Cancer: Mainstream and Alternative Therapies

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Trying to be measured and not dismissive, I take a look at the origins of cancer, and mainstream & alternative therapies.

Contents

  1. 1. Origins and Related Material
  2. 2. Origins and Motivations
  3. 3. Causes of Cancer
  4. 4. Viruses and Cancer
  5. 5. Fail-safe Mechanisms
  6. 6. Further Cancer Developments : Angeogenesis, Containment and Metastisis
  7. 7. Benign vs. Malignant Cancers
  8. 8. Types of Cancer
  9. 9. The Immune System
  10. 10. Carcinogens, Cancer's Origins and Other Views from the CISS
  11. 11. Mainstream Medicine: Problematic?
  12. 12. Attitude and Survival
  13. 13. The Objectives and Outcomes of Cancer Treatment
  14. 14. Conclusion


Origins and Related Material

This article was the basis for a pair of segments for the Diffusion radio program, broadcast in 2009 and 2010, and a talk I gave to the Sydney Skepticamp, but has not been previously published in its own right.
See below for links to the radio segments, which appeared on Diffusion Science Radio:

Part One
Part Two

Here's a link to the talk I gave on Cancer at a previous Sydney Skepticamp

There was a Q&A session. It included a a personal attack from Dr. Rachie - well, what else do you call comments like "that's bullshit actually" and "the only accurate thing you said was admitting you could be wrong". It illustrates the difference between the Skeptic propaganda and the reality. A past member of the NSW Skeptics committee said that Dr. Rachie's attack was "un-called for".

If you watch carefully, you can see the moment when she changes from being agressive to patronising

After the talk, Dr. Rachie and myself had a twitter exchange; I suggested she listen to the radio piece above. At a talk I gave a year later, she feigned ignorance about my radio piece, inviting me to write to her telling her the link. Sorry, no - I did that already. No, Dr. Rachie, it doesn't wash. ... Maybe I'll comment more on this conflict another time, but for the moment I'll continue with the article. Perhaps I sound defensive, but if you'd been at the receiving end of Dr. Rachie's venom, you would be too.


Origins and Motivations

I've had a longtime interest in three major institutions which tower above us : law, education - and health. They are occupied by elites who speak an imposing jargon and occupy an important place in society.

I'm interested in several biological and medical issues. I wonder about the origins of life. I wonder how human beings can vary so that 1 in a 1,000 people will have an allergic reaction to something, while others will not. I'm intrigued that some people can be carriers for a disease - and not suffer from it, but pass it on. You wonder - what is the immune system doing when this is happening?

I'm also interested in cancer. We know a lot about how the body works. But in order that it work, there must be ways for it to go wrong. And those openings - those processes - the mechanisms behind cancer - are things I find fascinating. It is a controversial field - all the more so because it is a matter of life and death, and because different people engage with it in different ways. We have the high priests who are the ones who consult the entrails - and the rest of us, who are encouraged to stand back.

I've had my mother die of cancer, along with my uncle and natural father. I found out, at a very tangible level, what cancer is all about. Statistically, it's likely it has me in its sights.

There's cancer in the south of France
Cancer lurks in Rome.
Cancer circles the whole wide globe,
until it finds you home.

TISM, or This is Serious Mum. In 2008, their guitarist James Paull (Tokin' Blackman) died of cancer

Years ago, I was talking to Professor Peter Doherty, immunologist and Nobel Prize laureate, who mentioned that a Canadian researcher was looking at links between the mind and cancer. A nurse I knew spoke of how cancer patients with fewer "issues" were more likely to survive longer. In fact, she was sympathetic to groups promoting alternative therapies, like the "Cancer Information and Support Society" (CISS). The stage was set. I thought I'd take a good look at the range of views, trying not to dismiss alternate views, but also talking to mainstream cancer researchers as well.

If you have cancer or someone you know has it, please do your own research and review for yourself the warnings about alternative therapies. Even given all the concerns I have about the institutions which tower above us, such therapies can seriously mess you up. This article is not medical advice, but I hope it's interesting regardless.


Causes of Cancer

Cancer is run-away cell growth resulting from several mutations, first causing unrestrained growth, and then bypassing the cell's "self destruct" mechanisms which would otherwise cut in. Blood vessels are drawn into the tumour to provide nutrients. Lastly, it needs to invade other tissue and grow past physical restraints, possibly budding (or "metastasising").

Cancer cells are not necessarily dividing faster than cells which are meant to - they're just doing it regardless. The basal layer behind the skin is a single cell layer of continuously dividing cells which provides the growing skin layer. These cells continuously divide because in their location chemical signals prompt it. It's a problem if cells which are not in this single layer divide at the same rate - you have at least the start of a cancer.

"Proto-oncogenes" promote cell growth, and "tumour suppression genes" discourage cell growth or temporarily halt it in order to carry out DNA repair. Copying errors or "mutations" which take place during DNA strand duplication distort the balance between these two genes. Left to themselves, cells normally identify and correct errors. They usually have two copies of each gene, and can correct errors from the intact copy. However, when cells are dividing rapidly, they have less opportunity to correct errors, and are more susceptible to cancer. It's not just the total number of divisions, but rather the rate of division.

Also significant are "epimutations" which change the cell's idea of its "specialisation" without changing the DNA sequence as such. Cells start out as stem cells, but along the way, metaphorical "switches are set" so that a cell which specialises into a skin cell divides into more skin cells rather than, say, turning into a liver cell. This is stored as additional methyl (-CH3) groups attached to the DNA molecule. These methyl groups stop specific proteins from being synthesised, setting the cell "type" During the embryo's initial growth, different cells develop different methyl groups on their DNA molecules, and the molecules together with their methyl groups are duplicated from that point onwards. ( The DNA can also coil around histone proteins, making the DNA inactive).

Such "epimutations" mean that the cell is much more willing to reproduce, though there may be further hurdles - cells dividing in the embryo are controlled by chemical signals, and other DNA coding sequence mutations may be necessary for uncontrolled division.


Viruses and Cancer

Some viruses can cause cancers. It's not deliberate, but rather in taking over the cell, they disable "fail safe" mechanisms, increasing the chance of cancer from the cell's own mutations. It's why we have vaccines against viruses which cause cervical cancers.


Fail-safe Mechanisms

Most cells have a limited number of telomere chains, losing one per division. This stops continued division - unless the cell can generate telomerase, which rebuilds the chain. However, as noted, some cells are meant to divide continuously; continuous division when they are not supposed to makes for cancer - the telomere barrier will be irrelevant.

Cells have a self destruct mechanism, apoptosis, which can be triggered if the cell is too badly damaged to repair. But this mechanism may not trigger, particularly if the genes behind this mechanism have themselves been corrupted.


Further Cancer Developments : Angeogenesis, Containment and Metastisis

Angeogenesis is the growth of blood vessels into the tumor, and involves the cell generating hormones to prompt this growth.

One stage towards malignancy is the ability of the cells to "get past" the surrounding cells - which may involve secreting proteins to soften structures between the cells, similar to how a placenta attaches itself to the wall of the uterus.

The final stage towards malignancy is often an ability to bud and travel through the blood or lymph streams to another location, so giving rise to other cancers.


Benign vs. Malignant Cancers

A tumor with many of the above features may still be benign because it is physically constrained by surrounding cells. Such a tumor may persist for years, only causing problems when it presses against a vital organ or blood vessel.

We need between 4 and 6 mutations in total, culminating with the final mutation of a single cell, with a possible gap of 20 years between the first and last mutations.


Types of Cancer

Cancers are divided into three general types : carcinomas, sarcomas and others. Carcinomas derive from "epithelial cells". Broadly speaking, such cells cover "surfaces" - the skin, the respiratory tract and gut, and line glands like the breast, pancreas and thyroid.

Sarcomas derive from connective and structural tissue, such as bone cells, blood vessels, fibrous tissues and muscle.

In the last category, we have several cancers : lymphomas and leukaemias are derived from blood and bone marrow cells; mesotheliomas derive from the cells lining the abdominal cavity and the lung cavity; gliomas derive from the glia, the most common type of brain cell after the neurons themselves; germinomas : derive from germ cells (or reproductive cells), including the teratomas, ovarian or testicular cancers; and


The Immune System

For the immune system to identify the cancer, it has to be recognised as foreign - this isn't easy, as the cancer cell was originally a body cell, and may not look any different. For the most part, either the immune system can see the cancer or it cannot. There are exceptions - AIDS disrupts the immune system enough that Kaposi's Sarcoma develops, and melanoma's advance does seem linked to the immune system.


Carcinogens, Cancer's Origins and Other Views from the CISS

Carcinogens cause mutations; they don't affect the immune system, one example being smoking. The CISS see lung cancer's association with smoking resulting from a predisposition; it started in the lungs, but it would have developed somewhere anyway. The "immune system" and personal health are claimed to be more important than our chemical environment or genes. However Professor Bruce Armstrong of Royal Prince Alfred Hospital sees an increase in total cancers and lung cancer with increased smoking. Older people have more cancers because of accumulated mutations - and children born with immature immune systems do not develop cancers. Mainstream medicine focuses on "risk factors", including exposure to carcinogens and lifestyle. Dr. Andrew Penman of the NSW Cancer Council, says diet and exercise can reduce the initiation and/or development of cancers by perhaps as much as 10% - not a "cure", but rather one factor in the mix.

The CISS seem to have missed the mark. They seem genuine - showing the bruises of being ignored and perhaps actively sidelined by mainstream medicine. Understandable. Still, there's other problems with their views.


Mainstream Medicine: Problematic?

The CISS claim mainstream medicine is "blinkered", seeped in jargon and beholden to money. Still, jargon can help professionals communicate - though it might also mark out an elite.

For mainstream medicine to analyse something, it has to be "on the radar". Decisions about what gets analysed are to some degree outside of the scientific method itself, and new ideas can be strongly resisted. We know about the discovery that bacteria cause stomach ulcers - which was rejected by the mainstream for quite some time. And this was in fact a credentialed mainstream researcher. If this was the consideration given to a mainstream researcher with a worthwhile idea, how would science treat a dissident voice ? The potential for problems is clear and apparent.

While money has an influence, there's also competition; a new discovery could provide a profitable niche. Big money may reinforce the status quo; but small money will look for opportunities. Not all money is the same.

Mainstream medicine does in fact endorse alternative therapies like meditation as complementary. It is said to help with coping, but not necessarily survival.


Attitude and Survival

Many workers have seen a connection between attitude and survival, reinforced by a few studies. In Canada, Dr. Cunningham and his team at the Princes Margaret Hospital have found evidence that psychological therapy can improve survival. However, it's rare, and does not show up in normal statistical analyses. It's like looking at how a chancy training technique improves people's ability to punch. You won't see much change to the average if it's rare. It will be more apparent if you instead look at people punching above their weight.

Patients were assessed for their expected survival. Researchers then looked at their ability to develop an "authentic" personality through therapy; in some cases this led to improved survival. Some cancers, however, were just too aggressive, and unfortunately it didn't matter what you did.

It seems that cancer's progress is related to changes in the body. Hormones are also significant. Overweight women have worse breast cancer because of the hormone oestrogen, which has also been linked to exposure to light at night causing cancer.

"Stress" compromises the immune system and changes the hormone distribution. But if you're particularly calm, your even lower stress level may prompt additional healing. The body also needs less repair and growth - which the cancer can't benefit from.

This complements conventional therapy, which the CISS disagree with, not to mention their incorrect view of the immune system. They might have increased mortality by scaring people away from conventional treatment. But equally - it is just possible their approaches may have - through an ad hoc approach - acted to reduce stress and have helped to cure some patients.


The Objectives and Outcomes of Cancer Treatment

The CISS criticise conventional treatments for not making the patient "as good as new". But the objective is improvement, not perfect renewal. They also criticise mortality improvements for being sometimes small - but the goal is often to improve the quality of life, not survival. They also claim that breast cancer patients have long term mortality twice healthy women of the same age. But cancer patients are different to "healthy women" in genetic predispositions and lifestyle.

If a cancer recurs after ten years, is this a new cancer or the old one ? The CISS claim the new cancer is a result of the underlying disease, while mainstream medicine considers it a new random mutation, perhaps more likely because of risk factors which prompted the original cancer.

Mortality being higher even after the cancer is cured does suggest persistent residual factors which increase mortality. Perhaps there are pre-cancerous cells which are "just one mutation" away from being cancer. Some increased mortality might result from treatment being an assault on the body which weakens the patient. Regardless, "continuing risk factors" seems as good an explanation as "a continuing systemic illness".


Conclusion

Some will criticise cancer treatment as ineffective. It is in some cases, but the failings do not make the successes mean nothing. It does not mean the promise of cancer treatment has been betrayed. Mainstream therapy can be criticised - but also praised.