VIDEO
Angiogenesis: How Cancer Grows and Spreads
Attacking Cancer
How Cancer Grows: The Basis of Cancer Treatments
• A fifty-five-year-old man feels a twinge in his back while golfing. The pain persists and begins to pierce his abdomen. Soon after, he is diagnosed with pancreatic cancer and learns that the tumor is too large to be surgically removed. He asks, “How could I be so sick and not know it? Does cancer grow overnight?”
• A forty-year-old woman with breast cancer undergoes surgery to remove the cancer. Afterward, the surgeon tells her, “The surgery went very well, I got all of it. But you should see the oncologist for chemotherapy.”
The patient asks, “Why do I need chemo if I’m cancer free?”
• For four years, a sixty-eight-year-old man with prostate cancer has been receiving hormone treatments that have kept both his cancer and his PSA level (a blood marker of cancer growth) at undetectable levels. Suddenly, the PSA rises and a bone scan shows that the cancer is growing in his bones. He asks, “Why did the medicine stop working?
How could the cancer move from my prostate to my bones?”
• A thirty-eight-year-old woman with lymphoma experiences a complete remission of her cancer after two cycles of chemotherapy. She asks, “Why do I need six cycles of chemo if the cancer is already gone?”
• A forty-three-year-old woman with metastatic thyroid cancer involving her lungs is referred to another cancer center for a promising experimental treatment. She returns after a year and informs me that she never received any other treatments despite multiple consultations.
I immediately order CT scans, which show that the cancer is no longer present. She asks me, “How can my cancer just disappear?”
I reply that it rarely happens and ask if she did anything special to achieve this remarkable result. “Prayed a lot and drank a lot of Gatorade,” she said laughingly. “God and Gatorade, who am I to question that?” I replied.
Cancer seems to grow in mysterious ways. It can begin in one location and remain there, or it can spread to other parts of the body. It may grow aggressively from the outset or begin as a slow growth but over time change its stripes and increase rapidly in size. Some cancers remain the same size for long periods, and some can even shrink spontaneously (this is rare except in lymphomas and kidney cancer).
After a successful treatment, cancer may never return and be cured. Alternatively, it may return in the original areas of involvement or in entirely new locations. Again, no two cancer cases behave exactly the same way, and no oncologist has seen every manifestation of every cancer.
There are well-described patterns of growth for each cancer type, which is what oncologists are expert at recognizing. But there is a great deal that we do not know about why cancer grows the way it does. For any individual patient with cancer, it is not possible to predict if and when and in which areas the cancer will grow in the body. Yet just as yesterday’s mysteries are common knowledge today, so will today’s questions about cancer yield to the light of ongoing scientific sleuthing.
Through advances in cancer research, many of the mysteries of cancer growth are becoming more clearly understood. Paralleling these discoveries are improved ways of treating the disease. How cancer grows and how it is treated is closely intertwined.
