Biology of Cancer

"I considered the renowned textbook, The Biology of Cancer by Robert Weinberg , which I highly recommend if you have some background knowledge of biology—but it’s still a textbook. Then I remembered the Rebel Cell by Kat Arney. Arney is a geneticist and science writer, and I would say that Rebel Cell is more a biography of cancer than The Emperor of all Maladies . The book is also very much in line with my own perspective on cancer. We both build on a fundamental evolutionary understanding of life, but whereas Arney goes deeper with regard to cancer biology, I aim to explain cancer in a broader medical, philosophical, and societal context. Rebel Cell explains how cancer is fundamentally related to multicellularity. We are multicellular organisms, and our bodies have not evolved to live forever: they are temporary vessels to propagate the germ cells and, more specifically, the genes to the next generation. In terms of evolutionary biology, that is why we get cancer. We are multi-cellular organisms, and the somatic cells of our body are there to do a job. They’re like the worker ants in an ant colony, where the queen is the germ cells that are going on to the next generation. So the value of this book is especially for this evolutionary perspective. As the author says, this is where the modern understanding of cancer is going, and it changes the perspective from this ‘enemy’ that we are going to eliminate to understanding that cancer is a consequence of aging and our multicellular nature. It is an integral part of who we are and what it means to be human. In fact, almost all animals are organized in this manner, and they all get cancer. And the longer they live, the more likely they are to get cancer. I meet many cancer patients, but not as their doctor. I’m purely academic now but these issues are highly integrated with working in the field of medical communication, behavioral medicine, and medical education. It is important how we talk about disease, and how we talk about cancer. But you make a good point. If I were a clinician treating cancer patients, I wouldn’t say things like ‘cancer is really a success story.’ Oncologists say to me, ‘What you’re saying isn’t something we can say to a cancer patient getting a diagnosis and being in shock.’ As I write in Making Sense of Cancer , understanding cancer as an evolutionary phenomenon isn’t very helpful for parents who are losing their child to leukemia. Yet, many cancer patients say that the book has helped them understand and accept the disease. Some even say that it made them less afraid of dying. Support Five Books Five Books interviews are expensive to produce. If you're enjoying this interview, please support us by donating a small amount . The hard reality of cancer may be unpleasant, but in a debate about society, about healthcare and technology we have to raise these questions. There is a time for everything, and the context matters. In the beginning, I was worried about talking about my book to cancer patients, but they are perhaps more receptive to this message than the medical community, which is so invested in curing the disease. There is this attitude of: ‘We should fight cancer by all means. What you’re saying is defeatism, you’re giving up the fight.’ But I think more and more people are realizing that this is not the way it works. The better we get at curing cancer, the more cancer there will be. Why is that? We need an explanation. A lot of people just assume that, ‘It’s because of all the toxins, we’re eating the wrong food and everything in society is wrong.’ There are a lot of conspiracies, ‘They’re trying to poison us’ or ‘Big Pharma is hiding the cure because they make more money this way—they would lose so much money if they found the cure.’ It’s amazing how many people actually believe that. But then you explain it in a sensible manner and say, ‘No, this is because we are now living a lot longer than before. It is an almost insurmountable dilemma and paradox. How will this end? What is going to happen? It is modern medicine that is responsible for the cancer epidemic.’ Yes, but not in the way they believe. People are trying to do good. Biomedicine is trying to keep people alive because that’s what all of us want. We’re the driving force. Every single one of us wants to live healthily for as long as possible, and we’re willing to spend almost anything to achieve that. That results in more older people with more disease. There is no simple solution to the problem, but we can’t pretend it isn’t happening. No, not at all. How the environment and lifestyle factors drive cancer development is a key aspect of the book. The evolutionary perspective on cancer is all about gene-environment interactions. Yes. We get cancer from living. The tougher we live—with tobacco and alcohol and unhealthy food and sunlight—the more we accelerate the process. But even if we live our lives as perfectly as possible and do everything right, if you’re unlucky, you can get cancer in your 40s or as a child. Mutations can happen in the wrong place, at the wrong time and the longer we live, the more likely they are to happen. We need to understand this. The body is a living community of cells, an ecosystem. Our cells are living entities that evolve in different directions. We’re back at Rebel Cell… ."