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From the First to the Last

Now that I am no longer living the daily trauma of hearing “You’ve got cancer,” I find myself more curious about the “How” of it than “Why me?” I’ve always been fascinated by the mysteries of science. And to satiate that curiosity, I have amassed a collection of partially read and even less-partially understood books on physics, biology, anatomy, botany, even astronomy that line my bookshelves. But with one particular science, cancer, it’s personal. I want to understand what actually happens, how the body makes cancer, what exactly goes on during treatment and how the body recovers from such an overwhelming onslaught. And so, I read. I ask questions. I get a glimpse of something that sheds some light for a moment, only to lose it again moments later. 

In my quest for understanding, I recently came across two books that, in addition to educating me further on the topic, seem to bookend the approaches research doctors take in dealing with the disease. The First Cell, by Azra Raza, (published by Basic Books, 2019) focuses on the author’s realization that we are so much better at eliminating cancer when it is caught early, so therefore, we should be certain to focus on early detection and early assault. At the other end of the spectrum, Thomas Grogin’s book, Chasing the Invisible, A Doctor’s Quest to Abolish The Last Unseen Cancer Cell, (published by Koehler Books, 2019) shares the doctor’s perspective that it is only by eradicating the vary last cancer cell that we can be sure it won’t come back. Both are right, and fascinating. And both are really saying the same thing — it’s complicated, and cancer is a beast.

To Better Understand

I know not everyone is a cancer geek the way I am, and perhaps you don’t want to digest pages and pages of science to better understand the disease. But I thought I would share a couple of excerpts I found particularly clarifying, just in case. First is Dr. Raza’s clear description of cancer:

Cancer begins with genes. Genes, made up of DNA, coiled and packed into chromosomes during mitosis, carry the code for proteins. DNA is first copied into RNA, which serves as a template for protein synthesis by the cell. Proteins carry out cellular functions. Each time a cell divides, it must faithfully double its DNA, to parcel it out equally to the two daughter cells. Because three billion base pairs need rapid replication, errors or mutations occur. Mutations are continuously edited, repaired, and corrected by built-in cellular mechanisms. If repair is not possible, and the mutation is in a vital gene, the cell is forced to commit suicide. If the mutation is in a gene not vital for the cell, it can persist and be passed on to the next generation. Most DNA mutations are inconsequential—their resulting proteins are either insubstantially changed or not changed at all. If, however, the error affects genes whose function is to either promote or arrest growth, a cell can be driven into wildly irregular paths of unstoppable proliferation: cancer.

Essentially, cancer-initiating events can be triggered by a factor internal to the individual, such as increasing age or a genetic predisposition, or by something external to the individual, such as DNA-damaging environmental toxins, tobacco, alcohol, ultraviolet radiation, or pathogens.”

Waging War

All of which makes it perfectly clear that we may never fully understand why or how a particular cancer, such as mine, occurs. Cancer happens. If we are lucky, we find out soon enough to stop it. And it also makes it abundantly clear why doctors want to loft bombs at cancer and fire missiles, send in snipers and even set up semi-permanent trench warfare, all at the expense of a patient’s sense of well-being and sanity. As Dr. Grogan explains: 

To eliminate a cancer, you must eliminate the last immortalized cell. To kill that cell, you must know the nature of the beast. You must know its workings, its derangements, its dependencies, it’s driving force. The driving force may then become the target of a drug, making a knockout punch possible. And repeated treatment with the targeted drug over time will deal with any dormancy issues. 

These principles underlie personalized targeted therapy. But what if the beast has more than one driving force? What if the beast is a multi-headed serpent like the Hydra? What if when you lop off one head, as Hercules did in Greek mythology, another springs forth? What if the serpent evolves and grows more heads as you treat? What if the drug stimulates new heads? What if the serpent has the capacity to change like a chameleon? 

[a] new approach [became necessary] based on boosting the patient’s own immune-cell response to eliminate their cancer. The idea was to strengthen the body’s lymphocytes, the wolves of the immune system, to induce healing. The surprise was the discovery of that cancer cells often confound the self-healing response by putting up a molecular blockade, a cloak of invisibility that keeps the wolves at bay. [Now we have] a new generation of drugs to block the blockage, remove the invisible cloak and allow self-healing.” 

Taking Comfort and Taking Care

I take comfort in the fact that there is new understanding about the disease, new approaches and new drugs for eliminating and controlling it, new hope for those diagnosed. But I remain humbled by the mysteries of nature, the black box we call our bodies, and the unknown — and perhaps unknowable — science of the human body. I’m not sure anything I’ve read reduces my concern that we may never know when cancer will strike, or if it is ever really gone. But somehow, I’ve learned to live with that uncertainty. 

Turn’s out there’s a lot about life we can’t control. But by diffusing the psychological hold that cancer has had on me, I can get on with it. That doesn’t mean I won’t keep a watchful eye out for the proverbial bus, or stop buying and reading cancer books, but it does mean I’ll allow myself a glass of wine with my healthy dinner, knowing that there are more knowledgeable experts out there who continue to search for the better detection lens and the secret sauce that will help take the sting out of cancer.

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