Sunday, June 23, 2013

What is Cancer?

Before being diagnosed with cancer, I had ideas about what cancer is and what causes it - and of course what I should be doing to avoid it. I've lived a pretty healthy life, believing that the choices I was making would protect me from diseases like cancer. Oh well. 

Cancer is a scary word for most people, and a big part of fear is a lack of understanding. For me, understanding what was happening inside me has helped to make it all easier to deal with. Understanding has reminded me that it's not worth my while to do anything I might regret, including being afraid and paranoid about cancer and what might cause it.

It's not my fault that I got cancer and cancer is not some inherent weakness that should be judged or pitied. People say I'm brave for writing about my experiences so publicly, but it doesn't feel like bravery. It seems like a logical thing to share. My experience can (and already has) helped other people to be more cautious, getting those check-ups that are easy to forget to schedule. Others have said my blog is helping them to deal with diagnosis and treatment. And some have pointed out that if they admit to their peers, colleagues, employers that they have cancer, they will be judged, pitied, deemed weak, and written off - hence the sense that what I'm doing is brave. 

I abhor the secrecy with which we treat medical problems, as if we should be ashamed on top of sick, sad, confused, and afraid. That's one good reason to be public about cancer. Even vaginal cancer. 

a candle in a paper lantern

This post is about understanding cancer. Of course, if cancer was better understood, it would be less of a problem. Cases of cancer have been recorded in people for centuries, but treatments have progressed slowly. For a very long time, cancer was just a thing that nobody could do anything to reverse. In the last sixty years, doctors and scientists have done a lot of experimentation, looking for "a cure". What they've discovered is that cancer is many things and that a single cure is unlikely to ever exist. However, we're slowly getting to the point where certain cancers are being cured. Not just bombed out of existence, but reversed quietly, successfully, completely. 

If you're curious about this stuff, I'm going to (again) recommend that you read The Emperor of All Maladies by Siddhartha Mukherjee. If you're not ready to read a history of cancer and its treatment, I can understand that. But I also think it's good to know the basics. Even if I understood some things about cancer before, I have been surprised by how little I knew and how much I was wrong about. 

Just a Lump of Tissue

Cancer tumors are just lumps of tissue. They do not poison your body, they are not dangerous in a vacuum. The problem is that they grow and grow forever, eventually blocking off the functions of your body. Tumors in the lungs destroy the healthy tissue just by being there, and then it gets harder and harder to breathe. Tumors in the abdomen or pelvis can rearrange internal organs, keep the stomach from properly digesting food, block the intestines, and take over organs, like the pancreas or liver, which we need and use every day. 

Without proper function of the organs, the body cannot continue to live. Organs are made of tissue, tissue is made up of cells. Most tissues are built by and of healthy cells that know what your body needs. Cancer tumors are made up of cells that are so selfish and out of control that they ultimately destroy their own environment.

This is why someone who seems and feels healthy (ahem) can suddenly be diagnosed with cancer. 

I am not even going into leukemia or other cancers that do not present as tumors, because I don't know enough about them. But they also involve the proliferation of cells that inevitably out-compete the healthy cells and cause malfunctions of our basic bodily systems.

The elusive Waldmeister

Cancer cells are mutated cells. That means they start out just like other healthy cells and then something changes in their DNA to make them act differently. The mutations can be caused by a wide variety of things. Some are passed through families. Others are obviously environmental, some avoidable, some unavoidable. 

One problem is that we do not understand the vast majority of mutagens, the causes of mutations. We know that smoking tobacco causes cancer because the mutagens in tar are very effective. Don't breathe asbestos dust, either. We know that diet is probably part of the problem, or that it can be part of the problem. Psychology probably plays some role. The way we've messed with the environment and the food chain is also a pretty big suspect. Breathing exhaust from cars, buses, trucks, ships, etc is an obvious one. Again with the fossil fuels. However, most are just guesses. We're looking backward for a reason, a poor way to distinguish actual cause and effect.

And cancer cells haven't just mutated once. It's not that they are happy cells one second and then they mutate and turn into tiny demons. They mutate many, many times. It can start out slowly, which is why women have Pap smears. The initial mutations - of cells that are on the path to becoming cancer cells - are visible. If the doctor can see it before it's actually cancer, it can be stopped before it learns the skills that allow it to spread and become a real problem. 

Amazingly, many of the mutations of cancer cells give them skills of healthy cells. For example, one mutation adds the ability to create blood vessels. New capillaries stemming from local arteries can bring food and oxygen to cells and tissues, something every cell needs. It's really cool that our bodies can build a food network! But when cancer cells learn how to feed themselves, it's not cool at all. 

The most famous malfunction in cancer cells is their ability to reproduce indefinitely. Cancer cells are immortal. Immortality is very unhealthy, believe it or not. Immortality in cancer cells is caused by two genetic mutations. The first permanently presses the "on" button. The second is the loss or destruction of the "off" button. It may sound like these are the same thing, but they're two different things. Either one is very bad, but some cancer cells have both. Healthy cells know when to die. Cancer cells do not.

Cancer cells learn their many skills and acquire mutations over time. One mutation might be inherited, the next might be from breathing crappy air, the next from smoking cigarettes, and another caused by a virus. At some point, cancer cells learn to travel locally or in the bloodstream and lymph system. Then they survive in other tissues besides the tissue where the cell originated. That's called metastasis. And it's bad because it's currently much harder to treat cancer cells that are traveling all over the body. This is why early detection is a big deal.

Cancer's World

So it's cancer's world and we're just living in it. Cancer is immortal and takes over anywhere it gets a foothold. What can we possibly do!? 

Now that we know more about genetics, mutations, and the problems of cancer, we're doing some really great things. The best research looks at a specific mutation and then tries to shut it off. 

In the UK, a pill designed to change a certain protein in a very particular type of lung cancer may reduce the growth and spread of that form of cancer. There are other examples that have been even more successful, and I read about them in The Emperor of All Maladies and can't remember them right now. But the idea is that if you identify the protein that embodies the mutation in the DNA, you can work to fix the mutation.

My favorite option so far is being studied right now at Stanford. It's worked well on mice and now they're trying it on humans. They've targeted the invisibility of cancer cells. Yeah, they're invisible too - at least to the immune system. The immune system doesn't see cancer cells as a problem, and at Stanford they think they know why. So they hypothesize that a certain protein will fix that particular mutation (the invisibility mutation) and put the immune system on the alert. And... well... the immune system is better than magic.

Actual Treatment

That kind of research is going on now, but the standard treatment for cancer is still the atomic bomb version. Just kill all the bad cells without killing the patient; that's a type of cure. It's not as bad as it used to be, but if you've been reading this blog you know that it's not exactly nice. For a long time, the lack of understanding about the way cancer works has kept us from finding a really effective cure, but it hasn't been entirely fruitless. Chemotherapy, radiation, and surgery work to cure many people of cancer by simply removing or killing all the mutated cells. It's not an exact science, but it's getting better and better.

There are other great studies going on which are not related to genetic mutations, like the one about mole rats. Or the crazy "cancer vaccine" idea, which my doctor dismissed in my case because he was not willing to experiment on someone young with a relatively good prognosis. As cancer is studied further, we're learning a bit more about what actually causes cancer, which would be the real solution. Stop it before it starts, right? But it's not easy to isolate and identify exact cause after the fact and we can't test out mutagens on humans just to see what causes cancer.

The exciting stuff that is happening right now, in my opinion, looks at the way cancer works in the body. It won't be long now. Some solutions have already been found for some particular cancers. More will be created in my lifetime.

rhubarb cake and homemade ice cream: cancer cure

What Can We Do?

Cancer is really lame, for humans and animals - especially for the millions of mice that are making it possible for us to one day have cures. 

But cancer is not one single thing to be terrified of. Besides the obvious (quit smoking!) there are very few things we can do to avoid cancer. And not everyone who smokes gets lung cancer, nor does every lung cancer patient have a history of smoking. We know about smoking tobacco because the incidence of lung cancer in cigarette smokers is so ridiculously high, but it's not the only factor. We still don't know enough about the causes of most cancers. We've got a better handle on the mechanics, but what I've described is a very general idea. Each type of cancer operates in its own realm, very literally. The individual immune system and the body of the patient play a role as well. There are still many more questions than answers. 

The bottom line is that you shouldn't worry about cancer unless you have to. I am not worried about cancer. What good could possibly come of worrying? What exactly should I be doing right now? Stop eating sugar, don't drink alcohol or caffeine, go gluten-free? If making those changes helps some people, they should keep it up. But there is a contradictory study for each conclusive study out there and I'm not in the business of stressing myself out over each bite of food I ingest. I take care of myself, eat healthily, and indulge from time to time - because that's what makes me happy.

I haven't stopped riding a bicycle because sometimes people die while riding bicycles. We don't wear helmets when walking down stairs because some people die of head injuries while walking down stairs. Everyone dies. It's a cliché for good reason and I hope it doesn't take disaster for you to realize the truth in it: life is short. Do what you want to do right now and enjoy what you've got.

in the woods, smelling the flowers, enjoying friends


  1. " especially for the millions of mice that are making it possible for us to one day have cures."

    And we know from "The Hitchiker's Guide to the Galaxy" that the mice are really in charge!

    Great post Ramona, insightful and perceptive.

    Carry on!


  2. As far as I know, I don't have cancer, but like you Ramona I've become fascinated by the subject. What we're doing now with our genetic studies is truly landmark. Arguably the first real work on cancer in the history of our species -- if you have a high bar like I do and kind of despise the barbaric chemo and radiation, which will certainly be looked back upon with a shudder some day.

    My guess on the ETA for a comprehensive cancer cure remains in the 50-100 year range, which would be personally disappointing of course. But the fact that as a people we finally seem to have the demon in our rifle sights -- forgive the violent analogy -- is something I find excessively wonderful. A concrete example of how we will pass on a better world to our descendants. Our children, biologically or spiritually.

  3. Ramona, I was actually just checking out a few of your posts and loved this. I had a quick question about your blog and was hoping you could email me back when you get the chance -emilywalsh688 (at) Thanks : )