New Delhi: “Cancer is an expansionist disease; it invades through tissues, sets up colonies in hostile landscapes, seeking “sanctuary” in one organ and then immigrating to another. It lives desperately, inventively, fiercely, territorially, cannily, and defensively — at times, as if teaching us how to survive. To confront cancer is to encounter a parallel species, one perhaps more adapted to survival than even we are.”
– Siddhartha Mukherjee, Pulitzer Prize winner and author of ‘The Emperor of All Maladies’.
Dr Mukherjee, who is an assistant professor of Medicine at the Columbia University, has aptly described our ‘war’ against the disease called cancer in this quote.
In his findings, Dr Mukherjee has shown the role that cells play in cancer therapy, including immunotherapy, chemotherapy, and targeted therapy. But is supportive therapy the only way forward for cancer treatment in India as well as the world?
While humanity awaits a ‘universal’ cure for cancer, there have been significant advancements in cancer treatment leading to improved outcomes.
In the short term, the real deal maker or breaker is the play of odds on whether we can treat our way out of the rising cancer caseload. But the big question needs an answer too — Can a full-throttle defense mechanism be devised that could achieve what looks unachievable today – a cancer-free world?
The journey towards that lofty goal – at least in our understanding – must traverse through the distinguishing feature of the malady, that it only takes a cell – out of the roughly 37 trillion in an average human body – to go berserk, then go on to make its brethren fall prey to what ails it, slowly at first, and then gallop across the body to spread its tentacles far and wide.
The fight against cancer and the urgency behind the endeavour to tame, if not eliminate it, can be understood by the grave statistics surrounding the disease. As per the World Health Organization for 2022, an estimated 20 million new cases of cancer were detected globally and 9.7 million died from the disease in its myriad form. The outlook is grimmer still, the global health body predicts that cancer burden will increase by 60 per cent over the next two decades.
The figures for India are worrisome as well. India saw a spike in cancer cases with over 14 lakh fresh incidences and over nine lakh deaths, in 2022. The alarming numbers indicate that 10.6 per cent of India’s population will face the risk of developing cancer before the age of 75, with a mortality rate of 7.2 per cent.
India is the second most populous country in the world that faces a significant burden of cancer, and various states contribute to this growing crisis.
Rise and rise of cancer
Cancer can be triggered by multiple factors like unhealthy lifestyle choices or factors that are beyond one’s control. Rising pollution, eating habits and poor living style are some of the key contributors but there are more factors involved.
But the emerging worry is that the factors involved, and their interplay are also going through a metamorphosis.
Dr Shriniwas Kulkarni, a consultant medical oncologist at Sahyadri Super Speciality Hospital, Pune, told News9 that this is indeed the case because over the years, “the mutant clones have evolved to be even more cancerous, and the disease has progressed by more and more genetic damage and mutations”.
A look at the graph below reveals two distinct features about the cancer epidemic.
1. The incidence of 29 cancers between 1990 and 2019, including breast, colorectal and lung cancers has increased across the world in the population under the age of 50 particularly among women.
2. On the other hand, the mortality from these cancers has dropped but the total number of deaths has risen.
More numbers to show how cancer has evolved in the last decade or so (Reference: A British Medical Journal Study in 2023)
1. Global incidence of early onset of cancer increased by 79.1 per cent
2. Early onset cancer deaths increased by 27.7 per cent
3. Early onset breast, lung, stomach, colorectal, bronchus cancers showed the highest mortality in 2019
4. Globally, the incidence rate for prostrate cancer and nasopharyngeal cancers showed fastest increasing trend
5. The projections of the study indicate that global incidence and deaths of early onset cancer would increase by 31 per cent and 21 per cent in 2030 respectively
While the causes and the spike in the incidence of cancer cases is no mystery, the fact that there is no one diagnosis or prognosis that can point towards the actual cause behind the disease is what makes it an enigma!
No, cancer is NOT A MYSTERY
From time immemorial, the puzzle called cancer has been an area of concern and interest. Ancient physicians who had little clue about the real cause behind cancer offered or relied on a multitude of explanations rooted in tradition and folklore. Age-old ‘beliefs’ attributed the onset of cancer to curses, imbalances in bodily hormones, or even the malevolent influence of supernatural forces. Others pointed fingers at dietary choices, stressing over daily life, or wearing tight clothing as potential triggers for this disease.
However, with the advent of modern science, today the medical fraternity has answers to most questions about the illness. Cancer is not a blind mystery any more.
According to Dr Vivek Belathur, a senior consultant of Medical Oncology at the Fortis Hospital, Mumbai, “The dawn of modern science has illuminated the true nature of cancer, revealing its origins lie within the intricate machinery of our cells rather than in supernatural forces or dietary habits.”
Dr Belathur attributes the causes to two broad reasons:
1. Traditional causes
Contemporary understanding recognises cancer as a consequence of genetic mutations within the DNA of cells. These mutations, which can be inherited from parents or induced by environmental factors, disrupt the normal functioning of cells, and drive them towards uncontrolled growth and division, characteristic of cancerous tissue.
2. Environmental causes
Exposure to carcinogens — found in tobacco smoke, ultraviolet radiation, and industrial pollutants — can inflict damage upon cellular DNA, increasing the risk of cancer development. Likewise, infectious agents like certain viruses (e.g. HPV, hepatitis B and C) can infiltrate cells, hijacking their machinery and fostering genetic aberrations conducive to cancer progression.
Am I more prone to cancer than others?
Let’s understand this question with an example: Smoking causes cancer in some people but not in others. Is there a scientific reason that certain individuals are more prone to the disease?
Dr Sreenivass BJ, senior consultant medical oncologist, at the HCG Cancer Centre in Bangalore, explains that numerous variables, such as lifestyle, environment, and genetics, might impact the development of cancer.
Even though smoking is an established risk factor, not all smokers get the disease, which emphasises the significance of individual differences. This diversity is influenced by immunological responses, genetic predispositions, and exposure to carcinogens.
“Research on the molecular pathways behind cancer is still ongoing, providing insight into differences in vulnerability. BRCA1/BRCA2 genetic mutations raise the risk of cancer. The risk of cancer is influenced by lifestyle variables including nutrition and UV radiation as well as environmental factors, with immune system function being a major component. These variables interact in a complicated way; for example, risk is increased when genetic susceptibility and environmental exposure are combined,” adds Dr Sreenivass.
However, on the other hand, even with inherited genetic traits, the risk of contracting cancer can be reduced by leading a healthy lifestyle and having a strong immune system. Comprehending an individual’s vulnerability entails considering a combination of genetic, environmental, and behavioural components.
Current research endeavours to adapt preventative and treatment plans for cancer according to these complex factors.
A look at the top 6 factors that lead to cancer:
Addressing the elephant in the room: Cancer and Inflammation interplay
Inflammation is body’s best friend. It is the immune system’s natural response to bacterial, viral, and parasitic infections. In simple terms, inflammation is the response triggered by body’s response to external pathogens and unwanted substances (lifestyle/environment related) that enter its hallowed space and threaten the body’s well-being.
In business-as-usual situations, the immune system via its weapon called inflammation does a pretty neat work of keeping the body healthy by eliminating the troublemakers. How the body fights off a seasonal flu is an example of the acute inflammation mechanism triggering in to restore normalcy in the body.
However, matters get complicated when inflammation adopts chronic nature. As explained above, tobacco is known to lead to chronic inflammation. If the body is subjected to a sustained fight, then it might lead to disastrous results.
The mechanisms behind it are still not clear or fully understood – the link between chronic inflammation and cancer is quite complex.
According to Dr Ishwar Gilada, consultant in Infectious Diseases, Unison Medicare and Research Centre, Mumbai and Secretary General People’s Health Organization, inflammation can play a dual role. First, it can help the cancer to progress further and second, it can stop the cancer by having anti-cancer activity. “In the first part, it can help in meta stasis which means if the cancer is in one part of the body, it can go to the other part of the body as well. Inflammation can itself be a cause of cancer, for instance inflammation can itself become chronic as it becomes a breeding ground for cancer cells.”
Treatment – Care, cure, or prevention?
The landscape of cancer care and treatment has witnessed remarkable advancements propelled by scientific research and technological innovation. One notable stride lies in the realm of early detection, where sophisticated screening techniques like mammograms and colonoscopies enable the identification of cancer at its nascent stages, offering patients a higher chance of successful treatment and recovery.
Dr Belathur concurs that the advent of targeted therapies heralds a paradigm shift in cancer treatment, moving away from indiscriminate chemotherapy towards precision medicine. These therapies, designed to exploit vulnerabilities unique to cancer cells while sparing healthy tissues, promise improved outcomes and reduced side effects for patients. Moreover, harnessing the body’s immune system as a weapon against cancer has emerged as a promising frontier in oncology.
Immunotherapies, such as checkpoint inhibitors and CAR-T cell therapy, empower the immune system to recognise and eradicate cancer cells with remarkable precision and efficacy. While cancer remains a formidable adversary, the collective efforts of the scientific community have ushered in a new era of hope and progress in the fight against this insidious disease. “By unravelling the complexities of cancer biology and developing innovative approaches to its management, we inch closer towards a future where cancer is no longer synonymous with despair and suffering,” says Dr Belathur.
Over the past few decades, cancer treatment procedures have seen a significant revolution. With the advent of new diagnostic specialised tools, and techniques in cancer treatments.
Dr Abhishek Bansal, Unit Head & Sr. Consultant, Interventional Radiology, Action Cancer Hospital, adds, “Traditionally, the realm of oncology rested on three fundamental pillars—chemotherapy, surgical oncology involving extensive procedures, and radiation oncology utilizing high-dose x-ray beams. However, the emergence of interventional oncology has swiftly claimed its position as the fourth pillar, reshaping the landscape of cancer care. Every cancer type finds its role within interventional oncology, beginning with the crucial step of precise biopsies for personalised medicine.”
Amidst the triumphs of modern science, it is essential to acknowledge the enduring value of traditional beliefs and holistic approaches to health. While science provides invaluable insights into the mechanisms of cancer, it is complemented by a broader understanding of the human experience and the inter-connectedness of mind, body, and spirit.
Even as we come increasingly closer to understanding the ‘Emperor of All Maladies’ and, possibly a permanent cure for cancer, an emphasis on reducing the case-load when it comes to preventable types of the disease can be the real game-changer.
Millions of humans, millions of fathers, mothers, brothers, sisters, children, and millions more in the years to come along with their millions of dreams, all part of the grim cancer caseload and death statistics can move out of the danger zone and embrace life.
We have one life…
Here’s a concise overview of the article in 9 pointers:
In the short term, the real deal maker or breaker is the play of odds on whether we can treat our way out of the rising cancer caseload. But the big question needs an answer too — Can a full-throttle defense mechanism be devised that could achieve what looks unachievable today – a cancer-free world? Health Conditions Health News: Latest News from Health Care, Mental Health, Weight Loss, Disease, Nutrition, Healthcare
