Every news story about cancer research should come with a health warning: believe the hope, but not the hype. Good headlines are quick and catchy, good science is steady steps taken on a complicated issue over a long time. If a new treatment is still being researched, it could be metaphorical miles and actual years away from getting into the hands or bodies of patients. As blogger Kay Curtin, who has advanced melanoma, puts it: “The media tend to pick one line on a report and run with it, but they do not draw attention or highlight that it’s just a potential benefit, or the fact that many of these are just proven in a petri dish or a mouse and very often do not prove effective when tested on humans. It is cruel to existing patients to make claims with misleading headlines.”
One of the best ways to deal with cancer is to divide and conquer, based on as much knowledge as we can get of how individual tumours work. Treating all cancers from the same part of the body equally isn’t good enough – you must match the right patient with the right treatment.
For example, some breast cancers need a protein called HER2 to survive, and can be treated with the drug Herceptin. Other breast cancers rely on oestrogen and can be treated with drugs, such as tamoxifen, which starve it of this source. Tamoxifen was the first “targeted therapy” for cancer, and proved that there was a more intelligent way to help patients than traditional chemotherapy, which often couldn’t tell the difference between cancerous and healthy cells.
As Dr Justine Alford, senior science information officer at Cancer Research UK, explains: “As science continues to reveal more about cancer, we’re starting to think of it in a different way, as we know that two tumours affecting the same part of the body won’t necessarily behave in the same way. Some will be more aggressive; some might be resistant to one treatment, but respond to another. Our understanding of these unique features of different tumours has helped to produce one of the most exciting areas of research for all cancer types: personalised medicine.”
Prostate cancer, according to Dr Robert O’Connor, head of research at the Irish Cancer Society, has in recent years “seen the greatest revolution in terms of new agents”. One huge step forward was the use of radiation to reduce the impact of prostate cancer that spreads to bones. Another was the development of better diagnostics, including PSA tests, which mean that most men are diagnosed while their prostate cancer is still curable. The jury is still out on the ideal timing of treatments, but researchers at the University of Birmingham found this summer that giving a drug earlier saved more lives.
Eight out of 10 women now survive breast cancer, but research won’t be over until no one dies and survivors have a far easier journey. Researchers are trying to find out more about how we might prevent breast cancers, how some become resistant to therapy and how to stop them from spreading.
With the number of cancer survivors in the UK expected to increase by 1 million each decade, “survivorship” – how to live as comfortably as possible with and after cancer – is an important area of research for all cancers.
Lung cancer, however, remains deadly. There are often no symptoms until it has taken over a large part of the lungs or spread to other parts of the body. On top of this, it grows quickly and is sometimes intrinsically resistant to chemotherapy. Other cancers that don’t come with clear early warnings include pancreatic cancer – the Pancreatic Cancer Research Fund says it is “the only cancer that has seen no improvement in [survival rate] over the last 40 years” – and oesophageal cancer, which is on the rise, partly due to obesity and alcohol use. Pancreatic and brain tumours are hard to get drugs into. The brain is surrounded by a very selective gatekeeper called the blood-brain barrier, which normally keeps possible poisons out; while as much as 90% of pancreatic tumours comprises of a dense tissue called stroma, which surrounds the tumour like a shield.
Researchers are looking for kinder, more effective treatments for these cancers, as well as ways to catch them sooner. Innovative ways to get drugs into brain tumours, such as modifying bee venom or adjusting the chemistry of nanoparticles, offers hope. Lung cancer research, much of it at the University of Manchester and UCL, is carving out a better understanding of how the cancer works and how we can treat it better. Meanwhile, both pancreatic and oesophageal cancers had breakthrough discoveries this year when subtypes of each cancer were discovered, meaning they can both potentially be treated with personalised medicine in the future.
Of course, if we already knew the answer, it wouldn’t be research. The greatest challenge, always, is the complex and wily nature of cancer, but there’s no getting away from the fact that finite funds aren’t evenly spread across different cancer types. More people donate towards breast than lung cancer research, partly reflecting the number of people affected by breast cancer and the well-organised advocacy behind it. And according O’Connor, in Ireland, of the tens of thousands of cancers diagnosed every year, less than 200 are in children. However, because childhood cancer is so emotive, many more donations come in for paediatric than geriatric cancers.
In a recent video on Twitter, the charity Breast Cancer Now said that every £25 raised supports one hour of research. It’s impossible to guess at how many more hours will be needed before we can live free of the fear of cancer. The only certainty is that we won’t give up.