[Science] What if cancer was just a series of bad luck?

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Source: C. TOMASETTI, B. VOGELSTEIN AND ILLUSTRATOR ELIZABETH COOK, JOHNS HOPKINS UNIVERSITY, The Scientist magazine.

Since the “war on cancer” decorated by Richard Nixon in the 1970s, where are we after 40 years of research on cancer and why do not we have a cure for cancer?
We have learned a lot about cancer:

* We referred to cancer as a single disease, but it is indeed  an umbrella for many different types of diseases. A brain cancer is different from a lung cancer.

* We have been classifying cancer based on the tissue of origin (carcinoma, sarcoma…),

* We have identified many genes that once mutated result in cancer, we have identified many environmental factors capable to increase your risk of cancer (tobacco, smoke, obesity, polyaromatic compounds, ionizing radiations….). http://www.ncbi.nlm.nih.gov/pubmed/24816517.

* We learned that cancer is a disruption of a physiological balance, for instance we thought that an excess in oxidative stress and free radicals were promoting cancer. http://www.ncbi.nlm.nih.gov/pubmed/25496272.

* We have highly improved the way we detect cancer, remove surgically cancer and found new chemotherapy that really improved survival rate in many cancer. Yet, malignant brain tumors (glioblastoma multiform and brain metastasis) remain the most deadly form of cancer, in partly because we fail to deliver therapeutics across the blood-brain barrier. The tragic case of Brittany Maynard as well as children with aggressive form of medulloblastoma makes me feel helpless because I know how powerful the blood-brain barrier is in blocking the delivery of these agents. It will be hard to untangle a evolutionary trait to protect our brain from neurotoxic and poisons to deliver it.

* Stem cells and malignant cancer cells seems to share a dark common origin. If you inject stem cells in an animal, they become wild and form teratomas, just as cancer cells would do. But they also share similarity and I like to refer that stem cells keep “the primitive cell phenotype” in a evolutionary standpoint. I like to think that cancer are cells that “accidentally” turn on the time machine and reverse their biological and evolutionary clock back to the time were LUCA (the Last Unicellular Common Ancestor) were swimming in the “Primeval soup”.

So now, we now that “one size fits all” approach to treat cancer and we really need to think about treating it as a personalized approach, using modern technology (genomics, epigenomics, proteomics….) to dress an identity card of the cancer for each patient to find which approach is the best.

Cristian Tomasetti1,*, Bert Vogelstein2,* Science 2 January 2015:  Vol. 347 no. 6217 pp. 78-81  DOI: 10.1126/science.1260825

Source: Cristian Tomasetti, Bert Vogelstein. Variation in cancer risk among tissues can be explained by the number of stem cell divisions. Science 2 January 2015: Vol. 347 no. 6217 pp. 78-81. DOI: 10.1126/science.1260825.

The recent study from Tomasetti and Vogelstein indeed show that incidence of cancer is “bad luck”. We know that each time our cells divide, the duplication of our genome is not “fool-proof” and introduce a mutation (1 base pair mutation for every million replicated). This is a handicap (because you loose your information over time) but it is also a blessing because this is how evolution works and what we are. Just a bunch of lucky mutations spanning over a billion of years of zillions of cell divisions. Under normal circumstances, we have “safe-fail mechanisms” (tumor suppressors) that are here to send defective cells into apoptosis (a sort of auto-destruction mode or if you like the cellular version of “hara-kiri”). But sometimes these defective cells do not follow that path and keep proliferating. This is all about. More you have cells within a tissue that keeps dividing, more you increase your risk to increase your pool of potentially tumorous cells. At the end, it is just a long equation of probability in which risk factors just increase the probability to success of the event.

My recommendations? Stay healthy (exercise often, follow the nutritionist recommendation for calories intake), stay safe (especially if you are working in a risky environment, follow your safety and OSHA guidelines), keep a regular check on your health and if you feel something weird do not hesitate to further investigate. And please, follow your physician recommendations.

Happy new year y’all.

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