Biography of Cancer

Finished reading the book "Emperor of All Maladies: A Biography of Cancer". Written by Siddhartha Mukherjee, this book won the 2011 Pulitzer prize. In detail, it discusses the Chronology of Cancer - how different kinds of cancers were detected and how different kinds of treatments have evolved over the last 500 years, and in the end... it shows how vulnerable and helpless human beings are in front of this disease. Usually, reading Chronology of anything is a boring task. But, Siddhartha Mukherjee has written it so vividly that it is an informative and interesting journey through a terrain which is absolutely hostile towards us.

After pre-degree, there were only two choices in front of me - either become a Doctor or an Engineer. The guideline was... "learn biology to become a doctor or learn mathematics to become an engineer". Earlier in school, at first Biology was an interesting subject, but the stupid requirements to draw different body parts (cells, heart etc.) as part of examinations killed my interest since I was that bad in drawing. With the help of "Jananardhanan Pillais" books, cruising through the mathematical landscape was much easier. Even though ended up as an Engineer, various kinds of health issues and the fight to survive them, have increased the curiosity to know more about the human body and various kinds of treatments in the world. This particular book has taken that curiosity to another level. Hope it continues like that.

Even though, I keep a "radar like" eye/ear to all kinds of treatments to all kinds of diseases, Cancer was something to which I had paid less attention. But, it changed from the beginning of this year (2019), when my mother was diagnosed with Cancer. Now, after reading this book, it looks like all of us are potential targets for this disease and it is better to have an early awareness to try to dodge the bullet.

How does Cancer happen?

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Since this book is a Chronology of Cancer, the earliest detection of Cancer reported was long way back in 2500 BC in Egypt - "Breast Cancer with no treatment". At that time, the disease was not named "Cancer".

What is Cancer? In simple terms, it is uncontrolled growth of cells. At this point, after some 500 years of research/experimentation, cancer is found to be caused by "gene mutations". The different traits of a living thing is decided by the one of the lowest building blocks called "genes" found in our cells. As part of living thing's growth, cells multiply and when cells multiply the genetic information is copied from parent cell to children cells. Sometimes, the genetic information in the cell gets corrupted or modified permanently (which is called gene mutation), and from that point onwards the corrupted genetic information will be copied to future cells. There seems to be mainly 3 reasons for gene mutation - exposure to carcinogens, "copying error" by cells, and viruses.

Carnicogens - asbestos, chemical dyes, cigarette smoke etc.

Copying Error - when cells multiply they copy the genetic information to children cells, errors happen in copying the "genetic information". It happens in everyone.

Viruses - even though Cancer is not considered to be caused by Viruses, viruses also cause gene mutations. (It is a little complicated process)

Just one mutation (or just one corruption which gets copied to so many cells) may not cause cancer. Multiple mutations are needed to cause cancer. It is found that Colon/Lung/Brain cancers happen after 100-150 mutations, while Leukemia (blood cancer) happens after 10-15 mutations.

If Brain cancer is caused after 150 mutations, it was all good even after 149 mutations happened... but what causes the 150th mutation to cause cancer? What caused "Uncontrolled growth of cells" after 150th mutation? An analogy is to the working of an automobile... A car has an accelerator and brake. Both of them control the speed at which the car runs. Accelerator increases the speed and brake reduces the speed. Similarly, for cell multiplication also there are accelerators and brakes. Some genes work as the accelerator to control the cell multiplication while some other genes work as the brake to control the cell multiplication. After certain number of mutations (e.g. after 150th mutation for brain caner), the gene which works as the accelerator or or the gene that works as the brake, gets mutated or corrupted and the cell loses it control on multiplication. From that point onwards, that cell and its copies keep on multiplying without control, leading to cancer.

Of all the mutations that needs to be happened to cause cancer (e.g. 150 mutations for cancer), some of them may be caused by carcinogens, others may be caused by "cell copying error" or viruses.

How does Cancer Happen? (before Genetic Mutation explanation)

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Even though current theory on Genetic Mutation seems to be very convincing, previously Cancer was considered to be caused by other reason as follows...

- Long ago, when there were no explanation, Cancer (like any other disease) was considered to be due to the Curse of God, witchcraft, bad deeds in the previous birth etc.

- Later, it was considered to be due to "Black Bile"... This Black Bile theory was a continuation of how Hippocrates considered body to be. As per Hippocrates, human body was composed of four cardinal fluids (with distinct color) called humors: blood, black bile, yellow bile and phlegm. In AD 160, a Greek Doctor named Claudius Galen, classified all illnesses in excess of various fluids. Inflammation (usually red, hot painful distension due to abundance of blood), tubercle (cool white colored due to abundance of phlegm), jaundice (yellow due to yellow bile) and Cancer (black in color due to some "Black Bile" in the body). This "Black Bile" was proved to be wrong only during the AD 1500 timeframe.

[Note: In the current world, as per the western medicine, human body's health is monitored/assessed by many minute lower level details like - cholestrol, glucose, vitamin-D, creatinine etc. Ayurveda considers body's heath issues to be caused by an imbalance of Vata, Pitha, Kapha. Acupressure/Acupuncture considers body's health issues to be due to an imbalance in the flow of life energy through various meridians in the body etc. In other words, different medicine systems view the body differently to cure diseases]

- For quite long time, all Cancers were considered to be caused by Viruses. Since Viruses spread very quickly, Cancer patients were isolated from rest of the people. It all started when a Chicken Virologist named Peyton Rous proposed the idea that, Cancer is caused by viruses. A quite long period of time (I guess about 50-70 years), a lot of people spent an enormous amount of money to find out the viruses that caused Cancer. They could not find viruses that cause cancer. But, as of now, a few cancers are found to be caused by viruses (e.g. Liver cancer, Cervical Cancer etc.).

[Note: Even though western medicine and science has brought a lot of progress and innovation, even now some of the fundamental theories might be based on some foolish theories like the "Bile Theory". Future generations will know the truth. So, people who gives too much importance to western medicine thinking it is the most modern and correct solution to various diseases, needs to rethink]

Cancer Treatments

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The book talks about how different Cancer treatments have evolved over time. First and foremost... most of them are found by just trial and error... some of the treatments works for certain types of Cancer.

The following are the different kinds of treatments..

- Chemotherapy

- Radiation

- Surgery

- Hormonal Balancing medicines

- Bone Marrow transplant

- Genetic Medicines

- Immunotherapy (not discussed in the book, but discussed in the 6 hour video based on the book)

Chemotherapy: In Chemotherapy, various toxic chemicals (in other words poison) is injected to the body to kill Cancer cells. For some cancers, some of these medicines will be effective. But, the chemicals cannot distinguish between good body cells and the cancer cells. So, the good body cells also will get destroyed in the process, causing a lot of issues to the patient.. Basically, immunity system fails completely (based on the intensity of Chemotherapy) and patient is vulnerable to diseases. Book discusses in detail about the various brutal trial & error experiments conducted in different parts of the world (USA and Europe mainly). The experiments progressed to a point where 4 or 6 chemicals are tried together on patients, which was later found to be unnecessary. I think, nowadays these chemicals are used more cautiously in a limited manner.

Radiation: Radiation is the treatment where special rays (X-Ray) are applied to tumors to burn them. It is effective for cancers localized to a certain region of the body.

Surgery: For almost 90 years, surgery was considered to be the "solution" for cancer, especially breast cancer (radical mastectomy). Initially, only breast was removed.. but cancer relapsed soon. So, Doctors cut more and more muscles/tissues under the breast, towards the shoulder etc... with the theory that "cancer spreads from a center point towards others in a circular fashion. Even though there was some success for some people, cancer relapsed for a lot of people. These "surgery" supporting Doctors were like a cult and anyone questioning "surgical methods" were ridiculed and isolated. It took about 90 years to prove that "radical mastectomy" (or cutting a lot in the breast or surrounding tissues/muscles) is unnecessary for many cases of breast cancers and only minor breast surgeries are needed for many women and if the cancer has spread all around the body there is no point in doing surgery.

[Note: To a few friends of mine, many times I have engaged in a religion vs. science discussion. General opinion of those friends are... religion is bad for society, religious people act like cults, religion causes narrow mindedness. While reading this book, I could easily find that people who preach science are not free from the above... Doctors who supported surgery were acting like a group of fanatics against those who challenged surgery]

Hormone Medicines: For some breast cancer patients, the hormone estrogen was the reason for cancer. (but not the reason for all breast cancer patients). To such patients, estrogen reducing medicines were given and they were found to be effective. I think similar theory applies to some prostate cancers in men (testosterone sensitivity)

Bone Marrow Transplant: The blood is produced in the bone marrow (or inside the bone). For children, most of the bones will be having bone marrow. But, in adults, bone marrow is produced primarily in specific bones (e.g. rib bone, vertebrae, bones of the pelvis etc.). For some Leukemia (blood cancer) patients, replacing the bone marrow seems to work for some patients. I learned that there are two kinds of bone marrow transplants - autologous bone marrow transplant and allogeneic bone marrow transplant. In allogeneic bone marrow transplant, bone marrow is taken from another person to replace patient's bone marrow. In autologous bone marrow transplant, patient's own bone marrow is collected/preserved and later transplanted back (this is used in situations where extreme Chemotherapy is used to kill all blood cells... a complete wipe out of red/white blood cells and even bone marrow... Before doing that, bone marrow is collected and preserved. After Chemotherapy, preserved bone marrow is transplanted back to the patient)

Genetic Medicines: With the modern understanding of genetic mutation causing cancer, medicines are created to correct or modify the corrupt genetic sequences. These medicines are effective for some kinds of cancers. Hope, more effective medicines will be available for cancer.

Immunotherapy: Looks like our immune system is not able to detect and kill cancel cells. So, idea of this treatment is to activate our immunity to fight the cancer.

In USA over the last 40 years, public awareness on the causes of cancer ("exposure to carcinogens") has helped to reduce the rates of some cancers. For example, with constant awareness of the dangers of cigarette smoking, lung caner rate had been brought down. But, the book talks in details about how cigarette companies were able to advertise, mislead and push their cigarettes to the public for more than 50 years till 1970s. When they were pushed against, cigarette companies went out of USA to other countries to advertise, mislead and sell their products. At one stage, researchers/doctors were gaining upper hand to prove cigarette smoking was causing lung cancer. To counter them, cigarette companies also started supporting the research with their own man heading all the efforts, who can influence how the research results are informed to the public.

[Note: Pay attention to what is marketed most in the society. What we consume is not based on "how those things make our lives better"... it is based on how "we make the big corporations profitable". Initially, coconut oil was considered to be bad for health.. now in USA coconut oil is being marketed and sold as a very healthy oil. Do your own research and thinking to decide whether to consume those products. Examples are oats, quinoa etc.]

For the other reason for cancer, "viruses", vaccines are developed and they are helpful if cancer was diagnosed very early.

I guess one of the main research nowadays is to find out why the "cell copying errors" happen..

[11122019]