Cancer: the prognosis

news@nature.com ^ | 16 August 2006 | Helen Pearson

[neverdem]

Close window

Published online: 16 August 2006; | doi:10.1038/news060814-7

Cancer: the prognosis

Helen Pearson finds out how far we have come, and have to go, to cure cancer.

When was cancer first recognized?

Cancer has been recognized as a disease for millennia: one of the oldest descriptions comes from an Egyptian papyrus describing breast tumours, and dated to 1500 BC or earlier. By the 1800s it was proposed that cancer was a transformation of normal tissue rather than an invading pathogen. In the eighteenth and nineteenth centuries, hemlock poisoning, swallowing a lizard, or applying ice and salt were some practiced treatments. It wasn't until the Second World War that a drug was finally shown to work — albeit modestly — against cancer.

How far have we come since then?

We now know that surgery, chemicals and radiation can remove or shrink many cancers, and this remains a mainstay of modern treatment. In the past two decades, major advances in molecular biology and genetics have helped researchers to reveal far more about the molecular changes that occur in cells as they morph from healthy to cancerous ones.

Yet today, the World Health Organisation estimates that the runaway cell division that causes cancer kills more than 7 million people each year, accounting for around 12.5% of all deaths worldwide.

Are there some types of cancer that can now be 'cured'?

A combination of earlier detection, better surgery, radiation, chemotherapy and drugs means that more patients live longer. In the United States, two out of three patients diagnosed with cancer will survive for 5 years after diagnosis, although some cancers can recur many years later. This year, US statistics showed a tiny drop in the absolute number of cancer deaths from 2002 to 2003, despite a growing and aging population. It's the first such decline since records began in 1930.

The prognosis varies radically from one type of cancer to the next. Testicular cancer is one example with very good survival rates: the vast majority of patients go on to live long lives if their cancer is detected early. This is mainly because of a platinum-containing drug called cisplatin, approved for cancer in the 1970s. Cisplatin acts by crosslinking DNA, making it impossible for the cells to duplicate their DNA and thus divide.

Or prevented?

CANCER SPECIAL PACKAGE
FEATURES New fronts in an old war
WEB FOCUS Cancer

The one thing that could cut cancer rates more than anything else is wiping out tobacco: it is thought to be the cause of at least 30% of cancer deaths in the United States.

Similarly, alcohol, poor diet, lack of exercise and obesity are significant, often unappreciated, contributors to cancer and could account for as much as one-third of cancer deaths, says Carolyn Runowicz at the University of Connecticut Health Center, Farmington, and president of the American Cancer Society. This means that the battle against cancer is actually becoming part of a broader fight against obesity and unhealthy lifestyles. "It's not really what people want to hear," Runowicz says, "they want to know that we can take a pill."

Another strand in prevention is the identification of genetic sequences that predispose people to certain cancers and may allow them to take preventive action. Women carrying certain mutations in the BRCA genes are at high risk of breast and ovarian cancer and can be watched more closely for early signs of disease, or even choose to have a mastectomy to prevent any future disease. But this approach is unlikely to work for all cancer types: for many, an as-yet unknown combination of low-risk genes probably makes people susceptible.

How far do we still have to go?

The survival statistics for certain cancers remain grim because they are often detected late and do not respond well to conventional therapies. In the United States, less than 5% of people with pancreatic cancer and 10% of those with liver cancer survive beyond 5 years after diagnosis. And cancers that have spread to other parts of the body, called metastases, are particularly difficult to treat.

A major part of the problem is that cancer is an enormous collection of different diseases masquerading under one name. There are around 200 different anatomically different cancers — and an estimated 250,000 different ones when they are subdivided according to the molecules underlying the disease, says Cancer Research UK's director of clinical programmes Richard Sullivan. In reality, every cancer is subtly different because it arises in a genetically unique individual, by a unique set of changes in their cells. "It's phenomenally complicated," Sullivan says.

What types of new treatments look the most promising?

Researchers are particularly excited by targeted therapies such as the leukaemia drug Gleevec and breast-cancer drug Herceptin, which show that it is possible to identify a protein gone awry and design drugs that specifically act on it. This contrasts with conventional cancer drugs that typically blast all dividing cells indiscriminately and have toxic side effects.

The general aim is to repeat the 'targeted' approach for a host of key proteins now known to be switched on or off inappropriately in subtypes of cancer.

Many researchers are also carrying out more detailed profiles of the genes and proteins that make up certain cancer types. They hope that a particular profile could be used to predict how rapidly a cancer is likely to progress, which drugs will attack it best and whether they are working. "We're just scratching the surface," says cancer biologist Riccardo Dalla-Favera at Columbia University Medical Center in New York.

Will cancer be cured this century?

It is more likely that the death rates will continue to drop slowly rather than cancer vanishing completely. And even then, for some very elderly people, cancer is likely to prove fatal as a part of normal ageing. "You'll never completely eradicate cancer because your body eventually gives up," Sullivan says.

In the meantime, the fight is swallowing enormous amount of money. The National Cancer Institute, one of the biggest spenders, has a budget of US$4.9 billion for 2006 — around 17% of the National Institutes of Health total.

Visit our newsblog to read and post comments about this story.

	Top

Story from news@nature.com:
http://news.nature.com//news/2006/060814/060814-7.html

		© 2006 Nature Publishing Group | Privacy policy

[neverdem]

There are around 200 different anatomically different cancers — and an estimated 250,000 different ones when they are subdivided according to the molecules underlying the disease, says Cancer Research UK's director of clinical programmes Richard Sullivan.

Yikes!

[sten]

since the early 90s, the american medical types gave up on curing those things they could 'manage'... indefinitely. This has come to be very concerning for the future of american medicine.

[nopardons]

bttt

[c-b 1]

since the early 90s, the american medical types gave up on curing those things they could 'manage'... indefinitely. This has come to be very concerning for the future of american medicine.

We have a winner!!!

Follow the Money!!!

[Moonman62]

There does seem to be more money in therapy than cures.

[Moonman62]

The one thing that could cut cancer rates more than anything else is wiping out tobacco: it is thought to be the cause of at least 30% of cancer deaths in the United States.

Where are my Pufflist buddies?

[Moonman62]

OTOH, there has been research into affordable nutritional supplements such as curcumin, CLA, folic acid, and vitamin D that may not only prevent cancer but cure it.

[Smokin' Joe]

The one thing that could cut cancer rates more than anything else is wiping out tobacco

Sorry, lost me right there.

If cancer has been known for millenia, I must presume they all smoked back when?? NOT!

Getting to the core of the runaway cell division and stopping it will cure cancer. All cancer.

Pissing and moaning nonstop to the tune of billions of wasted dollars a year (about tobacco) will not cure anything. What it will do (and has done) is waste untold sums of research (fill in the currency of your choice) which could have been used to find a cure.

Then everyone can die of something else.

[Moonman62]

If cancer has been known for millenia, I must presume they all smoked back when?? NOT!

The article said smoking is linked to 30% of cancers, not 100%

[raisincane]

When I was a kid, my family knew no one that had cancer. Now, my family knows hundreds of folks with cancer, or have died from the desease. I have discussed this with other people, and they say the same. We agree that cancer has become rampant the last 40 years. What has caused the increase?

[neverdem]

What has caused the increase?

IMHO, increased longevity.

[Westlander]

If there is no CA, there would not be a need for the AMA, a self sustaining institution.

[garandgal]

since the early 90s, the american medical types gave up on curing those things they could 'manage'... indefinitely.

It's "palliative" care for those poor cancer patients unlucky enough to have an inoperable cancer.

They use that term as though they are referring to the first definition in the dictionary (helping to ease the ravages of disease). In reality, it is the second (from Merriam-Webster).

2 : to cover by excuses and apologies.

[Smokin' Joe]

OK. 30% smoked?

Now I'm not arguing tobacco is good for you.

I am saying the fixation on smoking is detracting from basic research funding which could benefit everyone.

This has reached the point where the focus is not on curing cancer, but attacking tobacco. What a fricking waste of money.

Smoking isn't going away, despite the ludicrous efforts to make second class citizens out of smokers, ones which have established precedents for control over the lives of individuals and businesses which otherwise would not have been tolerated--and which will haunt us all later.

Just as alcohol did not go away during prohibition.

Regardless of how you feel about tobacco, recognize that immense sums are being pumped down the anti-tobacco rathole which would be better invested in finding a cure.

As for linking things, water consumption can be linked to 100% OF ALL CANCERS. If you don't consume water, you die. Everyone who consumes water has a risk of contracting cancer.

See how easy that was??

Do you honestly think the researchers who are only concerned about tobacco ever ask about occupational or other daily exposures to other carcinogens?

Nope. They found what they were looking for and quit looking.

But because smoking cannot account for all lung cancer, they have tried to establish more and more tenuous ties between lung cancer and exposure to tobacco smoke. Second hand smoke, even third hand smoke.... all researched with the money which could be used better doing microbiology and biochemistry to better understand the mechanisms of cancer.

Now I know there are other carcinogens out there, I read the labels that tell me lots of things are 'known to cause cancer in the State of California' and must presume that distinction does not cease at the state line. But how many of those are ever even asked about--especially in the case of a smoker?

Sure, I have smoked igarettes for a few decades. My bad. I have been exposed to crude oil two days out of three, when the price was up, for nearly three decades, various and sundry other chemicals and particulates, welding smoke, rock dust, in short, a wide variety of toxins and irritants. If, however, I contract lung cancer, none of the other poisons I have been around will get the blame. Only tobacco.

Sorry, but that is junk science, plain and simple. So don't waste funding on the pikers raving about tobacco, instead, spend it on the folks finding a cure.

If we find a cure, it won't matter why you have cancer.

[Smokin' Joe]

What has increased in the past 40 years?

Wall to wall carpeting, TV, telephones, synthetic fabrics, 'engineered' building materials, pesticides, air fresheners, atmospheric nuclear testing (now banned, but there during the formative years for the last 1/2 of the baby boom and beyond), processed foods, the list goes on.

Tailor made (as opposed to roll your own) cigarettes have been around since the early 1900s, so that probably isn't it.

[Lexinom]

Everybody will eventually get cancer if they live long enough. The reason is simple, mathematical: the right combination of cumulative mutations in individual cells will inevitably get the "right" combination to shut off telomorase regulation thus allowing for indefinite cell multiplication.

Info that should have been in this article:

All cancers start from one individual cell (contrary to the article; just bad wording on their part): Cells multiplying out of control are indicative of either a benign (non-metastasizing) or malignant tumor. It can be low-grade, like basal cell skin cancer, or high grade, like small-cell carcinoma of the lung. Another interesting if morbid fact: the cell must divide 40 times or more to make over one trillion copies of itself equating to (depending on cell size) perhaps ten percent of one's total body mass. That is the approximate fatal threshold - 10% of cells that are energy-sucking deadweight.

The article's most significant point is what you caught: "cancer" is not one disease, but many - differentiated primarily by cytological origin and histological type. For pragmatic reasons it is also separated by treatment methodology. Lung cancer alone consists of four major types, each with subtypes.

Going forward with a view toward cure (rather than milking for money), it is my very modest opinion that the future lies in better targeting - such as the allusion to the new treatment agent for leukemia.

[AnotherUnixGeek]

Will cancer be cured this century?

It is more likely that the death rates will continue to drop slowly rather than cancer vanishing completely. And even then, for some very elderly people, cancer is likely to prove fatal as a part of normal ageing. "You'll never completely eradicate cancer because your body eventually gives up," Sullivan says.

I admit to being a complete layman on medicine, geriatrics, etc. but this sounds extremely pessimistic. There are 94 years left in the century and at the current rate of technological growth it'd be amazing if cancer was not cured by the end of the century, with a cure for aging either also achieved or within reach.

Unless Western civilization falls to Islamic barbarism or some other future threat, of course.

[Lexinom]

I think you're right about sheeple following the anti-smoking lobby to the detriment of other overlooked etiologies. You've mentioned some very good examples: wall-to-wall carpeting, processed foods, etc.

[Jedi Master Pikachu]

Also, smoking is voluntary; some cancers come about even though the people who get it are trying to prevent cancer.

People can smoke, but they shouldn't (it's their choice, but it isn't the most intelligent one).

Granted, people can become addicted to nicotine, but they should try to remove that nicotine addiction.

[Jedi Master Pikachu]

People are living longer; there are more people; people are being bombarded by radio waves from transmission stations and satellites (though this does not necessarily cause cancer); people consume lots of chemicals (from both food and household cleaners, etc.); and cancer could have been misdiagnosed in the past, for starters.