> A cancer 1cm3 in size has a hundred million cells in it or thereabouts. Therefore in advanced cancer you are looking at billions of cancer cells in the person. This is a very large amount of disease biomass. And the task is to make it all go away.
But we do successfully treat cancer in many people, and prolong life in many others.
Same analysis applies. Smaller tumours are easier to cure. Cure means eradicating every cell. That is why chemotherapy is given in cycles, to achieve fractional cell kill until there are no cells left to regrow.
Prolonging life in advanced incurable disease is important but it isn't getting us to where we want to be. Having advanced cancer is a state associated with immense suffering, as much psychological and spiritual as it is physical, even when things are under control. We can pat ourselves on the back for saying on average we have given this person an extra 6 months of life, but when you are administering these treatments or recieving them it does not feel like a win. Also, young people get cancer - eg the most common cause of non-accidental non-suicide death in women aged 25 - 40 is breast cancer. An extra year isn't enough for a woman with advanced breast cancer in that phase of life, especially as it is spent running back and forth from hospital and in various states of ill health either from the disease or treatment side-effects. Almost all of them would rather be alive and having the treatment of course, but taking a step back, I feel very strongly that we need to do better than this and we need to offer more than this, and what is the best of all is if as few people as possible ever meet an Oncologist. It's important not to lose sight of that.
The other point I was making is that successful cancer treatment is difficult and expensive, and if you are mentally ill or poor or homeless or in the wrong country or in a warzone etc then you will miss out.
> Having advanced cancer is a state associated with immense suffering, as much psychological and spiritual as it is physical, even when things are under control.
That is certainly not the experience of a great many people whose lives are prolonged. Many experience lots of healthy, productive years that they woulnd't get otherwise.
I'm not sure we are talking about the same thing, or what your conception of advanced cancer is. There are relatively few people with advanced cancer who could be considered healthy or would consider themselves that way. This is what I see in front of me with my own eyes every day. Of course they would rather have the time, or any time, than not.
You can chose an example of a slow growing low volume malignancy like a neuroendocrine tumour, but that isn't representative of the majority by any means.
But we do successfully treat cancer in many people, and prolong life in many others.