simply don't understand enough about cancer.  And often the treatment is almost as bad as the disease - it causes significant short (hair loss, nausea, etc.) and long term side effects (future cancers from radiation and chemotherapy, heart damage).

Cancer treatment is often only treating the symptoms. Surgery excises the tumor and the clump of cells. They hope chemotherapy will zap any remaining cancer cells in your body - but my non medical brain asks if chemotherapy zaps all cancer cells, why are there so many kinds of chemo if they zap all cancer cells? I feel that this goes back to the all cancers are the same theory that was disproved generations ago. One treatment does not fit all. Radiation tries to zap the cancer cells in a certain area - where they think they are. But it also damages the healthy cells and causes all kinds of burning. Some systemic treatments like Tamoxifen or aromatase inhibitors work for some women and not for others and are trying to make your body less attractive to hormone receptor cancer cells.

But none of these treatment focus on what I call the key questions:

- Where did these cancer cells come from? Why did they start mutating in the first place?
- Why was this part of the body more attractive to the cancer cells than others?
- What is the underlying cause of all of this?
When I heard Dr Love talk on Friday and she talked about the importance of the type of cancer not just its location, I was intrigued to say the least. I have also heard many times of the trend to personalized medicine. But now the next step is beginning to expand on these areas and actually take concrete steps to make changes.

Brigham and Women's Hospital and Dana-Farber Cancer Institute have launched a massive study to test cancer patients' tumors for hundreds of genetic aberrations. The goal is to obtain a better understanding of the underpinnings of cancer and how to tailor patient's treatments.  They want to have 10,000 patients each year to include in their study.

There is another program at Mass General since 2009 where they have been scanning the genes of 50-60 patients each week of their tumor tissue and have identified 160 genes and 15mutations. Their goal is to help guide treatment or to pave the way for new clinical trials. MD Anderson is moving toward a broad genetic analysis of all cancer patient's tumors.

There are two issues here. Dr Susan Love wasn't talking about  genetic markers but more of the type of tumor characteristics - hormone receptors, Her2/nu status, etc. However as cancer cells have damaged DNA, their genetic sequencing grows in importance.

I think this is the way of the future and how we will look at cancer as we move forward in both a way to find their cause and to find a cure.


Anonymous said...

The book, Emperor of All Maladies, which is a biography of cancer, explains everything that you question in this essay. It REALLY gives a profound NEW understanding of the disease, the treatment, and the history. I highly recommend it. Robin

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