My mother was diagnosed with endometrial cancer at the start of 2020. If you haven’t known someone diagnosed with cancer recently, it might not be obvious how advanced cancer treatment and care is now. You see so many stories about new cancer treatments or prevention strategies all the time, and it’s so easy to discount it as just more spam, but we’re getting extremely good at making people better, even in comparison to as recently as a decade ago. Not perfect, but the trajectory is very steep.
(Disclaimer, I’m not an expert, I was just pretty amazed by how the whole process was customized and targeted for her specific case.)
I’m sure this isn’t a catch-all, and it’s bad to put hope in “one thing to solve it all”, but this sure is exciting.
My uncle (<60, healthy) was diagnosed with pancreatic cancer. Although they used extremely expensive wonder drugs, personalized drugs targeting his cancer cells etc, they were completely ineffective and he died less than 11 months after the diagnosis. He was extremely healthy and athletic at the beginning of 2022, and looked basically like a skeleton by the end of it. Cancer is a terrible disease and although we made incredible, awe-inspiring amount of process, we still have some way to go. Of course, I understand that pancreatic cancer is a particularly nasty cancer, one of the worst.
I lost my dad to prostate cancer last year with much the same timeline. Healthy as could be, out surfing and building decks and shit one day, dead a year later.
Really sorry for your loss. My dad died of cancer about 20 years ago when I was pretty young. It has gotten easier over the years, but still, sometimes it feels like grief punches me in the sternum. Wishing you the best.
Sorry to hear that. I had an uncle die from lung cancer (smoker, but otherwise healthy) about a decade ago. I know how horrifying the process is. Hope you have been able to process your grief.
Yep. Even with "old drugs" the new programs using those give significantly better chances than with the old programs. Year of data collecting sure have given results.
I had testicular cancer in 2006 in Chile. I was a teenager so I went with the public system (AUGE back then). My parents friends were giving the condolences for my soon to occur death. The doctors had a laugh as in the last 10 years (by then) my chances of dying of it became basically nil.
Last year we hired a new guy at $JOB that 1 week after being hired was diagnosed with testicular cancer too. He really thought he was gonna die. He was at stage 4 (which is a highly zone specific metric). Last time I saw him he is still coding and more bald. It was more difficult to sort payments than the treatment as he is in the US.
Most testicular cancer is now reliably curable by harsh but effective chemotherapy. Mission accomplished? Not quite. Curative drugs such as cisplatin are scarce. Their patents are long-expired, so they're less profitable to manufacture, so manufacturers don't manufacture them. Hooray for the free market.
Some cancer treatments have advanced a lot. Some are still using the same old drugs. Mother with StageIIIc ovarian in 2019 resection, HIPEC, then chemo. Recurrence in 2020 and every 6-9mo after that with some areas appearing, others shrinking. Platinum resistant in 2022 (many many many different times combined with taxol, doxil, etc). Taxol alone not working now as she had a spread event. Doxil + Avastin is now being tried (again but without platinum). Probably out of options sooner or later even though she can physically handle more chemo. Avastin is pretty much the only advance for this cancer and it's not very good. She's been on it on and off several times with the other chemo drugs. Of course all this depends on the mutations and such. Hers aren't ones anything new if it exists works for. This is a major research hospital with distinguished specialists.
Different diseases. Not every colon cancer, for example, behaves the same. And if colon cancer spreads to the lungs, it's still colon cancer, not lung cancer.
There are different cell types in the colon, and I would expect a colony of each cell type to behave differently.
Cancer is like a bacterial infection, but with cells from the host. Of course if your lung has an infection of colon cells those don’t suddenly become lung cells.
I don’t see how that makes it different diseases. It is only treated that way because we aren’t attacking the root cause (i.e. the actual broken replication inhibitor in whatever line of cells).
Figure 2 shows the different mutations present in cells in a variety of cancers carry. These genes have a variety of functions. The DNA of cancer cells from different tumor types is different, and TP53, the gene featured in OP, is never mutated in some cancer types. In the end the discussion is a little semantic (what defines a different disease), but if the prognosis, treatment, and molecular mechanisms behind different types of cancers are different, I would consider it fair to consider them different diseases.
By my honestly shallow understanding of cancer it's not that simple.
For the cancer to not get killed immediately several things have to get broken, not just the replication inhibitor. Once they get to that state is not far fetched to think that they can have or get in the future different mutations, not specifically required to get cancer in the first place.
The comments below us talk about the folate receptor mutation that not all cancers have.
Sure but aren’t the other mutations incidental, in the sense that if we repaired the replication inhibitor the cancer would be cured in all cases? Perhaps there are even different types of replication inhibitors in different cell types, which would add complexity, but fundamentally it’s all still the same class of problem.
Do you know if she has been treated with the new antibody drug conjugate (ADC) technology? Here is an example: https://www.elahere.com/
I am not a physician but I work in the space.
> You see so many stories about new cancer treatments or prevention strategies all the time, and it’s so easy to discount it as just more spam, but we’re getting extremely good at making people better, even in comparison to as recently as a decade ago.
IF we catch the cancer early, we are much better at treatments.
What we are getting good at is treatment with early detection because we can just cut it out with surgery. What we are only marginally better at is treatment with late detection.
For cancers that we don't have early detection, the success rates are far, far lower and the treatments are far more limited.
For example, a significant fraction of women get diagnose with lobular breast cancer--it doesn't form lumps. So by the time you detect it, you are almost always already Stage 3 or worse.
Radiation, in particular, is much better thanks to computing. The only advance in surgery I have seen since the 1970s is that they use a radioctive marker to trace where the lymph nodes are--it helps with lympedema but not the cancer. Chemotherapy is only marginally better than 20 years ago--they're a little better at managing side effects but chemo is still horrible.
Medicine does well on things that can be fixed by physical means--cutting things out or sewing things together. Medicine still doesn't do all that well from a chemical standpoint.
This really hits the nail on the head, so many people miss this.
Didn't realize myself until I was diagnosed with a sarcoma (1% of adult cancer diagnoses), MPNST (a single digit percentage of sarcomas).
Doctors scrambled to figure out what to do - first we should just cut it out, then, well maybe we should do chemo + radiation. A day before getting a port put in receive a phone call that "oops, chemo doesn't work, just cut it out and radiation afterwards."
Luckily I was in a good position to get multiple opinions and read the data myself.
Almost 2 years cancer free now and am so grateful, but looking at the data, it's all seems like a toss up unless you can just cut it out with clean margins.
I really can't help but think modern medicine is really missing the mark with the reactionary approach to disease in general, but of course I have no clue what to do about it.
> I really can't help but think modern medicine is really missing the mark with the reactionary approach to disease in general, but of course I have no clue what to do about it.
There are two hard problems here:
1) Medicine doesn't always have anything good to actually do
As you point out, there was nothing other than cut it out and do radiation for your case. Those are very physical processes. Chemical processes that either do something directly to problematic cells or cause the body to do something to problematic cells are very lacking. We don't have very many knobs that do something to diseased cells that don't also do horrible things to the patient.
2) The source of being "reactionary" is that statistically rare diseases show up as false positives way more often than real positives without some Bayesian prior.
Medical testing is a balance between causing too much harm in testing and not enough detection.
Lobular breast cancer only shows up on MRI. So, women should get an MRI with their mammogram, right? Well, except that the MRI requires a gadolinium contrast which bioaccumulates. And you needed an IV for the contrast which can get infected. And, you will find a lump of something with a modern MRI. Now what? You really should leave it alone and watch it, but some women will be unable to deal with the anxiety so you will need to biopsy it. Biopsies have their own problems. etc.
She’s doing better, only about a year off treatment currently. It was originally found at stage 3 but it seems that surgery + 2 radiation rounds + 2 chemo rounds has worked alright.
My mother-in-law passed away in 2007 within just a few months of her diagnosis, whereas today I suspect that same melanoma today would likely be entirely treatable. My father-in-law passed in 2015 from leukemia, and while I suspect things have improved, my understanding is that treatment outcomes are better for younger patients. Another extended family member was able to fight lung cancer for more than a decade. While we will likely never have a "cure" and from one type to the next the treatments and outcomes vary, I'd certainly agree that it's clear we are making big strides.
Cancer outcomes in Canada are approximately the same as in the US. Give or take. Some are better in Canada, some better in the US.
> Conclusions: Among younger Canadian cancer patients in the lowest SES group, greater access to health care may have resulted in higher cancer survival, while higher screening prevalence and access to health insurance (Medicare) among older Americans during the period of this study may have resulted in higher survival for some screen-detected cancers. Higher survival in the highest SES group for stomach and liver may relate to treatment differences. [1]
This study breaks it down by type, and socioeconomic status too, if you're curious.
This is just one more recent study, but there's a lot of evidence to support this.
[edit] Note that 5-year survival rate comparisons tend to benefit the US because the US does more aggressive testing. Studies show that this testing often doesn't actually reduce mortality, but it does start the 5-year survival clock earlier. So odds are this data overstates the outcomes in the US, particularly in the older demographic as the conclusion calls out. But that's a conversation for another time.
For liver cancer it's about 15% higher in Canada for all SES, 10% higher for cervical cancers - and for all childhood cancers it's 5-10% higher in Canada depending on SES.
For prostate cancer specifically, that's likely due to higher screening rate guidelines in the US leading to earlier detection, not lower mortality. Prostate cancer comes up a lot because it's often used as a stalking horse, and it's generally a disease of the elderly. [1]
Specifically it came up in re: Guiliani and the UK:
> For one thing, according to the American Cancer Society, many more men are screened for prostate cancer in the U.S. than in Britain. This leads to more cases being diagnosed. And many who have prostate cancer live for years, without treatment, whether they are diagnosed or not. Thus, a higher number of diagnoses leads to a higher official survival rate. But this tells us nothing about the quality of treatment available to those who have the disease. A spokesman for the ACS told us that comparing rates in the two countries is “misleading.”
There have been evaluations of this between the US and Canada [2]
> US and Canadian differences in screening due to guidelines can potentially explain cross-country differences in breast cancer mortality and affect interpretation of international comparisons of cancer statistics.
The outcomes really are very comparable in the two systems, despite them trading top spots in different categories.
It really helped me appreciate how we went from treating people with anything that'd kill their cells to highly specific drugs that target genetic pathways.
My cancer has a mutation that is uncommon in lung cancers (< 2%), but common in breast cancers (> 25%). All of the treatments for my mutation are breast cancer treatments. It has been alternately not too bad and hellish getting insurance to agree to give me medications that could be saving my life. That plus a previous steroid-treated pneumonitis disqualifies me from about 90% of clinical trials, so the tip-of-the-spear treatments (CRISPR-T, CRISPR-NK) are unavailable to me.
So yes, lots of advancements are being made...in common cancers. Uncommon cancers, we have to wait and take the older stuff, or stuff that's just been approved.
And even through all of that, it's a crap shoot as to whether it will work or not. I took 2 conjugates, in the same class of medication - each had a slightly different chemo med. One worked fabulously, about halved the size of my main tumor. The other did nothing, and ended up giving me neuropathy in my feet (it can be numbness, but in my case it felt like my feet were on fire, 24/7. I am on a medication now to fix that, and my feet feel totally normal). Fun fact - the neuropathy chances for that med were stated as 0%. I guess someone rounded down from 0.1%, because I got it.
Sadly cancer is a fact of life for a multicellular organism as you age.
But elephants don't ever get cancer as they more than 20 p53 (DNA repair) genes compared to our single one.
> If we can screen for cancer earlier we will save a huge number of lives (and prevent a lot of pain and misery).
It's not clear.
The last time I looked at these data (about a decade ago), we were catching more cancers than ever and people were living longer. But really we were screening earlier so time from detection->death was longer.
Some of these cancers didn't matter. The studies I refer to above were for breast cancer. In the case of prostate cancer, most men have it when they get old. It develops slowly and most patients "die with it but not of it", i.e. it had nothing to do with their death. For those cases intervention is unnecessary pain and misery. And indeed, I believe the treatment regime in the US is now "watchful waiting" with rare intervention.
There has been a revolution (several, actually) in cancer treatment over the past decade and the prognoses for several are much more promising. So this comment is specifically about your general hypothesis, not to criticise your aim in commenting with it.
(Disclaimer, I’m not an expert, I was just pretty amazed by how the whole process was customized and targeted for her specific case.)
I’m sure this isn’t a catch-all, and it’s bad to put hope in “one thing to solve it all”, but this sure is exciting.