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Rethinking Tumor Growth | Part 1 - Where Does Cancer Begin?
I have shared my thoughts on tumor growth and cancer without a unifying framework. If you have ever had the nagging thought that the current cancer paradigm is incomplete, this is for you.
Setting the Stage
When discussing cancer with most people, including colleagues, it quickly becomes apparent that we approach the topic from entirely different perspectives. This disconnect is often evident on the faces of those I converse with - puzzled, confused, and perhaps even wary.
"What is this person talking about?"
To illustrate the reason for this, consider the following definitions of cancer:
Wikipedia defines cancer as "a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body."
The American Cancer Society describes it as "a group of diseases in which cells in the body change and grow out of control. Most types of cancer cells form a lump, or mass called a tumor."
These definitions are consistent across virtually every mainstream source of medical information.
Excluding certain malignancies like leukemia and lymphoma, cancer is generally characterized as starting with an abnormal cluster of cells that can proliferate, become locally malignant, and eventually metastasize to other parts of the body. This concept forms the foundation of the modern oncology paradigm.
Cancer is understood to:
Begin with a limited number of cells
Grow out of control and eventually cause death
Our treatment approach is based on this framework:
Identify malignant cells
Surgically remove them
Apply chemotherapy and radiation as needed
Why this framework?
The answer is a little complicated.
To a great extent, modern western medicine takes an egotistical view of the body.
In this perspective, there is the individual, complete with well-defined boundaries. Everything else is considered foreign.
For instance, immunology is frequently taught with a militaristic approach. The immune system produces foot-soldiers (white blood cells) responsible for patrolling borders and detecting foreign intruders.
Upon identification, these foot-soldiers combat the invaders while simultaneously alerting the immune system to add the foreigner's fingerprint to its database for continuous surveillance.
This concept is particularly evident in infectious disease, where the body is perceived as being invaded by foreign entities that must be eradicated using drugs.
Though the list goes on, this unspoken belief structure pervades much of modern medicine's thinking and has seeped into our comprehension of cancer as well.
Cancer diagnoses are typically confirmed visually. Even if a blood test initially indicates the presence of cancer, the subsequent step involves locating the cancerous cells.
This process requires a series of visually confirmatory tests including radiologic imaging, endoscopic evaluations, and tissue sampling for microscopic examination.
And, would you look at it!
Does this tumor look out of place?
This alien-appearing entity seems to be growing out of our normal body. But, how did it get there?
Unfortunately, numerous fields in medicine, including oncology developed alongside genomics.
Historically, this has resulted in the study of oncology being significantly influenced by the genomics industry. The genomics sector is highly lucrative, via research grants, diagnostic tests, and treatment approaches – all wildly expensive.
As a consequence, if genomics were to dominate any field of medicine, it would become a financial goldmine for many.
That is precisely what has happened.
Cancer research rapidly embraced the idea that tumors arise due to genetic mutations. The theory suggests that a randomly placed mutation may adversely impact a gene responsible for promoting or inhibiting cell growth.
If both are affected, we are off to the races.
Throughout the history of cancer research, several such concepts have been proposed, with the two-hit hypothesis being a commonly taught concept.
This is how most people studying and treating cancer perceive the process:
x → Mutagen → Mutation → Tumor → Cancer
This narrative is compelling and has gained significant traction.
What's the problem?
This story fails to thoroughly examine the causal chain of events.
Where did the mutagen (the agent causing mutation) come from?
Solve for x.
A Short Story
The implications of my perspective on cancer may face considerable pushback, primarily because it challenges the application of science within medicine.
Having clarified the dominant view of cancer, I'd like to propose an alternative framework for understanding tumor growth.
But first, a brief story.
The nervous system is my specialty. I studied it in undergrad, conducted lab research in medical school, and specialize in it as a doctor.
I probably see 40+ brains a day.
One day, I discussed glioblastoma with a highly experienced and well-regarded neuropathologist from the Ivy League, surrounded by his trainees and staff - all fluent in mainstream thought.
In neuro-oncology, there's a belief that glioblastoma is incurable. Regardless of the tumor size and the extent of brain tissue removed, the tumor always comes back.
The pathologist remarked, "You cannot resect enough brain."
The underlying assumption is that gliomas are incredibly infiltrative, growing into crevices between normal brain tissue in such an imperceptible and indolent manner that complete removal is impossible, thus preventing a cure.
This is the doctrine regarding glioblastoma.
On that day, I posed a simple question to the neuropathologist:
We assume that these tumors start from a central core of abnormal and malignant cells, and grow outward.
Could it be that what we are witnessing is a diffuse state of illness throughout the brain, and this diseased state is converging at a point in the brain that we see as a tumor?
If that were the case, how would we even know?
No one has ever asked me that before.
It is a plausible interpretation, and I don’t know how I would go about distinguishing which phenomenon is happening.
Immediately, his other staff and trainees chimed in.
“Well, we know that’s not true because tumors derive from a single cell line.”
and, so on.
Credit to this man, who is on the brink of retirement, for having the depth of understanding and awareness to tell them:
“None of what is being implied is negated by these objections. We do not have the information to exclude this possibility.”
Implications & Next Steps
To this neuropathologist’s credit, he knew exactly what I was implying.
Have you ever watched a video of a gigantic ocean wave growing out of what seems to be a relatively docile body of water?
We see the wave.
We don’t perceive all of the preconditions that lead to the formation of that wave. Seismic activity, shorelines, undercurrents, impact of celestial bodies, atmospheric changes and so on.
All of these background preconditions have to be present for such a wave to manifest visually and physically.
Our vision, our hearing…all of our senses operate within a spectrum.
We see visible light. Not ultraviolet. Not infrared.
We hear a specific range of frequencies (Hertz). We don’t hear radio waves, nor microwaves.
There are thresholds that must be crossed for us to be aware of a phenomenon.
Imagine you are looking at an ocean horizon. That horizon is the threshold.
You see a wave above that threshold as a result of what has happened below it.
This is how we perceive.
Tumors are no different.
We detect tumors visually, metabolically, and biochemically using thresholds.
We do not see below the threshold. That’s noise to us.
We don’t see all that is happening that leads to the manifestation of a tumor.
Even if you insist that cancer is explained by the gene-mutation model, remember…
This is the story:
x → Mutagen → Mutation → Tumor → Cancer
Solve for x.
In Part 2…
Now that we have reviewed how cancer is viewed in the mainstream medical literature, and provided a thought experiment to approach the problem of tumor formation from a new perspective…we need to dive into the reality of tumor growth and the experimental evidence.
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