Categories
Health and Disease

Cancer: Will We Ever Cure it, And How Long Will That Take? A Scientific and Humanitarian Perspective.

By Cameron Davies

Published 8:08 EST, Tues October 19th, 2021

Abstract

Cancer, by definition, is a disease caused by the uncontrollable cell division of mutated cells (Rosenbaum, 2011). This arises from both genetic and spontaneous causes but can be influenced by the use of carcinogens (i.e., smoking) and unhealthy lifestyles. Cancer will affect half of the population of the UK (Anon, 2019) in their lives. This sorrowing statistic, along with the knowledge that cancer is now the most threatening disease alive, means that the future of medical advances in this field seems bleak. However, there are positives. For example, there were 1,112 trials in 2018 alone towards improving those odds (Blazynski and Runkel, 2019). It encouraged me to pursue this topic knowing there is a balanced argument. Even as new pioneering discoveries are made in medicine every day, it is difficult to quantify their success with the bigger picture.

What is cancer?

Before discussing how cancer is treated, it is important to understand how cancer can develop in the human body in a bit more detail. Cancer is either inherited or sporadic (Divan and Royds, 2020). If inherited, the chance of cancer being onset is much greater and much more imminent, but sadly there is no real way to know or prevent it. However, sporadic cancers caused by random mutations of cells can be prevented by reducing the risk factors, including smoking, exposure to UV light, and eating unhealthily (Divan and Royds, 2020). More cancers are sporadic than hereditary.

Background knowledge & History of treatments

Amongst all the discoveries over the past century to eradicate or treat the virus, chemotherapy and radiation rank amongst the greatest discoveries to date in widespread treatment for most cancers, whether in the early or late stage. Before this time, only surgical resection was available for those with cancer, along with a relatively low success rate overall. The statistics could not be included because of the variegated nature of cancer regarding the type and stage of advancement.

One of the most common treatments available in today’s world, chemotherapy, was first developed during World War II in the US. It was known to kill all living cells and took the name of nitrogen mustard. Back then, no one knew just how important this discovery would be in the journey to eradicating cancer. As time passed, Sidney Farber, a pioneering oncologist, discovered a new drug called aminopterin, which redefined treating leukaemia in children (Anon, 2012). This stemmed to the creation of toxic cell-killing drugs, which later developed into chemotherapy. Of course, to this day, many adaptations have been developed to fine-tune the treatment of cancer, including using cancer stem cells to reduce the possibility of drug resistance (Anon, 2012). 

Radiation also lists amongst the most beneficial discoveries in the fight for cancer within the past century. It originated in 1896 when a German physics professor named Wilhelm Conrad Roentgen discovered the X-Ray, which could diagnose patients unlike ever before. From there, he shaped this into radiation for cancer and soon won the Nobel Prize in Physics. Unfortunately, the course of its discovery was interfered with when it was discovered that radiation could also cause cancer (particularly blood cancers) (Anon, 2014). However, it did not stop scientists from continuing to make advances in the field: shortly into the 20th century, a type of therapy known as conformal radiation therapy (from CT scans) was a more precise method of locating cancer. Additionally, intraoperative radiation therapy was a treatment to particularly combat abdominal and pelvic cancer by minimising the amount of tissue when exposed to radiation (Anon, 2014).

It is not unusual for any cancer patient to experience effects from chemotherapy, and indeed radiation presents very harshly: nausea, tiredness, distress, and infection are inevitable effects caused by chemotherapy due to the harsh course it takes to remove almost every functioning cell from the body. This has been combated over the years with antiemetics to reduce nausea and vomiting (Divan and Royds, 2020) as well as several other clinical trials. However, it was made clear that in addition to chemotherapy and radiation, some major advances were required in order to improve the success rate of cancer treatment. Thus, oncologists are struggling to keep up with the modern-day to develop more targeted and cutting-edge therapies in this day and age. However, be rest assured that oncological trials are the number one ranking in the number of trials carried out (as of 2018), standing at a grand total of 1,112 in 2018 (Blazynski and Runkel, 2019) alone. These statistics go to show we are making progress towards the end goal: total eradication.

More modern targeted therapy and clinical trials

One group of scientists made a particularly groundbreaking discovery in reducing metastasis (cancer recurring after treatment) by inserting a drug called BBI608. This is a particularly significant exploration because ‘current cancer treatments ultimately fail owing to metastasis and relapse.’ Overall, the trial was largely successful in killing most cancer stem cells without affecting stem cells from dying. They concluded that BBI608 was a ‘novel approach’ to this issue (Rogoff, Keates, Gao, Murikipudi, Mikule, Leggett, Li, Pardee, Li, 2015).

Bone marrow transplants and stem cell research are two life-saving methods that are fast arising in cancer. In the past, bone marrow transplants were poor in terms of success rate and were about to be terminated. Even today, stem cell and bone marrow transplants result in a success rate of around 50-60% (Carrier and Kelvin, 2004), which is alarming considering the importance of these surgeries. Unfortunately, in addition to this low success rate, there is a lot of controversy towards Stem Cell research. For example, questions like ‘is it right to test animals?’ and ‘is it right ethically to clone someone?’ have arisen throughout the process. In addition, there are some serious scientific flaws to the process, which include the tumour growing somewhere else, stem cells forming tumours, and the knowledge that we are still in the clinical trial phase (Thomas, 2012). This means that stem cells are a novelty for us. Stem cells are the parts of our body that contain unspecialised cells. This means replacing it would create completely new cells that are not cancerous and potentially lead us to defeat cancer cells 100% of the time. Therefore, it has certain potential in the eradication of cancer.

Targeted therapies interfere with and block signals of cancerous cells, which reduce the amount of cell division that takes place. Whilst some trials have been extremely successful, dosing and cost (for example, the fact that it costs over $30,000 for eight weeks of treatment) hinder its progress. This is why some clinical trials are fatal in the future of therapy (Khahil, Smith, Brentjens, Wolchock, 2016). But, if finance was not a problem, this would have great potential in the fight to cure cancer.

Finally, one more clinical trial was carried out in the early days of 2007 and concluded in 2009, looking at GSK46134, a potential drug for curing advanced-stage cancers. Some side effects from this drug at higher doses included a decline in blood cells and some blood clots, which unfortunately ended the trial (De Bono, 2015).

In conclusion, it can be said that there is a mixed number of successful and unsuccessful trials around in the current day. Whilst the efforts of a team of scientists to create the BBI608 drug paid off, other trials and stem cell research are still seriously dragging behind. This puts us in a tricky situation, moving forward, as the treatment element of cancer continues to be difficult. This is mostly due to the aggressive and clever progression and metastasis of cancer, which is seriously limiting possibilities.

There are unscientific and scientific reasons why cancer has a very limited future. Some of which are purely permanent and cannot be ‘eradicated.’ Other reasons are the very peril of scientists and medics today, who are scrambling to create a cure to this awful disease.

Scientific barriers

According to scientists, there are a few main scientific reasons that have led the treatment and eradication of cancer into turmoil. The first of which is that targeting stem cells is hard (Chakraborty and Rahaman, 2012). When we target cells, all cells have originated from the stem cells, meaning the cancerous stem cells are never killed off. With this in mind, it is difficult to completely kill cancer because the cancer stem cells have the ability to ‘self-renew’ and put the body into what is known as cancer relapse (i.e., cancer comes back) (Chakraborty and Rahaman, 2012). Additionally, they could grow resistant to the drugs being given as a result of epigenetics. Prostate cancers, Esophageal cancers, and Pancreatic cancers, all extremely aggressive cancers, are challenging to diagnose for two main reasons: firstly, they are what is known as latent cancers (meaning the patient could have cancer but be asymptomatic), and the tumours start very small, giving no ‘tell-tale’ signs. Finally, metastasis is a huge problem for most cancer patients. Tumours, once killed, can still re-grow in other parts of the body, either spreading locally through the blood or through the lymphatic system (Chakraborty and Rahaman, 2012). This can happen easily, and so significantly limits the progress that can be made to eradicate it.

Financial and discriminative barriers

There are also racial and discriminative reasons why cancer treatment and eradication have been limited. These are issues that can easily be fixed, but if not, they also significantly reduce the number of possible outcomes available. The first of which is a lack of follow-up care. The average African-American cancer patient has a concerningly higher 32% chance of mortality than a white male cancer patient (Jabson and Bowen, 2013). This blatantly tells us that your race decides whether you will be treated or if cancer can be eradicated; it’s simple – if race determines your healthcare, and BIPOC people continue to get cancer, we can never fully eradicate this disease.

Additionally, cancer is missed every day in elderly patients. An interesting biopsy study was held on diseased patients over 65, and a staggering 32.5% of these patients had one or more cancer, most of which would have been fatal if their additional health issues had been dealt with (Suen, Lau and Yermakov, 1974).

Clinical trials are an extremely vital system that lead scientists to get a better understanding and idea of the kind of drugs and therapies that can cure diseases. Clinical trials in oncology are no exception. A reminder that over 1000 clinical trials in oncology took place in 2018 alone (Blazinsky and Runkel, 2019). With this in mind, it is no celebration that patients of Arizona (and indeed many other states of the US) are not receiving these possibly life-saving studies. About 20 years ago, a law was put in place in Arizona and other states that both the patient and staff had to fund these trials. Insurers also refused to cover this care, causing most of the clinical trials (which were imperative for life-saving care and advances in medicine) to be under-enrolled. As a result, a very poor and ‘flawed product’ (Olson-Garewal and Hessler, 2001) was produced, leaving much of the US without the cutting-edge possibility to make advances in cancer eradication.

These ideas show that our lack of care and discrimination is severely affecting this long and troublesome road to eradicating cancer; we forget that science does not have the only thing to do with that. Finance, race, and age are important factors but should never affect healthcare.

Conclusion

Cancer, by definition, is a disease caused by the uncontrollable cell division of mutated cells (Rosenbaum, 2011). Taking the lives of thousands of people, this disease ruins many lives and takes the lives of innocent and healthy communities. Without the quick action to find treatment and cure this disease, we are looking at a rather dim future, with around 4 million people living with cancer by the year 2040 (Anon, 2016); this is a shocking yet very real 13% of the population. Thus, cancer is the most deadly disease in the world.

But even with a cure, my question is, can we ever ‘fully eradicate’ cancer? When we look at this question carefully, we really mean ‘can we ever look at this world and not remember that cancer ever existed’? The answer is yes, we can. But what is the time frame? Is it in all countries? Is it in all cities? Is it to all species? The answers to these questions, alas, are unknown. But, due to the overwhelming scientific evidence stating that mutations are extremely hard to control and cancer stem cells are extremely aggressive, the time frame looks rather grim. In addition, the financial, racial, and age issues encompassing this disease inexplicably increase the deadline of defeating cancer. Unfortunately, this project is starting to look much more long-term than we hoped.

Cameron Davies, Youth Medical Journal 2021

Bibliography

Aysha Divan and Royds, J. (2020). Cancer biology and treatment. Oxford Oxford University Press.

Blazynski, C. and Runkel, L. (2019). 2018 Completed Trials: State of Industry-Sponsored Clinical  Development. 2018 Completed Trials:  State of Industry- Sponsored Clinical  Development.

British Medical Association (2004). BMA new guide to medicines & drugs. London: Dorling Kindersley.

Carrier, E. and Joanne Frankel Kelvin (2004). 100 Questions & Answers About Bone Marrow And Stem Cell Transplantation. Sudbury: Jones And Bartlett, Cop.

Chakraborty, S. and Rahaman, T. (2012). ecancermedicalscience. The difficulties in cancer treatment. [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4024849/.

De Bono, J. (2015). A trial looking at GSK461364 for advanced cancer. [online] Cancer Research UK. Available at: https://www.cancerresearchuk.org/about-cancer/find-a-clinical-trial/a-trial-looking-at-gsk461364-for-advanced-cancer-or-non-hodgkins-lymphoma#undefined [Accessed 30 Oct. 2020].

Gerber, D.E. (2014). Targeted Therapies: A New Generation of Cancer Treatments. American Family Physician, [online] 77(3), pp.311–319. Available at: https://www.aafp.org/afp/2008/0201/p311.html [Accessed 15 May 2019].

Jabson, J.M. and Bowen, D.J. (2013). Cancer treatment summaries and follow-up care instructions: which cancer survivors receive them? Cancer Causes & Control, 24(5), pp.861–871.

Khalil, D.N., Smith, E.L., Brentjens, R.J. and Wolchok, J.D. (2016). The future of cancer treatment: immunomodulation, CARs and combination immunotherapy. Nature Reviews Clinical Oncology, [online] 13(5), pp.273–290. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5551685/ [Accessed 21 Nov. 2019].

Li, Y., Rogoff, H.A., Keates, S., Gao, Y., Murikipudi, S., Mikule, K., Leggett, D., Li, W., Pardee, A.B. and Li, C.J. (2015). Suppression of cancer relapse and metastasis by inhibiting cancer stemness. Proceedings of the National Academy of Sciences, [online] 112(6), pp.1839–1844. Available at: https://www.pnas.org/content/112/6/1839 [Accessed 11 Mar. 2020].

Natural History of Cancer. (1959). BMJ, 1(5121), pp.563–564.

Olson-Garewal, J.K. and Hessler, K. (2001). Arizona’s Cancer Clinical Trials Law: Flawed Process, Flawed Product. The Hastings Center Report, 31(3), p.22.

Rosenbaum, B. (2011). Science of Cancer 101 | OncoLink. [online] http://www.oncolink.org. Available at: https://www.oncolink.org/healthcare-professionals/oncolink-university/general-oncology-courses/science-of-cancer-101 [Accessed 30 Oct. 2020].

Siegel, R., Miller, K. and Jemal, A. (2019). Cancer statistics, 2019. [online] Cancer statistics, 2019. Available at: https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.21551?dom=prime&src=syn [Accessed 30 Oct. 2020].

Statistics fact sheet. (2019). [online] Macmillan Cancer Support, pp.1–14. Available at: https://drive.google.com/drive/folders/1-cjdxWa06QCf2qqQQDabivxpLNubK-SI [Accessed 31 Oct. 2020].Suen, K.C., Lau, L.L. and Yermakov, V. (1974). Cancer and old age.An autopsy study of 3,535 patients over 65 years old. Cancer, 33(4), pp.1164–1168.

Abstract

Cancer, by definition, is a disease caused by the uncontrollable cell division of mutated cells (Rosenbaum, 2011). This arises from both genetic and spontaneous causes but can be influenced by the use of carcinogens (i.e., smoking) and unhealthy lifestyles. Cancer will affect half of the population of the UK (Anon, 2019) in their lives. This sorrowing statistic, along with the knowledge that cancer is now the most threatening disease alive, means that the future of medical advances in this field seems bleak. However, there are positives. For example, there were 1,112 trials in 2018 alone towards improving those odds (Blazynski and Runkel, 2019). It encouraged me to pursue this topic knowing there is a balanced argument. Even as new pioneering discoveries are made in medicine every day, it is difficult to quantify their success with the bigger picture.

What is cancer?

Before discussing how cancer is treated, it is important to understand how cancer can develop in the human body in a bit more detail. Cancer is either inherited or sporadic (Divan and Royds, 2020). If inherited, the chance of cancer being onset is much greater and much more imminent, but sadly there is no real way to know or prevent it. However, sporadic cancers caused by random mutations of cells can be prevented by reducing the risk factors, including smoking, exposure to UV light, and eating unhealthily (Divan and Royds, 2020). More cancers are sporadic than hereditary.

Background knowledge & History of treatments

Amongst all the discoveries over the past century to eradicate or treat the virus, chemotherapy and radiation rank amongst the greatest discoveries to date in widespread treatment for most cancers, whether in the early or late stage. Before this time, only surgical resection was available for those with cancer, along with a relatively low success rate overall. The statistics could not be included because of the variegated nature of cancer regarding the type and stage of advancement.

One of the most common treatments available in today’s world, chemotherapy, was first developed during World War II in the US. It was known to kill all living cells and took the name of nitrogen mustard. Back then, no one knew just how important this discovery would be in the journey to eradicating cancer. As time passed, Sidney Farber, a pioneering oncologist, discovered a new drug called aminopterin, which redefined treating leukaemia in children (Anon, 2012). This stemmed to the creation of toxic cell-killing drugs, which later developed into chemotherapy. Of course, to this day, many adaptations have been developed to fine-tune the treatment of cancer, including using cancer stem cells to reduce the possibility of drug resistance (Anon, 2012). 

Radiation also lists amongst the most beneficial discoveries in the fight for cancer within the past century. It originated in 1896 when a German physics professor named Wilhelm Conrad Roentgen discovered the X-Ray, which could diagnose patients unlike ever before. From there, he shaped this into radiation for cancer and soon won the Nobel Prize in Physics. Unfortunately, the course of its discovery was interfered with when it was discovered that radiation could also cause cancer (particularly blood cancers) (Anon, 2014). However, it did not stop scientists from continuing to make advances in the field: shortly into the 20th century, a type of therapy known as conformal radiation therapy (from CT scans) was a more precise method of locating cancer. Additionally, intraoperative radiation therapy was a treatment to particularly combat abdominal and pelvic cancer by minimising the amount of tissue when exposed to radiation (Anon, 2014).

It is not unusual for any cancer patient to experience effects from chemotherapy, and indeed radiation presents very harshly: nausea, tiredness, distress, and infection are inevitable effects caused by chemotherapy due to the harsh course it takes to remove almost every functioning cell from the body. This has been combated over the years with antiemetics to reduce nausea and vomiting (Divan and Royds, 2020) as well as several other clinical trials. However, it was made clear that in addition to chemotherapy and radiation, some major advances were required in order to improve the success rate of cancer treatment. Thus, oncologists are struggling to keep up with the modern-day to develop more targeted and cutting-edge therapies in this day and age. However, be rest assured that oncological trials are the number one ranking in the number of trials carried out (as of 2018), standing at a grand total of 1,112 in 2018 (Blazynski and Runkel, 2019) alone. These statistics go to show we are making progress towards the end goal: total eradication.

More modern targeted therapy and clinical trials

One group of scientists made a particularly groundbreaking discovery in reducing metastasis (cancer recurring after treatment) by inserting a drug called BBI608. This is a particularly significant exploration because ‘current cancer treatments ultimately fail owing to metastasis and relapse.’ Overall, the trial was largely successful in killing most cancer stem cells without affecting stem cells from dying. They concluded that BBI608 was a ‘novel approach’ to this issue (Rogoff, Keates, Gao, Murikipudi, Mikule, Leggett, Li, Pardee, Li, 2015).

Bone marrow transplants and stem cell research are two life-saving methods that are fast arising in cancer. In the past, bone marrow transplants were poor in terms of success rate and were about to be terminated. Even today, stem cell and bone marrow transplants result in a success rate of around 50-60% (Carrier and Kelvin, 2004), which is alarming considering the importance of these surgeries. Unfortunately, in addition to this low success rate, there is a lot of controversy towards Stem Cell research. For example, questions like ‘is it right to test animals?’ and ‘is it right ethically to clone someone?’ have arisen throughout the process. In addition, there are some serious scientific flaws to the process, which include the tumour growing somewhere else, stem cells forming tumours, and the knowledge that we are still in the clinical trial phase (Thomas, 2012). This means that stem cells are a novelty for us. Stem cells are the parts of our body that contain unspecialised cells. This means replacing it would create completely new cells that are not cancerous and potentially lead us to defeat cancer cells 100% of the time. Therefore, it has certain potential in the eradication of cancer.

Targeted therapies interfere with and block signals of cancerous cells, which reduce the amount of cell division that takes place. Whilst some trials have been extremely successful, dosing and cost (for example, the fact that it costs over $30,000 for eight weeks of treatment) hinder its progress. This is why some clinical trials are fatal in the future of therapy (Khahil, Smith, Brentjens, Wolchock, 2016). But, if finance was not a problem, this would have great potential in the fight to cure cancer.

Finally, one more clinical trial was carried out in the early days of 2007 and concluded in 2009, looking at GSK46134, a potential drug for curing advanced-stage cancers. Some side effects from this drug at higher doses included a decline in blood cells and some blood clots, which unfortunately ended the trial (De Bono, 2015).

In conclusion, it can be said that there is a mixed number of successful and unsuccessful trials around in the current day. Whilst the efforts of a team of scientists to create the BBI608 drug paid off, other trials and stem cell research are still seriously dragging behind. This puts us in a tricky situation, moving forward, as the treatment element of cancer continues to be difficult. This is mostly due to the aggressive and clever progression and metastasis of cancer, which is seriously limiting possibilities.

There are unscientific and scientific reasons why cancer has a very limited future. Some of which are purely permanent and cannot be ‘eradicated.’ Other reasons are the very peril of scientists and medics today, who are scrambling to create a cure to this awful disease.

Scientific barriers

According to scientists, there are a few main scientific reasons that have led the treatment and eradication of cancer into turmoil. The first of which is that targeting stem cells is hard (Chakraborty and Rahaman, 2012). When we target cells, all cells have originated from the stem cells, meaning the cancerous stem cells are never killed off. With this in mind, it is difficult to completely kill cancer because the cancer stem cells have the ability to ‘self-renew’ and put the body into what is known as cancer relapse (i.e., cancer comes back) (Chakraborty and Rahaman, 2012). Additionally, they could grow resistant to the drugs being given as a result of epigenetics. Prostate cancers, Esophageal cancers, and Pancreatic cancers, all extremely aggressive cancers, are challenging to diagnose for two main reasons: firstly, they are what is known as latent cancers (meaning the patient could have cancer but be asymptomatic), and the tumours start very small, giving no ‘tell-tale’ signs. Finally, metastasis is a huge problem for most cancer patients. Tumours, once killed, can still re-grow in other parts of the body, either spreading locally through the blood or through the lymphatic system (Chakraborty and Rahaman, 2012). This can happen easily, and so significantly limits the progress that can be made to eradicate it.

Financial and discriminative barriers

There are also racial and discriminative reasons why cancer treatment and eradication have been limited. These are issues that can easily be fixed, but if not, they also significantly reduce the number of possible outcomes available. The first of which is a lack of follow-up care. The average African-American cancer patient has a concerningly higher 32% chance of mortality than a white male cancer patient (Jabson and Bowen, 2013). This blatantly tells us that your race decides whether you will be treated or if cancer can be eradicated; it’s simple – if race determines your healthcare, and BIPOC people continue to get cancer, we can never fully eradicate this disease.

Additionally, cancer is missed every day in elderly patients. An interesting biopsy study was held on diseased patients over 65, and a staggering 32.5% of these patients had one or more cancer, most of which would have been fatal if their additional health issues had been dealt with (Suen, Lau and Yermakov, 1974).

Clinical trials are an extremely vital system that lead scientists to get a better understanding and idea of the kind of drugs and therapies that can cure diseases. Clinical trials in oncology are no exception. A reminder that over 1000 clinical trials in oncology took place in 2018 alone (Blazinsky and Runkel, 2019). With this in mind, it is no celebration that patients of Arizona (and indeed many other states of the US) are not receiving these possibly life-saving studies. About 20 years ago, a law was put in place in Arizona and other states that both the patient and staff had to fund these trials. Insurers also refused to cover this care, causing most of the clinical trials (which were imperative for life-saving care and advances in medicine) to be under-enrolled. As a result, a very poor and ‘flawed product’ (Olson-Garewal and Hessler, 2001) was produced, leaving much of the US without the cutting-edge possibility to make advances in cancer eradication.

These ideas show that our lack of care and discrimination is severely affecting this long and troublesome road to eradicating cancer; we forget that science does not have the only thing to do with that. Finance, race, and age are important factors but should never affect healthcare.

Conclusion

Cancer, by definition, is a disease caused by the uncontrollable cell division of mutated cells (Rosenbaum, 2011). Taking the lives of thousands of people, this disease ruins many lives and takes the lives of innocent and healthy communities. Without the quick action to find treatment and cure this disease, we are looking at a rather dim future, with around 4 million people living with cancer by the year 2040 (Anon, 2016); this is a shocking yet very real 13% of the population. Thus, cancer is the most deadly disease in the world.

But even with a cure, my question is, can we ever ‘fully eradicate’ cancer? When we look at this question carefully, we really mean ‘can we ever look at this world and not remember that cancer ever existed’? The answer is yes, we can. But what is the time frame? Is it in all countries? Is it in all cities? Is it to all species? The answers to these questions, alas, are unknown. But, due to the overwhelming scientific evidence stating that mutations are extremely hard to control and cancer stem cells are extremely aggressive, the time frame looks rather grim. In addition, the financial, racial, and age issues encompassing this disease inexplicably increase the deadline of defeating cancer. Unfortunately, this project is starting to look much more long-term than we hoped.

Cameron Davies, Youth Medical Journal 2021

Bibliography

Aysha Divan and Royds, J. (2020). Cancer biology and treatment. Oxford Oxford University Press.

Blazynski, C. and Runkel, L. (2019). 2018 Completed Trials: State of Industry-Sponsored Clinical  Development. 2018 Completed Trials:  State of Industry- Sponsored Clinical  Development.

British Medical Association (2004). BMA new guide to medicines & drugs. London: Dorling Kindersley.

Carrier, E. and Joanne Frankel Kelvin (2004). 100 Questions & Answers About Bone Marrow And Stem Cell Transplantation. Sudbury: Jones And Bartlett, Cop.

Chakraborty, S. and Rahaman, T. (2012). ecancermedicalscience. The difficulties in cancer treatment. [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4024849/.

De Bono, J. (2015). A trial looking at GSK461364 for advanced cancer. [online] Cancer Research UK. Available at: https://www.cancerresearchuk.org/about-cancer/find-a-clinical-trial/a-trial-looking-at-gsk461364-for-advanced-cancer-or-non-hodgkins-lymphoma#undefined [Accessed 30 Oct. 2020].

Gerber, D.E. (2014). Targeted Therapies: A New Generation of Cancer Treatments. American Family Physician, [online] 77(3), pp.311–319. Available at: https://www.aafp.org/afp/2008/0201/p311.html [Accessed 15 May 2019].

Jabson, J.M. and Bowen, D.J. (2013). Cancer treatment summaries and follow-up care instructions: which cancer survivors receive them? Cancer Causes & Control, 24(5), pp.861–871.

Khalil, D.N., Smith, E.L., Brentjens, R.J. and Wolchok, J.D. (2016). The future of cancer treatment: immunomodulation, CARs and combination immunotherapy. Nature Reviews Clinical Oncology, [online] 13(5), pp.273–290. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5551685/ [Accessed 21 Nov. 2019].

Li, Y., Rogoff, H.A., Keates, S., Gao, Y., Murikipudi, S., Mikule, K., Leggett, D., Li, W., Pardee, A.B. and Li, C.J. (2015). Suppression of cancer relapse and metastasis by inhibiting cancer stemness. Proceedings of the National Academy of Sciences, [online] 112(6), pp.1839–1844. Available at: https://www.pnas.org/content/112/6/1839 [Accessed 11 Mar. 2020].

Natural History of Cancer. (1959). BMJ, 1(5121), pp.563–564.

Olson-Garewal, J.K. and Hessler, K. (2001). Arizona’s Cancer Clinical Trials Law: Flawed Process, Flawed Product. The Hastings Center Report, 31(3), p.22.

Rosenbaum, B. (2011). Science of Cancer 101 | OncoLink. [online] http://www.oncolink.org. Available at: https://www.oncolink.org/healthcare-professionals/oncolink-university/general-oncology-courses/science-of-cancer-101 [Accessed 30 Oct. 2020].

Siegel, R., Miller, K. and Jemal, A. (2019). Cancer statistics, 2019. [online] Cancer statistics, 2019. Available at: https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.21551?dom=prime&src=syn [Accessed 30 Oct. 2020].

Statistics fact sheet. (2019). [online] Macmillan Cancer Support, pp.1–14. Available at: https://drive.google.com/drive/folders/1-cjdxWa06QCf2qqQQDabivxpLNubK-SI [Accessed 31 Oct. 2020].Suen, K.C., Lau, L.L. and Yermakov, V. (1974). Cancer and old age.An autopsy study of 3,535 patients over 65 years old. Cancer, 33(4), pp.1164–1168.

Categories
Health and Disease

Alice in Wonderland Syndrome: It Might Sound Like a Dream, but It is More of a Nightmare

By Cameron Davies

Published 12:06 EST, Sun October 25th, 2021

What is Alice in Wonderland syndrome (AIWS)?

Although it might sound like a fairytale filled with beautiful scenery and heavenly feeling, Alice in Wonderland Syndrome, more commonly known as AIWS, is a fatal disorder that creates hugely disorientating hallucinations and other intense symptoms.

Doctor Caro Lippman first discovered this rare disease in 1952 before it was named in 1955 by John Todd. It was defined as a neurological disease that affects the vision of young people, particularly between the ages of six and twelve. It was discovered when a six-year-old boy complained of a headache. In addition to this headache, he explained the symptom of seeing distorted objects, some of which looking further away or closer than they were as if his eyes were acting as a partial magnifying glass. He even explained that it was more prevalent during the evenings and caused intense pain. Several tests were conducted, including magnetic resonance testing and Epstein-Barr virus testing, which came back negative. As a result, no diagnosis could be made, and eventually, the child died. This is because, analytically, testing does not reveal small changes to the brain, which makes this disease devilishly hard to detect (Faroq and Fine, 2017).

What causes AIWS?

AIWS is a particular syndrome onset as a result of several different prior diseases. The first of which is known as Creutzfeldt-Jaukob disease (CJD), which affects the brain, and gradually worsens over time. It originates from a protein known as a ‘prion’ which is exceptionally infectious compared to viruses and bacteria because they cannot be treated by antibiotics or extreme heat. It causes distressing symptoms, including slurred speech, memory loss, loss of intellect, and vision problems, which get worse until it causes death as the brain shuts down. One of the symptoms caused amongst these is AIWS, as the brain’s messages from the optic nerve weaken. This distorts objects (Anon, 2021). However, this disease is very difficult to contract, and treatments are being pioneered to alleviate the symptoms and find a cure. 

There is also an additional cause known as the Epstein-Barr virus. This is a type of herpes, which is another contagious disease particularly affecting young children and transmitted via bodily fluids. In addition to causing AIWS, the Epstein-Barr virus can cause mono and other illnesses. Symptoms caused include headaches, fever, fatigue, swollen liver, and rash. This virus can also become latent, where it does not cause any symptoms but can re-emerge at different times (Anon, 2021). So far, there is no treatment for this virus and no vaccination. However, drinking plenty, taking medications to alleviate symptoms, and resting avoids contracting this virus and potentially developing AIWS.

Neurology behind it

AIWS is a very complicated syndrome neurologically, especially considering that on the initial Magnetic Resonance Imaging (MRI), Computed Tomography (CT), and serological testing, it cannot be detected. However, there are several signs which can point neurologists and doctors in the right direction in today’s world to tell them whether the patient is suffering from it, especially in combination with the description of symptoms. These include elevated proteins in the cerebrospinal fluid—the liquid around your brain and spinal cord—which could potentially be the proteins from CJD, and this was present in the 6-year old boy who was suspected of having caused CJD. 

Additionally, upon closer inspection, lower ADC levels may show AIWS. ADC level, short for the Apparent Diffusion Coefficient, measures the diffusion of water within the tissue. With less water diffusing into the tissue, this can disrupt the operation of the brain, which may cause distorted revision and headaches. These two signs are useful for scientists to detect whether AIWS has been caused in a situation where other tests come back negative, or the Epstein-Barr virus test is negative despite ongoing symptoms (Niknejad, 2016). 

Typical symptoms in more detail and demographic

As previously stated, the majority of cases seen affect young children around the age of six years, and the percentage of males is greater than that of females, though this may be due to the limited number of cases recorded of this disease. In children, a specific symptom personal to this demographic is a migraine, which typically is stronger than a headache, as well as body and object dysmorphia, the trademark sign of AIWS, as the lack of clear images with objects is seen in the story ‘Alice in Wonderland.’ 

Although the idea of not being able to see an object or body correctly seems rather harmless, and just like any other kind of hallucination, it can be extremely difficult to visualize anything when optics are so distorted, not to mention the mental deficits it can cause children, leading to going mad and psychologically unstable as a result of losing a sense of reality—30% of adolescents report these kinds of non-clinical symptoms. In addition to the mental issues, there are several physical issues caused such as nausea, dizziness, and agitation. The symptoms are also shown to worsen over time, as occurs with CJD (Anon, 2016 and Bittman et al, 2014).

Treatment options and conclusion

At this point, as with CJD and Epstein-Barr virus, there is no treatment available, despite the option to alleviate some of the hallucinations with drugs. Furthermore, because of the nature of the diseases causing AIWS, most patients who experience AIWS end up dying. However, the ICD is looking into the disease and researching possible cures with the growing number of patients contracting these neurological diseases. However, on a lighter note, 50% of patients suffer with the symptoms and lead a normal life following this syndrome (Naarden et al, 2019). It is another mystery of our incredibly weird and wonderful brain, which we are yet to understand fully, but it makes it all the more interesting and exciting.

Cameron Davies, Youth Medical Journal 2021

Reference list

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