Cancer treatment: state and prospects
Oncological diseases
Justin Stebbing, Post-Science
Cancer mainly affects the elderly, so it can be considered an age-related disease, although, of course, cancer has different meanings for different people. Our standard of living has increased significantly, and now we live much longer than before, so now every second person develops cancer. In addition to age, there are other causes of cancer: some people have genes that can lead to the formation of a tumor, and these people have had cases of cancer in their family. In addition, heavy smoking and drinking a lot of alcohol, obesity and some diseases can lead to the formation of cancerous tumors. A number of harmful environmental factors are also associated with the occurrence of cancer.
Cancerous tumors can quickly metastasize and pose a high risk, or they can grow very slowly. Often, early diagnosis of cancer leads to better results, and therefore we have a mass screening program for breast cancer, prostate cancer and cervical cancer, which we are trying to detect at an early stage.
In addition to the term "cancer", terms such as "tumor", "neoplasm" or "neoplasia" are also used. Previously, there were a lot of prejudices associated with cancer, they were not talked about, but science and healthcare are moving forward, and many social problems have disappeared, so now, I believe, people talk about cancer much more freely. We often manage to cure cancer, and some cases of cancer are completely curable – by cancer cure we mean that a person will live to old age and die not from cancer, but for some other reason. Other cases of cancer, especially if the cancer has metastasized, are incurable, and in these cases we try to control the development of the tumor so that people can live with it. You can draw a parallel with diseases such as diabetes or high blood pressure: with the right approach, you can also live with them for a long time.
As for cancer treatment, there are many methods. The surgical approach is very important if the cancer is diagnosed at an early stage. My specialization is the use of various drugs for the treatment of cancer, for example, the use of immunotherapy, in which the immune system itself is not stimulated, but the suppression of the immune system is restrained. This is important because cancer cells can turn off the immune system. Other specialists use radiotherapy. We consider the combination of surgery, radiotherapy, chemotherapy, immunotherapy, hormone therapy and other methods of treatment as an interdisciplinary approach, when a team of different specialists is working on the treatment of a tumor. But even if we cannot cure cancer, we strive to ensure that a person can live with a tumor for many years.
Oncology as a branch of medicine is developing literally at supersonic speeds. I became an oncologist, in particular, because I wanted to combine research and treatment of patients and apply new scientific achievements in therapy. Today we are talking about a personalized approach in the field of cancer therapy, when we treat a specific person with a specific tumor at the right time with the necessary means. This may not be easy, because it all depends on individual factors (for example, what the patient wants) and the characteristics of the tumor. For example, is it possible to apply the chosen methods of treatment (and we want to use medication, surgery and radiotherapy at the same time) in order to try to maximize the percentage of recovery, and if this is not possible, maximize life expectancy while maintaining its quality, since one makes little sense without the other. To achieve this, it is necessary to apply a team approach, combining the efforts of different doctors and other healthcare professionals, as well as the patient and his family.
Today, we often use genome sequencing of both cancer and normal cells to understand how they interact. If we examine our DNA to understand why cancer occurs and examine the DNA of cancer cells, we will be able to apply treatments based on the functioning of genes that work incorrectly either in our entire body or only in cancer cells. We know that such methods of treatment give the best results: with them, we can radically change the course of the disease. However, sometimes we still need to use chemotherapy.
Sometimes I imagine cancer cells as a map of the London Underground and try to figure out what exactly is not working: Charing Cross, Victoria or Waterloo, East Acton, Chalk Farm and the Embankment? If we understand which subway stations are not working, we will be able to apply targeted therapy to hit these branches or individual stations. Cancer cells are smart, and they can figure out how to outsmart targeted therapy, but still the ability to use it in treatment is a great advantage: it is more accurate, it has fewer side effects, and patients feel much better with it. Examples of such therapy can be, for example, ALK inhibitors for lung cancer or anti-PD-1 and anti-PD-L1 in immunotherapy – for those patients to whom they are suitable, these drugs have literally changed their lives.
Previously, people died quickly from diseases such as metastatic lung cancer, but now, thanks to the latest discoveries and laboratory research, we can change the lives of such patients. Now the life expectancy of a patient, for example, with metastatic melanoma when using these amazing drugs is more than five years, because these drugs not only kill cancer cells, but also strengthen the human immune system. We prefer a systematic approach to treatment: it is important not just to choose the right drugs, successfully perform surgery or apply radiotherapy – it is also important that the patient maintains good physical shape and adheres to the right diet.
Some types of cancer do not cause patients many problems: such tumors can grow very, very slowly. In fact, cancer is in some sense an advertising term that is used for everything: from pancreatic cancer, which can grow incredibly fast, leaving the patient a few months of life, to a small skin cancer, from which there will not be many problems. The most important thing is to work together with the patient and his family to understand the features of the tumor and how best to treat it – and if you were able to understand how to treat it, you usually maximize the patient's life expectancy, while ensuring its good quality.
As an oncologist, I learn new things about people, their families and cancers every day. If we imagine that before we know how to completely cure cancer, we need to walk a kilometer long path, then at the moment we have walked less than two meters. I really don't understand how and why cancer begins to spread through the body or why it occurs.
Let's take such a simple type of tumor as breast cancer: a woman has two mammary glands with the same genes, but only in one small area of one gland cancer cells are formed. Why is this happening? Why are they spreading the way they are spreading? And why don't our treatment methods allow us to destroy all cancer cells? Why can cancer come back after many years? We know that there are cancer stem cells that, like queen bees, can restore the population in 8-10 years. It is critically important for us to understand why some people have cancer and what methods it needs to be treated in order to destroy all cancer cells. If prostate cancer, breast cancer, colon cancer or lung cancer – common cancers – have metastasized, we no longer consider them curable. What makes them incurable? Why? What can we do to increase the recovery rate? These are the questions I ask myself every day.
About the author: Justin Stebbing – Professor of Medicine and Oncology, King's College London.
Portal "Eternal youth" http://vechnayamolodost.ru