{"id":28154,"date":"2022-06-20T11:00:14","date_gmt":"2022-06-20T11:00:14","guid":{"rendered":"https:\/\/news.cancerresearchuk.org\/?p=24367"},"modified":"2024-11-03T15:13:37","modified_gmt":"2024-11-03T15:13:37","slug":"why-havent-we-cured-cancer","status":"publish","type":"post","link":"https:\/\/ogkologos.com\/en\/why-havent-we-cured-cancer\/","title":{"rendered":"Why haven\u2019t we cured cancer?"},"content":{"rendered":"
\n

Despite big improvements in survival, cancer is still one of the world\u2019s biggest killers. Leading Cancer Research UK-funded scientists explain why it presents such a challenge \u2013 and look at how far we\u2019ve come<\/span> <\/span><\/p>\n

Written by\u202f Natalie Grover for Guardian Labs<\/span><\/i> <\/span><\/p>\n<\/div>\n

\"PartPart of a pancreatic tumour seen down a microscope, with tumour cells labelled in green, and different types of immune cell in pink, yellow, red, and turquoise. Image credit:<\/p>\n

” data-medium-file=”https:\/\/news.cancerresearchuk.org\/wp-content\/uploads\/2022\/06\/Pancreatic-cancer-cells-300×168.jpg” data-large-file=”https:\/\/news.cancerresearchuk.org\/wp-content\/uploads\/2022\/06\/Pancreatic-cancer-cells.jpg”><\/p>\n

Part of a pancreatic tumour seen down a microscope, with tumour cells labelled in green, and different types of immune cell in pink, yellow, red, and turquoise. Image credit: Silvia Cusumano, Assya Legrini, Leah Officer-Jones, Dr Nigel Jamison and Prof John La Quesne <\/span><\/p>\n<\/div>\n

<\/h4>\n

Recent decades have yielded extraordinary progress in cancer survival, but many cancers remain deadly, with half of people diagnosed <\/span>dying within 10 years<\/span><\/a>. So why hasn\u2019t science found a way to cure more people yet?<\/span> <\/span><\/p>\n

A major challenge is that scientists aren\u2019t in fact targeting a single disease but a constellation of hundreds of diseases that are lumped together under the umbrella classification of cancer. This came about because all cancers start in the same way, with mutations in genes that control cell function. <\/span> <\/span><\/p>\n

Such mutations can fuel the unfettered replication of a single cell. If conditions are right, the cell grows and divides, escalating to millions of cells that may clump together to form a tumour \u2013 in which no two tumour cells are identical in a single tumour.<\/span> <\/span><\/p>\n

\u201cI might have been pessimistic that we would ever be able to control these rapidly multiplying clumps of cells,\u201d says Prof Sir Mike Stratton, director of the Wellcome Sanger Institute and a genetics expert. <\/span> <\/span><\/p>\n

\u201cBut time and again, the achievements of cancer research have mitigated that pessimism and converted it to optimism. It isn\u2019t that one drug will wipe the whole lot [of cancers] off the map, but bit by bit we are eroding the mortality rates of many cancers.\u201d<\/span> <\/span><\/p>\n

Stratton, leader of the <\/span>Cancer Grand Challenges<\/span><\/a> Mutographs team<\/span><\/a>, which is working on a \u00a320m project to look for unknown causes of cancer, adds: \u201cWe\u2019re learning that research \u2013 finding out what is actually going on in cancer cells \u2013 is the route to new strategies for undermining the ability of cancer cells to behave in the way that they do.\u201d<\/span> <\/span><\/p>\n

How many types of cancer are there?<\/span><\/b> <\/span><\/h2>\n

While cancers may start in the same way, decades of research have shown that they evolve into very different diseases requiring a panoply of treatments. So far, scientists have classified more than <\/span>200 types of cancer<\/span><\/a>, and found a myriad of genetic mutations underlying them. <\/span> <\/span><\/p>\n

Out of around 20,000 genes in the human genome, between 500 and 1,000 have been identified as contributing, when mutated, to a cell becoming cancerous. There is, however, a set of cancers for which the genes are still unclear, says Stratton, who is credited with identifying the breast cancer susceptibility gene BRCA2 among others.<\/span> <\/span><\/p>\n

It\u2019s tempting to think that the way forward is to target all the genes known to be implicated in cancer by launching 500-plus drug development programmes. <\/span> <\/span><\/p>\n

But not only is this a huge task, it\u2019s by no means certain that the drugs developed would be the answer to \u201ccuring\u201d the different cancers. This is because tumours develop considerable genetic diversity as they evolve, and often become resistant to treatments as more mutations occur in cells.<\/span> <\/span><\/p>\n

Targeted therapies have been approved for a range of cancers including breast, liver and lung cancers, and are helping more people to live longer. For now, though, the <\/span>search for more \u201cprecision\u201d treatments<\/span><\/a> goes on. \u201cThere is a set of cancer genes \u2026 that are switched off by their own mutations,\u201d Stratton says. \u201cSo how do we use those genes in order to develop new therapies?\u201d<\/span> <\/span><\/p>\n

Cancer cells growing in 2D, labelled with fluorescent markers showing the cells\u2019 nuclei in blue, their cytoplasm in red, and areas of DNA damage in green. Image credit: <\/p>\n

” data-medium-file=”https:\/\/news.cancerresearchuk.org\/wp-content\/uploads\/2022\/06\/Fluorescent-Imaging-immunofluorescence-of-cancer-cells-growing-in-2D-with-nuclei-in-blue-cytoplasm-in-red-and-DNA-damage-foci-in-green-Getty-Images-300×168.jpg” data-large-file=”https:\/\/news.cancerresearchuk.org\/wp-content\/uploads\/2022\/06\/Fluorescent-Imaging-immunofluorescence-of-cancer-cells-growing-in-2D-with-nuclei-in-blue-cytoplasm-in-red-and-DNA-damage-foci-in-green-Getty-Images.jpg” class=” size-medium wp-image-24371″ src=”https:\/\/34p2k13bwwzx12bgy13rwq8p-wpengine.netdna-ssl.com\/wp-content\/uploads\/2022\/06\/Fluorescent-Imaging-immunofluorescence-of-cancer-cells-growing-in-2D-with-nuclei-in-blue-cytoplasm-in-red-and-DNA-damage-foci-in-green-Getty-Images-300×168.jpg” alt=”Cancer cells growing in 2D, labelled with fluorescent markers” width=”300″ height=”168″ srcset=”https:\/\/34p2k13bwwzx12bgy13rwq8p-wpengine.netdna-ssl.com\/wp-content\/uploads\/2022\/06\/Fluorescent-Imaging-immunofluorescence-of-cancer-cells-growing-in-2D-with-nuclei-in-blue-cytoplasm-in-red-and-DNA-damage-foci-in-green-Getty-Images-300×168.jpg 300w, https:\/\/34p2k13bwwzx12bgy13rwq8p-wpengine.netdna-ssl.com\/wp-content\/uploads\/2022\/06\/Fluorescent-Imaging-immunofluorescence-of-cancer-cells-growing-in-2D-with-nuclei-in-blue-cytoplasm-in-red-and-DNA-damage-foci-in-green-Getty-Images-220×123.jpg 220w, https:\/\/34p2k13bwwzx12bgy13rwq8p-wpengine.netdna-ssl.com\/wp-content\/uploads\/2022\/06\/Fluorescent-Imaging-immunofluorescence-of-cancer-cells-growing-in-2D-with-nuclei-in-blue-cytoplasm-in-red-and-DNA-damage-foci-in-green-Getty-Images-150×84.jpg 150w, https:\/\/34p2k13bwwzx12bgy13rwq8p-wpengine.netdna-ssl.com\/wp-content\/uploads\/2022\/06\/Fluorescent-Imaging-immunofluorescence-of-cancer-cells-growing-in-2D-with-nuclei-in-blue-cytoplasm-in-red-and-DNA-damage-foci-in-green-Getty-Images.jpg 620w” sizes=”(max-width: 300px) 100vw, 300px”><\/p>\n

Cancer cells growing in 2D, labelled with fluorescent markers showing the cells\u2019 nuclei in blue, their cytoplasm in red, and areas of DNA damage in green. Image credit: Getty Image <\/span><\/p>\n<\/div>\n

What are we doing to cure more people?<\/span><\/b> <\/span><\/h2>\n

Drug resistance is one of the biggest challenges in cancer \u2013 that\u2019s why it\u2019s so important to diagnose cancers early when treatment is more likely to be successful, says our chief clinician Prof Charles Swanton, group leader at the Francis Crick Institute, co-director of the charity\u2019s <\/span>Lung Cancer Centre of Excellence<\/span><\/a> and a consultant at University College London Hospitals (UCLH).<\/span> <\/span><\/p>\n

Early diagnosis isn\u2019t always possible, for a range of reasons. For example, there are very few techniques that can detect small, early tumours, and some cancers simply don\u2019t trigger symptoms early enough until they have already spread (or metastasised) \u2013 and it is at this stage that the oncologist\u2019s toolkit of drugs often falls short.<\/span> <\/span><\/p>\n

\n
\n

Each cancer has a different suite of signals which it\u2019s responding to<\/p>\n<\/div>\n

Robert Insall, professor of mathematical and computational biology<\/cite><\/p>\n<\/blockquote>\n

To help uncover the tricks that tumours deploy to evolve, spread and develop drug resistance, we are supporting the <\/span>TRACERx clinical study<\/span><\/a> for which Swanton is chief investigator. By following the progress of hundreds of patients with the most common form of lung cancer from the point of diagnosis onwards, the study views cancer through an evolutionary lens, and uses a vast array of cutting-edge techniques to monitor participants\u2019 disease.<\/span> <\/span><\/p>\n

According to Swanton, the lessons already learned from tracking these patients are applicable to many types of cancer. For instance, the study has shown that tumours with a high level of genetic diversity have the worst clinical outcomes, and that tumours use an assortment of ploys to elude the immune system, including losing the \u201cflags\u201d on their cell surface that enable them to be recognised as problematic.<\/span> <\/span><\/p>\n

Overall, says Swanton, the major barriers to successfully treating metastatic cancer are the genetic diversity within tumours, the evolutionary fitness of cancer cells that allows them to adapt, and \u2013 of increasing focus \u2013 the ways tumours modify their local microenvironment to support their survival.<\/span> <\/span><\/p>\n

A \u2018rogue organ\u2019?<\/span><\/b> <\/span><\/h2>\n

The tumour microenvironment is composed of non-malignant cells that have been hijacked by cancer cells to support and nourish the tumour. This allows the cancer to smother the body\u2019s immune defence. <\/span> <\/span><\/p>\n

Prof Fran Balkwill<\/p>\n

” data-medium-file=”https:\/\/news.cancerresearchuk.org\/wp-content\/uploads\/2022\/06\/FrancesBalkwill.jpg” data-large-file=”https:\/\/news.cancerresearchuk.org\/wp-content\/uploads\/2022\/06\/FrancesBalkwill.jpg” loading=”lazy” class=” size-full wp-image-24372″ src=”https:\/\/34p2k13bwwzx12bgy13rwq8p-wpengine.netdna-ssl.com\/wp-content\/uploads\/2022\/06\/FrancesBalkwill.jpg” alt=”Prof Fran Balkwill” width=”200″ height=”200″ srcset=”https:\/\/34p2k13bwwzx12bgy13rwq8p-wpengine.netdna-ssl.com\/wp-content\/uploads\/2022\/06\/FrancesBalkwill.jpg 200w, https:\/\/34p2k13bwwzx12bgy13rwq8p-wpengine.netdna-ssl.com\/wp-content\/uploads\/2022\/06\/FrancesBalkwill-150×150.jpg 150w, https:\/\/34p2k13bwwzx12bgy13rwq8p-wpengine.netdna-ssl.com\/wp-content\/uploads\/2022\/06\/FrancesBalkwill-96×96.jpg 96w” sizes=”(max-width: 200px) 100vw, 200px”><\/p>\n

Prof Fran Balkwill<\/p>\n<\/div>\n

Typically, half of the cells that make up a tumour are non-cancerous, and include fibroblasts (for structural support), fat cells and endothelial cells (which can form blood vessels that deliver oxygen and nutrients, and eliminate waste), says Prof Fran Balkwill, whose work at the <\/span>Barts Cancer Institute<\/span><\/a> in London centres on the links between cancer and inflammation.<\/span> <\/span><\/p>\n

Better understanding of this microenvironment \u2013 and potentially \u201creprogramming\u201d it \u2013 could restrict nourishment of this cancerous \u201crogue organ\u201d and reawaken the body\u2019s immune cells to recognise and destroy it.<\/span> <\/span><\/p>\n

Already this ecosystem of hijacked normal cells within tumours is being targeted by cancer treatments, whether immunotherapy or chemotherapy, says Balkwill, noting that it is likely that treatments in the future will be combinations of drugs that target malignant cells and this microenvironment.<\/span> <\/span><\/p>\n

What makes cancer ultimately so dangerous, however, is the suite of signals that induce it to move beyond its primary site into the blood, lymphatic system or other tissues. <\/span> <\/span><\/p>\n

Robert Insall, professor of mathematical and computational biology. <\/p>\n

” data-medium-file=”https:\/\/news.cancerresearchuk.org\/wp-content\/uploads\/2022\/06\/Robert-Insall.jpg” data-large-file=”https:\/\/news.cancerresearchuk.org\/wp-content\/uploads\/2022\/06\/Robert-Insall.jpg” loading=”lazy” class=” size-full wp-image-24370″ src=”https:\/\/34p2k13bwwzx12bgy13rwq8p-wpengine.netdna-ssl.com\/wp-content\/uploads\/2022\/06\/Robert-Insall.jpg” alt=”Robert Insall, professor of mathematical and computational biology.” width=”200″ height=”200″ srcset=”https:\/\/34p2k13bwwzx12bgy13rwq8p-wpengine.netdna-ssl.com\/wp-content\/uploads\/2022\/06\/Robert-Insall.jpg 200w, https:\/\/34p2k13bwwzx12bgy13rwq8p-wpengine.netdna-ssl.com\/wp-content\/uploads\/2022\/06\/Robert-Insall-150×150.jpg 150w, https:\/\/34p2k13bwwzx12bgy13rwq8p-wpengine.netdna-ssl.com\/wp-content\/uploads\/2022\/06\/Robert-Insall-96×96.jpg 96w” sizes=”(max-width: 200px) 100vw, 200px”><\/p>\n

Robert Insall, professor of mathematical and computational biology.<\/p>\n<\/div>\n

Typically, chemical signals steer a cancer cell to move in a particular direction, but in many cases we don\u2019t know what they are, says Robert Insall, professor of mathematical and computational cell biology at the our Beatson Institute in Glasgow. \u201cSo, if you\u2019re looking at this theme of why isn\u2019t cancer cured yet, it\u2019s because each cancer has a different suite of signals which it\u2019s responding to.\u201d<\/span> <\/span><\/p>\n

In the case of melanoma, a serious form of skin cancer, <\/span>Insall\u2019s research<\/span><\/a> suggests that the cancer cells themselves make their own spreading signals, creating the local instructions that direct them to spread. <\/span> <\/span><\/p>\n

\u201cOther kinds of skin cancer are not nearly as scary because they either don\u2019t, or rarely, spread. And one of the reasons is that they are not primed to drive themselves outwards in the same way,\u201d he says. \u201cMy suspicion is that the most metastatic, the most deadly, cancers have this same property [as melanoma].\u201d<\/span> <\/span><\/p>\n

\n
\n

Reprogramming a tumour\u2019s microenvironment could reawaken the body\u2019s immune cell\u2019s to destroy it<\/p>\n<\/div>\n

Professor Fran Balkwill<\/cite><\/p>\n<\/blockquote>\n

What progress are we making?<\/span><\/b> <\/span><\/h2>\n

Insights such as Insall\u2019s continue to inform research into the biology of cancer, building on the decades of endeavour that have gone before. This burgeoning knowledge has transformed the way doctors diagnose and treat cancers \u2013 in the UK, for instance, survival rates have doubled in the past 40 years for all cancers combined. \u201cOn this journey to cure patients with cancer,\u201d says Swanton, \u201cI think we\u2019re about half way there.\u201d<\/span> <\/span><\/p>\n

Part of an ovarian tumour viewed down a microscope, with cancer cells in blue and immune cells in brown<\/p>\n

” data-medium-file=”https:\/\/news.cancerresearchuk.org\/wp-content\/uploads\/2022\/06\/Ovarian-cancer-cells-300×168.jpg” data-large-file=”https:\/\/news.cancerresearchuk.org\/wp-content\/uploads\/2022\/06\/Ovarian-cancer-cells.jpg” loading=”lazy” class=” size-medium wp-image-24373″ src=”https:\/\/34p2k13bwwzx12bgy13rwq8p-wpengine.netdna-ssl.com\/wp-content\/uploads\/2022\/06\/Ovarian-cancer-cells-300×168.jpg” alt=”Part of an ovarian tumour viewed down a microscope” width=”300″ height=”168″ srcset=”https:\/\/34p2k13bwwzx12bgy13rwq8p-wpengine.netdna-ssl.com\/wp-content\/uploads\/2022\/06\/Ovarian-cancer-cells-300×168.jpg 300w, https:\/\/34p2k13bwwzx12bgy13rwq8p-wpengine.netdna-ssl.com\/wp-content\/uploads\/2022\/06\/Ovarian-cancer-cells-220×123.jpg 220w, https:\/\/34p2k13bwwzx12bgy13rwq8p-wpengine.netdna-ssl.com\/wp-content\/uploads\/2022\/06\/Ovarian-cancer-cells-150×84.jpg 150w, https:\/\/34p2k13bwwzx12bgy13rwq8p-wpengine.netdna-ssl.com\/wp-content\/uploads\/2022\/06\/Ovarian-cancer-cells.jpg 620w” sizes=”(max-width: 300px) 100vw, 300px”><\/p>\n

Part of an ovarian tumour viewed down a microscope, with cancer cells in blue and immune cells in brown Barts Cancer Institute <\/span><\/p>\n<\/div>\n

The second half of this odyssey demands further research. Research that will not just benefit the cancer patients of tomorrow, but is keeping hope alive for people affected by cancer now who may have limited or no treatment options if their cancer progresses.<\/span> <\/span><\/p>\n

Eileen Rapley, a participant in the TRACERx study who is being treated at UCLH, and who has also been receiving an immunotherapy drug that has so far kept her cancer at bay, says: \u201cWhen you\u2019re diagnosed with cancer and you\u2019re suddenly very dependent on other people, being able to contribute something makes it a little more palatable. You feel that at least this cancer is having a positive effect rather than a negative one.\u201d<\/span> <\/span><\/p>\n

But funding for this type of lifesaving research has come under considerable strain, in large part due to the pandemic, with CRUK needing to reduce its planned spending for 2022-23 from \u00a3400m to \u00a3300m.<\/span> <\/span><\/p>\n

\u201cMaintaining investment in cancer research and getting back to where we were in 2017, 2018 and 2019 is going to be absolutely crucial,\u201d says Swanton.<\/span> <\/span><\/p>\n

\u201cWe are now getting to the point of being able to personalise medicines given to patients upon the genetic basis of their disease,\u201d he says. \u201cBut we need new medicines to circumvent and overcome drug resistance in cancers that have spread, and new approaches to detect small, early stage tumours, and treat them before they become malignant \u2013 that\u2019s where some of the major advances are going to come from over the next five decades.\u201d<\/span> <\/span><\/p>\n

This article was originally published on theguardian.com as part of the Cancer Research UK and Guardian Labs Cancer revolutionaries campaign. <\/span><\/i> <\/span><\/p>\n

To dig deeper into why we haven\u2019t cured cancer, we heard from Dr Alanna Skuse, Dr Mariam Jamal-Hanjani and Sir Leszek Borysiewicz in the latest episode of our podcast That Cancer Conversation<\/a>. <\/em><\/p>\n

From Egyptian mummies and medieval wolves, to precision medicine and microscopic evolution, we take a look at the past to find out why curing cancer is more complex than we think, and what is needed next to get us closer to a future without cancer. <\/em><\/p>\n

More on this topic<\/h3>\n<\/p>\n

Source<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Despite big improvements in survival, cancer is still one of the world\u2019s biggest killers. Leading Cancer Research UK-funded scientists explain why it presents such a challenge \u2013 and look at how far we\u2019ve come  Written by\u202f Natalie Grover for Guardian Labs  Cancer cells growing in 2D, labelled with fluorescent markers showing the cells\u2019 nuclei in […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"footnotes":""},"categories":[5137],"tags":[],"class_list":["post-28154","post","type-post","status-publish","format-standard","hentry","category-world-news"],"_links":{"self":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts\/28154","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/comments?post=28154"}],"version-history":[{"count":1,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts\/28154\/revisions"}],"predecessor-version":[{"id":43289,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts\/28154\/revisions\/43289"}],"wp:attachment":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/media?parent=28154"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/categories?post=28154"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/tags?post=28154"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}