5 ms·

This is just my opinion, but cancer is my day job. Treating, let alone curing, advanced cancer is very difficult. Just look at the numbers - a human has about

by Gatsky 5y ago

This is just my opinion, but cancer is my day job. Treating, let alone curing, advanced cancer is very difficult. Just look at the numbers - a human has about 6 trillion nucleated cells. 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. Yes, there are some patients who have favourable disease biology who are otherwise healthy, not too old, relatively wealthy and have access to incredibly sophisticated and expensive cancer care who can be cured from advanced cancer. But this number is very small compared to the deaths, especially for the common cancers (Breast, Prostate, Colon). And there is no general strategy to extend these occasional wins/miracles to everybody. We can't wait to cure cancer one Nobel prize at a time. Furthermore, we are seeing large waves of ageing populations colliding with poorly resourced healthcare systems around the world, and these systems just can't deliver what one would call optimal cancer care which requires specialist surgeons, oncologists, nurses, radiologists, PET scanners, MRIs, sophisticated radiation equipment, supportive care and very, very expensive drugs. Unlike almost any other disease, cancers start from a single cell. The endgame has to be prevention. We should be preventing as much cancer as possible. And for most common cancers, we don't even understand why it happens with sufficient detail to think about how to prevent it. Detecting cancers earlier with tests like the one from Grail is a good thing to aim for, but trust me, being told you have cancer, and the inevitable surgery plus whatever else still sucks a lot even if the chances of cure are very good.

throw1234651234 5y ago
Is inflammation linked to cancer? Were there ever studies done on how eating sugar/stress (inflammation factors) contribute to cancer?
- Gatsky 5y ago
  Inflammation means many different things. There are specific cases of inflammation increasing the risk of cancer, for example inflammatory bowel disease like Ulcerative Colitis and colon cancer. At the moment, inflammation in otherwise healthy people is not well defined or characterised, so it is quite impossible to study it. On the other hand, some albeit very potent anti-inflammatory medication increases the risk of cancer (for example JAK2 inhibitors). Some conditions assocaited with chronic inflammation seem to be associated with less cancer (Familial Mediterranean Fever for example). As such I think inflammation is not the most useful concept. It is more a surrogate marker of some other undesirable behaviour related to lifestyle or diet for example, rather than a direct causative factor. Stress is similarly complicated and not well defined or easy to measure. There are different types of stress of course. It seems like moderate to severe stress isn't necessarily harmful, based on studies of I think it was Dutch women in WWII who were definitely stressed but not in Auschwitz or open combat. There is some poorly controlled data from concentration camps that extreme stress coupled with malnutrition and everything else that went on does result in more cancers, but this doesn't really help us today. Sugar is another complicated one. Any nutritional factor has different effects in different people. There is evidence that what sort of sugar you have, and even how you eat it matters (drinking sugars, especially fructose seems esepcially bad). Here it may be more relevant to consider the result of sugar intake, such as insulin resistance and high insulin levels.
  - throw1234651234 5y ago
    I really appreciate the detailed reply. Really helps to hear a professional opinion for someone who doesn't know much about the topic in any real sense.
wolverine876 5y ago
> 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.
- Gatsky 5y ago
  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.
  - wolverine876 5y ago
    > 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.

by Gatsky 5y ago

throw1234651234 5y ago

Is inflammation linked to cancer? Were there ever studies done on how eating sugar/stress (inflammation factors) contribute to cancer?

Gatsky 5y ago
Inflammation means many different things. There are specific cases of inflammation increasing the risk of cancer, for example inflammatory bowel disease like Ulcerative Colitis and colon cancer. At the moment, inflammation in otherwise healthy people is not well defined or characterised, so it is quite impossible to study it. On the other hand, some albeit very potent anti-inflammatory medication increases the risk of cancer (for example JAK2 inhibitors). Some conditions assocaited with chronic inflammation seem to be associated with less cancer (Familial Mediterranean Fever for example). As such I think inflammation is not the most useful concept. It is more a surrogate marker of some other undesirable behaviour related to lifestyle or diet for example, rather than a direct causative factor. Stress is similarly complicated and not well defined or easy to measure. There are different types of stress of course. It seems like moderate to severe stress isn't necessarily harmful, based on studies of I think it was Dutch women in WWII who were definitely stressed but not in Auschwitz or open combat. There is some poorly controlled data from concentration camps that extreme stress coupled with malnutrition and everything else that went on does result in more cancers, but this doesn't really help us today. Sugar is another complicated one. Any nutritional factor has different effects in different people. There is evidence that what sort of sugar you have, and even how you eat it matters (drinking sugars, especially fructose seems esepcially bad). Here it may be more relevant to consider the result of sugar intake, such as insulin resistance and high insulin levels.
- throw1234651234 5y ago
  I really appreciate the detailed reply. Really helps to hear a professional opinion for someone who doesn't know much about the topic in any real sense.

wolverine876 5y ago

> 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.

Gatsky 5y ago
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.
- wolverine876 5y ago
  > 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.