1: “One major reason why cancer is so deadly—and so scary—is that we still know relatively little about how it begins and why it spreads,” Dr. Peter Attia writes in his powerful book Outlive: The Science and Art of Longevity.
Cancer cells differ from normal cells in two critical ways.
First, “Contrary to popular belief,” Peter notes, “cancer cells don’t grow faster than their noncancerous counterparts; they just don’t stop growing when they are supposed to. For some reason, they stop listening to the body’s signals that tell them when to grow and when to stop growing.”
The second difference? Cancer cells can ” travel from one part of the body to a distant site where they should not be,” he writes. “This is called metastasis, and it is what enables a cancerous cell in the breast to spread to the lung.
“This spreading is what turns a cancer from a local, manageable problem to a fatal, systemic disease.”
Outside of these two factors is where the similarities of different types of cancer end.
Which is why one of the biggest challenges to “curing” cancer is that it is not a single, simple disease, but rather “a condition with mind-boggling complexity,” Peter observes.
The obstacles don’t stop there.
“Even when we treat a local cancer successfully,” he notes, “we can never be sure that it’s entirely gone. We have no way of knowing whether cancer cells may have already spread and are lurking in other organs, waiting to establish a foothold there.”
And it is cancer’s ability to spread, or “metastasise,” that is responsible for a majority of cancer deaths.
“If we want to reduce cancer mortality by a significant amount, we must do a better job of preventing, detecting, and treating metastatic cancers,” Peter writes. “With a few exceptions, such as glioblastoma or other aggressive brain tumors, as well as certain lung and liver cancers, solid organ tumors typically kill you only when they spread to other organs.”
Here is the reality: “Breast cancer kills only when it becomes metastatic. Prostate cancer kills only when it becomes metastatic,” he notes.
We “could live without either of those organs. So when we hear the sad story of someone dying from breast or prostate cancer, or even pancreatic or colon cancer, they died because the cancer spread to other more critical organs such as the brain, the lungs, the liver, the bones. When cancer reaches those places, survival rates drop precipitously.”
2: Why does cancer spread?
“We don’t really know,” Peter observes, “and we are unlikely to find out anytime soon because only about 5 to 8 percent of US cancer research funding goes to the study of metastasis.”
Where is the money being spent?
Treating cancer once it has spread, the point at which it has already become deadly.
“Once cancer has spread, the entire game changes: we need to treat it systemically rather than locally,” he notes.
“Right now, this usually means chemotherapy. Contrary to popular belief, killing cancer cells is actually pretty easy. I’ve got a dozen potential chemotherapy agents in my garage and under my kitchen sink. Their labels identify them as glass cleaner or drain openers, but they would easily kill cancer cells too.”
But these agents don’t just kill cancer cells. “These poisons will also slaughter every normal cell in between, likely killing the patient in the process,” Peter observes.
“The game is won by killing cancers while sparing the normal cells,” he notes.
“Traditional chemotherapy occupies a fuzzy region between poison and medicine; the mustard gas used as a weapon during World War I was a direct precursor to some of the earliest chemotherapy agents, some of which are still in use.”
The chemo drugs harm cancer cells that are rapidly dividing, but also other noncancerous cells that are also dividing quickly, like those in the lining of the mouth and gut, the hair follicles, and the nails.
“Which is why typical chemotherapy agents cause side effects like hair loss and gastrointestinal misery,” Peter asserts.
And that’s not all of it. Cancer cells that survive chemotherapy often come back even stronger, “like cockroaches that develop resistance to insecticides,” he observes.
In the beginning, the adverse effects of chemo seem like a fair trade for a “chance for a few more useful years,” as the late author Christopher Hitchens noted in his cancer memoir Mortality.
But as his treatments continued for metastatic esophageal cancer continued, he changed his mind. “I lay for days on end, trying in vain to postpone the moment when I would have to swallow. Every time I did swallow, a hellish tide of pain would flow up my throat, culminating in what felt like a mule kick in the small of my back…And then I had an unprompted rouge thought: If I had been told about all this in advance, would I have opted for this treatment?”
3: There is good news, however, on the horizon.
“Just because cancer is powerful does not mean it is invincible,” Peter notes.
In 2011, two leading cancer researchers named Douglas Hanahan and Robert Weinberg identified a property of cancer that has led to new treatments that reduce cancer risk.
“Cancer cells seem to have an uncanny ability to evade the immune system, which normally hunts down damaged and dangerous cells—such as cancerous cells–and targets them for destruction.”
Using the body’s immune system to fight cancer is an approach Peter is optimistic about because it is systemic, “a necessary condition for any new treatment to combat metastatic cancers. . .
“Immunotherapy traveled a rocky road, and it could have been abandoned completely at many points along the way,” he writes. “In the end, it survived because its chimerical successes turned out to be not so chimerical, but mostly thanks to the determination and persistence of visionary scientists such as James Allison, Tasuku Honjo, Steve Rosenberg, and others, who kept going even when their work seemed pointless and possibly crazy.”
What’s the important message here? There is hope.
More tomorrow.
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Reflection: Have I, a family member, or a close friend battled cancer? If so, what were the lessons I learned? How has this experience impacted me? Does anything surprise me about the metrics regarding cancer?
Action: Journal about my learnings.