February 14, 2013 1 Comment
Following a recent blog, I received an inquiry from one of our readers. The individual asked whether I could better explain my oft repeated statement that “cancer doesn’t grow too much, it dies too little.” The questioner was puzzled by my assertion that chemotherapy drugs acted to stop cells from growing, while she had come to believe that this was synonymous with killing them. This dichotomy is at the crux of our modern understanding of cancer.
In response, I would like to examine the very basis of what is known as carcinogenesis, the process by which cancer comes to exist.
For more than a century, scientists believed that cancer cells were growing more rapidly than normal cells. They based this on serial measurements of patient’s tumors, which revealed that tumor dimensions increased. A small lump in the breast measuring one-half inch in diameter would be found six months later to be one inch in diameter. And six months after that it was two inches in diameter. This was growth, plain and simple, and so it was reasoned that cancer cells must be growing too much. As such, cancer therapies, per force of necessity, would need to stop cancer cells from growing if they were to work at all.
And then, in 1972, a paper was published in the British Journal of Cancer that described the phenomenon of apoptosis, a form of programmed cell death. Although it would be almost a decade before cancer researchers fully grasped the implications of this paper, it represented a sea change in our understanding of human tumor biology.
Let’s use the example of a simple mathematical equation. Every child would recognize the principles of the following formula:
Tumor mass = growth rate – death rate
This simple equation represents the principle of modern cancer biology. Where cancer researchers went wrong was that they mistakenly posited that the only way a tumor mass could increase was through an increase in the growth rate. However, as any child will tell you, a negative of a negative is a positive. That is, at a given growth rate, the tumor mass can also increase if you reduce the death rate. Thus, the “growth” so obvious to earlier investigators did not reflect an increase in proliferation but instead a decrease in cell attrition. Cancer didn’t grow too much it died too little, but the end result was exactly the same.
It should now be abundantly clear exactly why chemotherapy drugs, designed to stop cells from growing, didn’t work. Yes, the drugs stopped cells from growing, and yes any population of “growing cells” would suffer the effect. But they didn’t cure cancers because the cancers weren’t growing particularly fast. Indeed, the fact that chemotherapy works at all is almost an accident. Contrary to our long held belief that we were inhibiting cell proliferation, chemotherapy drugs designed to damage DNA and disrupt mitosis, were actually working (when they did at all) by forcing the cells to take inventory and decide whether they could continue to survive. If the injury were too extreme, the cells would commit suicide through the process of cell death. If the cells were not severely damaged or could repair the damage, then they carried on to fight another day. None of this, however, had anything to do with cell growth.