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Wilkommen to my blog - my name is Karin Purshouse, and I'm a doctor in the UK. If you're looking for ramblings on life as a junior doctor, my attempts to dual-moonlight as a scientist and balancing all that madness with a life, you've come to the right place. I'm currently a doctor/research trainee in oncology after spending a year doing research in the USA. All original content is licensed under a Creative Commons Attribution 4.0 International License.

Sunday, 4 January 2015

Cancer - just an accident?

Four years ago, when I was doing my science degree in London, I went to my local florist to buy a bouquet of peonies for a departing colleague.  As I was in my fifth year as a student by this point, independent floristry was usually beyond my budget, so I relished the pooled funds that facilitated this acquisition (flowers are probably the one and only luxury item that I get squeaky about - they add so much sparkle).  At the end, the florist insisted on giving me a discount - 'you're doing cancer research - it's so impressive that you're working towards a cure'.  

Even then, I was sceptical.  Now, I am possibly beyond hope of a 'cure', a magic bullet.  And this article hit the headlines recently, and I feel it explains the source of all of those concerns. 

The Beeb reported on a Science paper with the headline 'Most cancer types 'just bad luck''.  In essence, it's an article which showed that 2/3 of cancers are caused by chance mutations, with the remaining (and that's a significant) third being due to lifestyle factors.  I guess I was a little surprised to read this, but on deeper thought, it's actually amazing that the balance is not more in the direction of random bad luck.  When one considers all the cells in the body (thats a few trillion, btw), all replicating at varying rates, some dying and being replaced by new ones, enough to sustain us for a lifetime.  And every time a cell replicates, it's got to make an EXACT copy.  And just like all of us, sometimes there's a mistake.  Some mistakes are harmless.  Others, not so much.  Cells have got a whole bunch of ways to scan for mistakes and erase them.  Cancer is essentially what happens when the mistake IS harmful and something happens which means the corrective system has gone wrong.  

So, there are a whole bunch of 'mistakes' that can happen, and equally there are a lot of steps in the 'identify-to-remove' repair pathway that can go awry.  Kind of amazing, PHENOMENAL, that it doesn't go wrong more often.  Some people are unlucky and inherit a gene which speeds this bad luck up - such as people with a BRCA gene mutation (like Angelina Jolie) who have a greater risk of certain cancers because they have lost part of the safety net.  

But how on earth can you a) know ALL the possible pathways which led to the cancer, b) work out which parts of the pathway went wrong and c) find a way to fix it?  And that's assuming it's one single thing that's bad enough to make cancer happen - what about if it's a team event involving multiple genes, multiple pathways, multiple errors?  

Snow in Connecticut
Clearly I don't think it's all hopeless - otherwise I wouldn't be so passionate about the research I'm doing.  This is ultimately what targeted therapy is all about, but I hope I've painted a picture of why 'curing cancer' is such a big ask.  It's not so much finding a needle in a haystack as throwing a needle into one and hoping it'll find the one green straw you laid in there.  Maybe we just need to change the language we use - rather than wanting a cure, how about 'living with cancer' - so it's not a fatal death sentence?  I was recently asked at an interview what specific area of cancer I was interested in; and it's not by accident that I have sidestepped to brain tumours as a research interest.  Imagine if patients with brain tumours, or pancreatic cancer, or small cell lung cancer, could just live with their disease rather than die from it?  I carry the patients I have cared for with these diseases with me, as a reminder of what we are trying to achieve, and it makes the goal less scary.  

'Cure' just makes me think that everyone is waiting for the single answer to the Cancer Question.  But what the article described above serves us to remember how blimmin' amazing the body is that we survive at all, and therefore what a huge wall cancer has placed before us.  But walls are made of many bricks rather than just the one; so perhaps chipping away and redefining the goal is a more achievable aim?

Perhaps this seems like a heavy post to kick off 2015 with, but as I approach a time of year which will forever be difficult for me and reminds me why I am in America, it is more designed to reiterate how incredible life is at all.  So go do something awesome to launch your New Year.

I'm not sure I could love this more. My latest contribution to quotation tennis, RH!

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