Let
me share an example from Siddhartha Mukherjee's book with few
modifications. Two guys, Mr. X and Mr. Y, develop a cancer at the same in
1991. Both don't have any symptoms as the disease slowly progresses.
Always cautious about health, Mr. X goes for a regular cancer screening in
1995 and diagnosed with cancer. Surgery-radiation-chemotherapy combo is
performed on Mr. X. Life of Mr. X is saved for another five years due to
early diagnosis and treatment. In 2000, the cancer relapses with
vengeance and he dies. On the other hand, Mr. Y never cares about
health and did not go for any screening. In 1999, the cancer spreads all
over his body and lethal symptoms force him to be hospitalised.
Surgery-radiation-chemo cycle is performed on Mr. Y in 1999. However,
due to late diagnosis his life could be saved only for an year. He dies
after one year of therapy, in 2000. Well. Mr. X and Mr. Y die almost on
same time. However, the early diagnosis gave Mr. X five years of life and
late diagnosis gave Mr. Y only an year.
Despite
the crude reality, the above example does not demean the importance of
early diagnosis. Cancers like breast cancer, uterine cancer or cervical
cancer can be 'completely' cured by early diagnosis. We have successfully
developed methods to diagnose these cancers at very early stage. The
early diagnosis in case of breast cancer has gone to the extent that the
women who are genetically prone to breast cancer remove their breasts
proactively, even before any possible development of cancer! Vaccination
helps to prevent some cancers of viral origin.
As
far as preventive life style is concerned, we know that tobacco causes
cancer. Apart from tobacco, we have a laundry list of carcinogenic
chemicals, but the chances of encountering them in normal life is rare.
Robin Cook's 'Fever' is based on cancer due to benzene. It was a common
solvent used in chemistry labs until two decades ago. It is completely
out of laboratory use nowadays. Radiation and asbestos may be
encountered sometimes, but highly avoidable. Alcohol is not
carcinogenic, but it can be a secondary agent to lead a damaged liver to
cancerous. Other than these, we are in the primitive stage to define an
ideal life which may be cancer free. We could not even definitely say
whether the use of cell phones causes brain cancer or not. All studies
conducted in this regard have holes at the bottom.
The
first reported case of cancer was as early as 2500 BC. The Egyptian
hieroglyphs mention about it. However, if we look at the history of our
battle against this disease, it is not certainly a battle that we have
won; neither have we lost. I haved my beloved family members succumbed
to this disease. I have also seen my family members who have survived
this disease. My grandmother lived for many years without any
relapse. She underwent radiation therapy for uterine cancer in late 1970s at Adyar Cancer Research Institute (Chennai) and she was not under any anti-cancer medication as far as I
know. She would not have taken, even if prescribed - I guess. After reading the literature on cancer, I think any
oncologist would conclude that her case was a miracle. Cancer is known
for its violent return after the treatment. Once relapsed, it is mostly
the end. The relapse can happen after days, months or years.
When Siddhartha
Mukherjee started writing his Pulitzer winning book on cancer in
mid-2004, he had also started treating an young lady, Carla, diagnosed
with acute lymphoblastic leukaemia. Ninety five percent of her white
blood cells were malignant, cancerous. The book naturally starts with
the chapter about her arrival to hospital and the events followed by.
Siddhartha had thought that the final chapter of the book would perhaps
about the death of Carla. The book describes the merciless chemotherapy
cycles performed on her. Siddhartha finished his book in June 2010. On
the last days of completing the book, he carried out routine blood test
on Carla. There was no trace of cancer, no relapse. The distinguished
oncologist, Siddhartha, calls it a miracle at the last chapter of his
book. However, we must not forget that there are many such miracles.
My
first - may be the last - practical acquaintance with cancer was during
my post graduation when we tried to test a newly synthesised drug
coupled with photo energy on cancer cell lines. The method is called photodynamic therapy whose
origin may be traced back to Dracula! We all know that we need oxygen
for life. How does oxygen get absorbed into our blood? You will wonder
if I say it is through the rusting of our blood. The iron forms rust
when it comes into contact with oxygen and water. Rust is nothing but
the oxides of iron. In our blood, we have haemoglobin. At its centre,
haemoglobin has a plate like molecule called porphyrin. At the centre of
porphyrin, there sits an iron atom. When the blood is exposed to oxygen
in our lungs, the iron atom 'rusts'. It forms an oxide like complex
with oxygen. This oxygen is carried to our cells through blood. Due to
some metabolic malfunction, the formation of porphyrin does not happen
properly in some people. They will have defective porphyrins in their
haemoglobin that cannot fit iron atom. These defective porphyrins,
literally useless, are deposited by the body in the fast multiplying
cells especially their skin cells. This disease is called 'porphyria'.
Well.
What is the link to Dracula and cancer?! When the skin of the porphyria
affected people is exposed to sun light, the defected porphyrins
deposited in the skin excite, corrode and kill the skin cells.
Therefore, they cannot come our during day. They also get some tendency
to drink blood which moderates the severity of the disease. Garlic
increases the severity of the disease. You would have guessed it now.
The scientists believe that the people with porphyria might have been
called as vampires! However, this strange disease gave a clue for cancer
therapy. The defective porphyrins are naturally deposited in fast
multiplying cells. When exposed to light, the cells are corroded and
destroyed. Since cancer has fast multiplying cells, the porphyrins can
be used to kill the cancer cells. This paved way for photodynamic
therapy. Porphyrin type compounds are injected to a cancer patients who
have cancer in the visible areas such as skin or eye. Once the porphyrin
compound is naturally deposited in the cancer cells, the cancer area is
exposed to light rays. The cells get killed. This is what we tried with
some porphyrin compounds synthesised at our lab. Since we cannot try on
patients, we bought cancer cells and tried on them. The results were
instantly perfect. However, there are several practical difficulties
with this therapy which have made its application limited. A drug based
on this therapy, verteporfin, is under trials for cancer treatment.
Cancer
is a lucrative area for any pharmaceutical company. We have basketful
of cancer drugs, but the treatment and cure are still elusive. Why? For
this we need to understand the emperor of all maladies, cancer. I will write about it later.