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The Thing from outer space v the biological programming error

Texas_wedge's picture
Texas_wedge
Posts: 2807
Joined: Nov 2011

Some of the books I've been reading lately have the same underlying theme - a great favourite: clear thinking. The excellent "Bad Science" by Ben Goldacre contains material flagged by the eponymous title but the book is really about correct thinking. Charles Merrett's "The Origin of Anxieties" could have taken its title from Hamlet (Act 2 Scene2) "for there is nothing good or bad, but thinking makes it so", a theme the Bard explored so powerfully also in Othello and in the person of Leontes in the wonderful "The Winter's Tale".

Anyway, musing on thinking and on the power of mind-body medicine, prompted me to speculate about the way we talk and think about cancer. I think we do ourselves no favours by the way we characterise the disease. [Just switched off a daytime soap called "Doctors" with a depressed patient with cancer saying "No, doctor, I mean how long have I got if I don't take the treatment" - maybe a bit too topical, I felt.]

Often we talk as though we're doing battle with some malignant alien. We label 'the enemy' as "the beast" or "my little bugger" or a variety of other terms. Correspondingly, we regard the condition as one where we desperately need someone else to get "it" out of us. Invariably we think in terms of entity rather than process. We abrogate any sense of our own role in treating our plight by regarding it as one which it's some expert's job to get us out of. I recall with admiration John Neary's extended metaphor (on KIDNEY-ONC) in which he likens the experience to going through a car wash (cf. CT scans, operating theatres with robots etc) where we're entirely passive, in one end and out the other with no control of what happens in between.

The fact is that cancer is not like that at all - not an invasion of the Thing from outer space. The whole problem is precisely because the cancer is not some alien organism - it's our own cells which are simply misbehaving and this is why our immune system can be caught with its guard down. It's a case of the enemy within and our immune system failing to recognise the fact that our own cells are acting in a way inimical to our interests. The cancer isn't an invader, it's a bit of us that's acting up.

A better conceptualisation is to think of it as a programming error within our own body. We now know (more and more as the spinoffs from the Human Genome Project advance) of genetic errors that can lead to cancer. However, a danger of this thinking is the tendency once again to totally cede control. We may think that our fate is pre-determined and that under unknown conditions some bug in our biological software code is going to be called into action with dire consequences.

We need a mental model that is more flexible and also one which can accommodate the bewildering complexity of the problem. The best researchers have such models and escape the caricatures that most of us saddle ourselves with. Maybe if we can understand a little better, we can be better placed to deal with the problems cancer presents us with? We can then see the sort of strategies that could prove useful, e.g. stopping the processes that cause uncontrolled cell proliferation, cutting off blood supply to tumerous tissues, alerting our immune system to inappropriate behaviours and finding ways of encouraging apoptosis or of attacking the errant cells and recycling their contents.

Thinking better about the subject can help us to have more of a sense of involvement, if not actual control. That way we can be more receptive to all of the possibilities that the current movements or schools of thought may offer - "evidence-based medicine" and "science-based medicine" and the sort of "Participatory Medicine" that is coming into vogue, not before time and promises to shake this world up in the very best of ways.

garym's picture
garym
Posts: 1651
Joined: Nov 2009

Sorry T, I couldn't help myself, hope this doesn't spoil what I found to be a very enlightening approach to a proper mental aspect regarding cancer. The humor from this may elude you over there, different story here.

THE YEAR WAS 1947

This clears up a huge question --
The year was 1947.
Some of you will recall that on July 8, 1947,
a little more than 64 years ago,
numerous witnesses claim that
an Unidentified Flying Object, (UFO),
with five aliens aboard,
crashed onto a sheep and mule ranch
just outside Roswell , New Mexico .
This is a well known incident
that many say has long been covered-up
by the U.S. Air Force,
as well as other Federal Agencies
and Organizations.

However,
what you may NOT know is that
in the month of April, year 1948,
nine months after the historic day,
the following people were born:

Barrack Obama Sr.
Albert A. Gore, Jr.
Hillary Rodham
William J. Clinton
John F. Kerry
Howard Dean
Nancy Pelosi
Dianne Feinstein
Charles E. Schumer
Barbara Boxer
Joe Biden

This is the consequence
of aliens breeding
with sheep and jack-asses.

I truly hope this bit of information
clears up a lot of things for you.
It certainly did for me.

And now you can stop wondering why
they support the bill
to help all Illegal Aliens.

Texas_wedge's picture
Texas_wedge
Posts: 2807
Joined: Nov 2011

Dangerous ground Gary - politics best avoided on this sort of forum.

The Roswell story is by now well known the world over, helped I guess by the likes of the X Files. [I still find it amazing to picture Gillian Anderson as a pain-in-the-arse, confrontational, purple-haired punk teenager growing up in Crouch End, London, not far from my original home.]

Did you know that Kevin Spacey has described Bill Clinton as "one of the shining lights" of the political process? (But then maybe you don't share my view of Spacey!)

garym's picture
garym
Posts: 1651
Joined: Nov 2009

Love Spacey and his alien in K-PAX among many other roles. Yes, politics is best avoided, but I couldn't help myself. FYI...I am a rebel independent on the political side, I dislike both parties equally.

icemantoo's picture
icemantoo
Posts: 1592
Joined: Jan 2010

The alledged facts in the above post about who was born in April , 1948 is not based on any facts, only fiction. Much like the Birther movement. Check the facts out for yourself.

Icemantoo

Texas_wedge's picture
Texas_wedge
Posts: 2807
Joined: Nov 2011

Wow - thanks for the pointer iceman. I suppose the Birther "movement" is something akin to the rocking motion of a paranoid schizophrenic? Do you have a special looney-breeding program over there?

icemantoo's picture
icemantoo
Posts: 1592
Joined: Jan 2010

If you will google Birther movement it is a far right movement who are immune to facts and insist Obama was born in Africa and any facts to the contrary are false. Much like a looney breeding program.

garym's picture
garym
Posts: 1651
Joined: Nov 2009

C'mon icy,

No facts were alleged, its a joke, I'm sure there is a similar one where the names have been changed to insult the other dimwits.

lbinmsp's picture
lbinmsp
Posts: 266
Joined: Jun 2006

with what you say - I guess the reason we (I) lay a name on it (The Beast) - is because I need to have a THING to get angry at - a THING to yell at - a THING I want to kill! It's psychologically easier than to know and admit that its my own body that has let me down. When I asked my first surgeon (after it was over) - what I could do better and perhaps ensure it would never come back - he said to drink at least 8 8oz glasses of water every day, eat healthier (more fruist and vegies)and to keep my immune system strong. The experts have said that reducing stress is a major factor for a healthy immune system. Easier said than done for most of us and, looking back, I can actually define the stresses I was experiencing in the months (years) before I received each of 'the diagnoses'.

Now we watch the scientists slave to discover the right "anti-virus" software they can load into us and perhaps a better operating system (mine seems to have too many bugs in it right now).

LizB

Texas_wedge's picture
Texas_wedge
Posts: 2807
Joined: Nov 2011

It was a sensible question you asked at that time Liz and good sound advice you got, of which Gary will greatly approve, especially if you add in walking :)

Your observation made me think back and consider hypothetical disposing causes in the way of stress. With a rough indication of time-scale, I guess my Family was, for many years, going through things far more terrible than cancer and maybe that period of trauma could have been implicated in my control systems starting to covertly go awry? But we'll doubtless never know.

One Lucky Girl's picture
One Lucky Girl
Posts: 68
Joined: Feb 2012

Hi Tex,

I'm not sure about aliens but I sure do feel like I fell down the rabbit hole in February!

At the beginning of April my post-surgery 'relaxation' came to a quick end with my celebratory ski vacation (wonderful!) followed by a huge backlog of client projects that are currently keeping me working night and day. Although I did manage to sneak away to Holland to bicycle through the tulips last weekend (I am determined to kick cancer in the butt!) I sadly haven't had more than a minute here and there to check in on this board. As it is, I'm supposed to be working right now. Uh oh...

Tex, your comments about the immune system and our bodies' reactions are interesting. Since I was 18 I have done battle with Crohn's disease, an auto-immune disorder. Sometimes the illness has gotten the better of me (I almost died twice due to massive haemorraging), but I fight the good fight and have been symptom and medication free for the last 5 years thanks to my healthy lifestyle! :-) But... I did have to take steroids for years, followed by years of 6MP (a chemotherapy drug that suppresses the immune system). Of course there is no way of knowing if the disease or drugs were related to my kidney tumour.

I am certain a mind-body link exists. I have modified my whole existence to eliminate negative stress (but I don't mind hard work). It has worked for me with the Crohn's and I am sure that a positive focus can help us beat cancer too!

PS So glad to see you are recovering well from your recent surgery.

alice124's picture
alice124
Posts: 860
Joined: Mar 2012

I'm with those believing there could be a traumatic time or experience linked to cancer birth/growth. A couple of months ago I had naievely asked about whether a tumor's age could be determined and was rather surprised that more specific information on tumor growth was not available, only general estimates of growth.

Maybe it's stupidity on my part, but I wouldn't think that the ability to determine age of the cancer/tumor would be too far in the future. With DNA and RNA advances seeping into numerous aspects of our lives, identifying the age of cancer doesn't seem too big a jump.
Maybe it's just wishful thinking on my part, but I believe it's in OUR future.

foxhd's picture
foxhd
Posts: 1951
Joined: Oct 2011

....Beam me up Scotty!....Couldn't hold back any longer.

Texas_wedge's picture
Texas_wedge
Posts: 2807
Joined: Nov 2011

"Scotty" here - got you Foxy! We could see you beaming from right across the Atlantic and, boy, do you have good reason!!!

foxhd's picture
foxhd
Posts: 1951
Joined: Oct 2011

..I think some of my molecules have been misplaced. Maybe Mars. ..Please no jokes about Uranus.

Texas_wedge's picture
Texas_wedge
Posts: 2807
Joined: Nov 2011

Improbable Alice. The average rate is around 1/3 cm per year but there is a wide spread, depending on histology for one thing.

Chromophobe is "indolent" so the rate may well be, typically, more like 1/4 cm per year. So, my (first) tumour being chromophobe and 9cm may have been developing for something like 36 years. This would probably not be the case for Chris Boone, who will be getting married in a couple of weeks time. At 21 cm, at a similar rate, his would have been developing since about 50 years before he was born! So I think we can safely assume that his grew a good deal faster than that.

Moreover, growth rate can change dramatically. For instance, mine had become sarcomatoid with the result that the second tumour (similarly sarcomatoid and necrotic) was not visible at my first, open, op on 5th December but when removed (exactly 3 weeks ago) was a hard nodule of 2.5 cm = zero to 2.5 cm in less than 4 months - say 8 cm/year!

In addition, necrotic tissue probably has a different specific gravity from highly vascular live tissue and other compositions. Factor in, further, the fact that we now know there can be varying cell types in the same tumour and it becomes more complex still.

In fact, take a look at almost any recent paper in, say, "Recent Molecular Oncology Articles" per Elsevier at

http://www.journals.elsevier.com/molecular-oncology/recent-articles/

to give you some presentiment of how mind-blowingly complicated the whole domain is. Articles summarised there such as, I suggest, in particular

"Molecular pathology" by Stanley R. Hamilton (Available online 23 March 2012)
"The challenge to bring personalized cancer medicine from clinical trials into routine clinical practice: The case of the Institut Gustave Roussy"
"Molecular imaging for personalized cancer care"
"Omics and therapy – A basis for precision medicine" [this is on cancer genomics]
"Discovery of small molecule cancer drugs: Successes, challenges and opportunities"
"Bioinformatics and systems biology"
"Moving molecular targeted drug therapy towards personalized medicine: Issues related to clinical trial design"
"Individualization of cancer treatment from radiotherapy perspective"
"Cancer biomarkers"
"The biology of personalized cancer medicine: Facing individual complexities underlying hallmark capabilities"
"Systems pathology: A critical review" [which forecasts "an acceleration of preventive medicine as a result of the coupling of personal genomics with systems pathology"]
"Exploitation of the propulsive force of chemotherapy for improving the response to cancer immunotherapy"
"The toxin component of targeted anti-tumor toxins determines their efficacy increase by saponins" [re side-effect limiting]
"Germline pharmacogenomics in oncology: Decoding the patient for targeting therapy" [cheering stuff here' like:

"The recent introduction of total exome sequencing has enabled the identification of patient tumor-specific epitopes generated through somatic point mutations, raising the possibility of targeting tumor antigens in individual patients which are even more tumor-specific. Transcriptional profiling and immunohistochemistry analyses have revealed a subset of patients with a pre-existing T cell-inflamed tumor microenvironment. This phenotype may be predictive of clinical outcome to immunotherapies and offers the possibility of a predictive biomarker. Further analysis of these tumors has identified a set of defined immune suppressive factors which themselves are being targeted with new immunotherapeutics, already with interesting early phase clinical trial results ...... generating a rich set of opportunities for the specific immunotherapy of cancer." Stirring stuff indeed!!!]

"Molecular-targeted nanotherapies in cancer: Enabling treatment specificity"
"Non-coding RNAs in cancer initiation and progression and as novel biomarkers"

This last, especially, reminded me of your speculation and I think this summary would disabuse anyone of supposing that we have much of a handle on this business at the present time:

"Cancer represents a complex group of heterogeneous diseases. While many cancers share fundamental biological processes (hallmarks of cancer) necessary for their development and progression, cancers also distinguish themselves by their dependence on distinct oncogenic pathways. Over the last decade, targeted therapies have been introduced to the clinic with variable success. In truth, single targeted therapies may be successful in only a subset of malignancies but insufficient to address malignancies that often rely on multiple pathways, thus evading single targeted agents. Investigators have recently identified potentially functional components of the human genome that were previously thought to have no biological function. This discovery has added to the already established complexity of gene regulation in the pathogenesis of cancer. Non-coding RNAs represent key regulators of gene expression. Improved knowledge of their biogenesis and function may in turn lead to a better understanding of the heterogeneity of malignancies and eventually be leveraged as diagnostic, prognostic and therapeutic targets. MicroRNAs (miRNAs or miRs) for example, have the capacity for the regulation of multiple genes and thus redirection or reprogramming of biological pathways. However, several other members of the non-coding RNA family may be of equal biological relevance. In this review, we provide a perspective on emerging concepts in the clinical application of miRNA and other non-coding RNAs as biomarkers in cancer with an eye on the eventual integration of both miRNA and other non-coding RNA biology into our understanding of cancer pathogenesis and treatment."

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