Treatments

Cancers are classified with three criteria. Firstly, there is the size of the tumor. T0 means there’s no evidence of a tumor, and if there is a tumor, then T1, T2, T3 or T4 are used (depending on size and location). Second depends on if the cancer involves the lymph nodes. Lymph nodes play an important role in fighting infections, viruses, bacteria, parasites, and more. N0 means that the cancer has not spread to the lymph nodes, and N1, N2 and N3 are classifications of lymph nodes infection. The last form of classification is whether or not the cancer has metastasized, meaning spread to other parts of the body besides the lymphatic system. M0 means it has not metastasized, and M1 meaning it has. Combining these classifications allows care providers to give an overall score from stage zero, a small local cancer often easily treatable to stage four, an aggressively growing form of cancer that has potential to be terminal.

Traditional Treatments

Once a cancerous mass is found, there are three traditional forms of  treatments that can be employed. These treatments aim to remove the cancer from the body, either in the form of cutting the tumor out of the body, or killing the cancerous cells while they are in the body.

Surgery

The first and most straightforward type of treatment is surgery. This is where the cancerous mass is cut out and removed from the body. Surgeons also cut out some of the surrounding healthy tissue as well as the cancerous tumor. This is because they need to be absolutely certain there are no mutant cells left in the area, or else the tumor will just grow back again. For breast cancer, a mastectomy or a double mastectomy (the surgical removal of the breast tissue in its entirety) may be used. Surgery is also oftentimes used along with radiation and chemotherapy, to be absolutely sure all of the mutant cells are gone.

Radiation

Radiation is where the specific site on a person’s body where the cancer is affected is targeted and bombarded with radiation. This radiation causes the cells to become mutated far beyond their ability to act normally, so they are triggered to undergo apoptosis. This process kills both mutant cells, as well as surrounding healthy cells. Multiple radiation treatments are often needed, and these sessions are quite painful; usually resulting in radiation burns on the skin. Radiation can also be administered in the form of a radioactive bead, or a radioactive pellet. These beads are inserted next to the cancerous growth. Over time, the cancer experiences damaging mutations from the consistent low levels of radiation emitting from the beads. These mutated cells undergo apoptosis as well. 

Chemotherapy

Finally, there is medication, also known as chemotherapy. Chemotherapy is simply short for chemical therapy, and is a broad term that categorizes many different drugs and chemicals. Oftentimes chemotherapy is used along with surgery and radiation, but it can also be administered for more regionalized cancers, such as lymphoma and leukemia. Chemotherapy is the process of introducing a chemical into the bloodstream that inhibits cell division. Drugs that are often employed for chemotherapy include nitrogen mustards, which disrupts the process of DNA pairing and causes DNA crosslinking. Ultimately, this will disrupt DNA replication, and this will keep DNA from replicating and will lead to apoptosis. This also leads to other rapidly dividing cells to be killed off as well, which is why hair and fingernail cells die. Fortunately, these cells typically regenerate after the chemotherapy is finished. 

Hormone therapy is often considered chemotherapy. However, hormone therapy is different from chemotherapy in the fact that it is not aimed to destroy the cells so that apoptosis is initiated. Alternatively, the goal of hormone therapy is to inhibit the proteins that play a role in cell division. A hormone therapy drug known as tamoxifen is often used to treat some forms of breast cancer. Tamoxifen binds to the estrogen receptor ESR1. When estrogen binds to ESR1, it will signal for the eventual stimulation of cell division. However, if tamoxifen binds to the receptor, estrogen is unable to bind and thus unable to stimulate for cell division, ultimately slowing the rate of cancerous growth.

Traditional treatment options are great in theory; if all the cancerous cells are removed, then there is no more cancer. However in practice, it is much more difficult than it may seem to eradicate all of the cancerous cells. This is due to evolution. When the cancerous cells are exposed to radiation and chemotherapy, many of the cancerous cells will die off. However, by random chance, a tiny fraction of those cancerous cells have mutations that make them incredibly resistant to the radiation and chemicals that the cancerous mass is subjected to. Again, these mutations that provide these resistant cells with their resistivity are just by pure chance. However, it nonetheless allows these cells to survive, while all the other cancerous cells die off. The big problem with this is that once all of the other non-resistant cancerous cells are gone, this allows the resistant cancerous cells to scavenge the resources left by those dead cancer cells, and then these resistant cells divide time and time again. This is an example of evolution; A random mutation is introduced to a population (in this example the population is cancer cells, and this is a mutation that allows for a cancer cell to survive radiation and chemicals), then that mutation allows for higher reproduction (since the non-resistant cancer cells all die and are unable to divide any further, the resistant cells are able to divide freely, because they are not affected by the treatments). 

This explains how cancer is able to sometimes return; in the event that a cancerous mass has any cells that have mutations which allow them to be resistant towards treatment, then those cells will survive the treatment, then the cancerous mass will regrow. Except this time, it is much harder to treat, because now all the cells are resistant to radiation and chemotherapy. 

Adaptive Therapy

An option that has the potential to avoid this cancer recurrence is a type of treatment known as adaptive therapy. Whereas traditional treatment can leave the door open for cancer recurrence (with even more dangerous cancerous cells that are harder to treat), adaptive therapy aims to avoid that chance. Instead of trying to eliminate the cancer from the organ, adaptive therapy aims at managing it. By keeping the tumor in check, the cancer would remain within the organ, but it would be maintained with just enough radiation and chemotherapy so that it is unable to grow and spread, but not enough so that it would allow potentially resistant cancer cells to take over the area. 

Adaptive therapy is not prescribed by a universal standard number of treatments, but instead it depends on the individual level. Multiple factors come into play that determine the amount of radiation and chemotherapy one may need; ranging from the type of cancer and the cancer case, the size and condition of the cancer, and so on. 

While adaptive therapy is still a growing area for cancer research and treatment, there are new publications regarding this new concept of care being published routinely. It is very possible that adaptive therapy may soon revolutionize the way modern medicine treats cases of cancer, allowing for longer and healthier lives amongst those who develop cancer in their lifetime.