HEALTH: WHAT IS CANCER? By Professor Shima Gyoh (Retired Professor of Surgery)

 

WHAT IS CANCER?

By Professor Shima Gyoh (Retired Professor of Surgery)

Cancer  is a word nobody likes, nobody even wants to hear! It strikes anxiety, fear, even despair in some people. Mention it, and many run for cover, usually under Religion. Nevertheless, it is always an advantage to study your enemy, know exactly what you are up against. Therefore, bite your lip, let’s go!

You can understand cancer best if you have a foundation in biology, the study of living things. It tells us that one of the most important properties of life is the ability to grow and reproduce. We all start life as ONE CELL, just visible under the microscope. That one cell multiplies in NUMBER, reaching billions, quadrillions by the time we become adults. It’s a miracle! But more! It DIFFERENTIATES into many, very different tissues! Some of it will become muscle, some bone, some thick lubricative fluid in joints, some the photosensitive light receiver (retina) of the eye and some thinking brain tissue! It is most surprising, but we are all used to it.

For this to happen after millions of divisions with no mistakes, that one cell, the original one, must have had a blueprint on which, no matter how many times it multiplies, is accurately passed on to its new “babies.” The blueprint is called the GENOME of the cell. It consists of tiny units called genes, strung together like beads on a necklace on structures called CHROMOSOMES. For every property exhibited in the adult, there is one or more genes that code for it. They are usually dormant until it becomes their turn to work, almost like Nigerian politicians taking their "turn" at the Presidency! For example, a new born will develop as a baby, a toddler, a child, and when it reaches the age of puberty, the puberty genes will suddenly switch on and produce the appropriate effect, e.g. the anatomical and other complements of puberty, like breasts, the start of menstruation, the growth of a beard. The process is so accurate, so good, so reliable! Unfortunately, mistakes do occur!

For the gene in me to produce exactly the same effect in my son, it must retain the exact anatomy and action it had in me. But that would be if it does not change after multiplying thousands of times! Some changes DO OCCUR, but if they are very small, the effect, if any, is not noticeable. On the other hand, if the change is very gross, the cell will die, and many cells are lost this way. If however, the change is slightly off the mark, the gene will still act properly, but a little differently. Maybe it made me short, the change in my son might make him tall. This is why children are never the exact copies of their parents. Incidentally, in genetics , instead of “change,” we use the synonym “mutation.”

Trouble starts if the mutation is not big enough to kill the cell, but gross enough to acquire new properties, like excessive growth beyond the needs of the body, and no longer responsive to the body’s control. It grows into a tumour! The mild form of this disorder produces tumours still recognisable as resembling the tissues of the body (lump of fat, cyst in breast, fibrous tissue) and they stay in one place, we call them “benign.” Some mutations, however, go beyond that to produce tissues that do not resemble anything in the body (undifferentiated), and can break off and grow in other places, we call them “malignant.” They escape the body’s control mechanisms and have little branches like the claws of a crab (cancer = crab) penetrating the tissue beyond where the main lump is. To completely remove them, you must also cut the normal looking tissue near them to ensure you include the “claws.” These are the features of cancer. Our immune system kills and removes all cells looking strange, but occasionally few escape and cause trouble.

The living body’s activities of growth, repair and reproduction do produce a background of mutations in cells, including some potentially cancerous. But for their clearance by immune cells, cancer would be more frequent than it is. Nevertheless, the cells of older people have been dividing for a longer time, and this may explain why the rate of cancer increases with age in humans, in addition to the immune system of older people being a bit weaker. The cells of big animals divide more times, and that increases the chances of cancer arising. We therefore have two conditions promoting the appearance of cancer: first, age and second, size. The elephant is enormous. The blue whale has about 1000 times more cells than a human being, and can live for 90 years, bowhead whales live up to 200 years!  Cancer in these animals should be much more frequent than it is in man if age and size are important as we have argued. Wrong! Cancer hardly ever occurs in elephants and whales, and our argument is also correct! This anomaly is called “Peto’s paradox” after the epidemiologist, Richard Peto who first noticed it in 1975.

Peto’s  paradox is caused by special genetic fortification of the fight against cancer. The body has a special cancer suppressor gene called p53 dedicated to a mechanism that seeks out and destroys cancer cells as soon as they arise. Research has revealed that, while we humans have only one pair of the p53 gene, the elephant has 20! No wonder! Each p53 gene usually has two halves (alleles), each half inherited from each parent. Children born with only one allele die young with multiple cancers. Fast developments and discoveries are going on in genetics, and sooner or later, the p53 gene will be artificially produced, but only in countries that appreciate the academia.

 Certain factors increase the rate of dangerous mutations. Ultraviolet radiation, which is part of sunlight can damage DNA, the basic unit of protein that makes up our bodies. We call it “ionising radiation” because it dislodges “ions,” basically electrons from DNA, making it acquire abnormal properties including cancer. Albinos are people who lack ability to produce melanin, the skin colour that prevents this radiation from penetrating to the deeper, live and sensitive growing layers of the skin. They have a high incidence of cancer of the skin. Other examples are X-Rays, beta and gamma rays. When strong enough, they can cause physical burns and unwanted mutations. Now you know why people taking your X-ray in the hospital wear heavy lead aprons that the rays cannot penetrate, and in addition run to hide behind thick walls before switching the machine on. You have only one brief harmless exposure, but they are constantly there and must not be over-exposed.

 The radiation from nuclear bombs is so powerful that if it does not kill immediately, it can damage genes and produce cancer in many subsequent generations: children, grand and great-grandchildren and even beyond. The people of Japan are still suffering from the two atomic bombs dropped on their “ancestors” 77 years ago.

Cancer cells grow fast, so the dose of drugs and radiation are adjusted to kill all fast growing cells without cooking the patient! Unfortunately, the speed of growth of some normal body cells is almost the same as that of cancer cells and they too get knocked, e.g. skin (rashes, hair falls out), and in the gastrointestinal tract, (diarrhoea). We see these as complications of cancer treatment.

In a short essay like this, I cannot talk comprehensively about the symptoms of cancer. If you do not feel well and are losing weight, it is time to go for a medical check-up—in Nigeria. Any of our doctors still left in the country can do it competently.

Beware! Talking of cancer can produce cancer-fear, and some people begin to feel psychological symptoms. These are difficult to manage. Reassure them and they will think you are not taking them seriously. Do tests and they might suspect you of hiding the bad results from them. If you find something and tell them, they will go to others, seeking someone who would to tell them there is no problem. Some people refuse to take their problems to a doctor for fear of being told it is cancer.

 The arena is full of people claiming “natural” preventive diets and curative concoctions. They include the fruits and vegetables we know, but other exotic nostrums are also offered. While some disparage scientific medicine, they still use modern medical terms to impress their audience. Most of all, they are full of confidence on concoctions and processes that have not undergone any analysis to identify active ingredients or subjected to trials to prove their safety and efficacy.

 I do not at all condemn these “natural” or “traditional” medical approaches at all. Modern scientific medicine started like that, and the drugs and healing methods were subjected to analysis and clinical trials. Many were found good and standardised, but others were found of no effect and discarded. This is the scientific age, and there is no excuse for working blind on human health. They should open up to the scientific method: analysis and clinical trials. Those that pass the test should be included in the medical armaments for fighting disease and human suffering.

 If you have the confidence that your drugs and methods are really efficacious, you will not fear tests and clinical trials. Afraid others will steal your secrets? You can protect your financial interest by taking a patent on your intellectual property. Anyone using your methods will have to get a license from you. Those doing so without the license would be liable to prosecution and will have to pay fines.

Source: Dr. Olanrewaju Shoyinka (FARSPON)