The tenets engendered by cancer have been slowly elucidated throughout the years. The hallmarks of cancer have been well documented by Douglas Hanahan and Robert Weinberg in Hallmarks of Cancer: The Next Generation. Some of these features are well known and are inclusive of sustained proliferative signaling, evading growth suppressions, and others clearly outlined in their review. These cellular processes have been discovered by basic science researchers and subsequently, modern therapeutic agents are being specifically tailored to counteract one or more of these hallmarks. The discoveries made by biomedical researchers further fuels the translational impact that these new bioagents may have in prolonging life in the clinical setting.
In a previous KevinMD.com article, Jack Westman makes a valid proposal in attempting to recognize cancer by not only an aberrant group of immortal cells, but an array of dysfunctional bodily processes stemming from neoplasia. Although, I find it hard to agree with the analogy of killing cancer cells similar to treating hyperglycemia in a diabetic patient. Neoplastic cells secrete a number of factors which lead to both peritumoral and systemic effects. Attempts at detecting these factors in the bloodstream are part of the foundation for advancing the biomarker field for early detection of cancer. The effects of these secreted factors may be numerous (e.g., immunosuppression in glioblastoma patients) but have not been fully elucidated in human subjects.
By eradicating cancer cells, we can make an attempt at restoring the systemic imbalances that may exist in patients with a cancer diagnosis. The main hurdle now is that most chemotherapeutic agents are inherently cytotoxic as well which have an added toll on the patient. As more specific therapeutic agents are created in the laboratory by the “lab-coated snipers,” we may be able to escape the dreaded side-effects of chemotherapy. To reiterate, I do agree that the systemic disease in cancer patients is neoplasia. But neoplasia itself is enrooted within the cancer cells that secrete factors which hinder the balance of various bodily processes. To refine the last point, I’m talking more specifically on malignant high-grade cancers and not indolent, slow growing tumors.
To counteract Dr. Westman’s point that all tumors have to be eradicated, one must take into account the patient’s expectations and long-term goals. Should a healthy elderly male undergo a radical resection to remove a small indolent prostatic lesion? Should a young female undergo radical resection of healthy breast tissue to prevent potential recurrence of a small benign breast tumor just because of a small risk of malignant transformation? Although there may be a standing risk of progression in certain individuals, Dr. Westman does not take quality of life into account. Added therapeutic intervention may drastically impair quality of life in order to marginally decrease risk of recurrence.
To conclude, Dr. Westman makes a valid attempt in pointing out that the current trend in cancer care is aimed at just killing cancer cells without taking other factors into account. I largely disagree that drastic measures should be taken in all individuals with early stage neoplasms.
To reiterate a previous point, the clinician’s role is to tailor therapeutic intervention based on the patient’s desire and goals. Moreover, I agree that neoplasia is a systemic disease but one that may also be attributed to the cancerous cells themselves. By targeting these neoplastic cells, we may be able to restore balance in patients afflicted by horrendous malignancies. Advances in cancer treatment are slowly, but surely, being implemented in the current clinical setting. This long stride in the cure for cancer will take a lot longer than expected, but through the sacrifice of both clinicians and lab-coated snipers, future generations will reap the benefits of our endeavors.
Leonel Ampie is a medical student.
