Book Recommendation: The Cheating Cell — How Evolution Helps Us Understand and Treat Cancer
What is cancer? Different people define it differently. To Athena Aktipis, a postdoctoral researcher at the University of Arizona, cancer is an inevitable product in the evolution of multicellular organisms. Cancer is a kind of "organism" continually evolving within the ecosystem of our bodies, subject to the same laws that govern all other evolutionary and ecological systems. Cancer arises in the course of cellular evolution, and once it arises, the cancer cells themselves keep evolving. Although multicellular life possesses cancer-suppression systems, their function is not perfect; therefore, whether now or in the future, it is impossible to find a way to control transformed cells one hundred percent.
Aktipis believes cancer cells are cunning cells, and she sets out her evolutionary perspective on cancer in a book called The Cheating Cell. Cancer cells betray some of the rules by which cells coexist in multicellular bodies: they grow without restraint, invade other tissues and organs, consume the host's resources, produce a great deal of unnecessary waste, and ultimately destroy the host, perishing together with it.
Cells continually change within the body through somatic evolution, yet the body cannot evolve the ability to completely suppress somatic evolution. The contest between these two scales of evolution ultimately produces cancer. Thus cancer is more like a biological competition in which our body's evolved capabilities lose to the cancer cells' evolved capabilities. The internal ecological environment of our bodies provides a breeding ground on which cancer cells multiply and run rampant, making cancer hard to deal with.
Even more troubling, cancer cells keep evolving in response to whatever treatments we adopt. The more survivable descendant cancer cells proliferate in large numbers; they can break through existing medical methods and also those invented in the future, continually evolving progeny better adapted to the environment. So aggressive treatment, though it seems a good idea, in fact makes cancer cells ever more powerful; most aggressive treatments shorten the patient's life.
Aktipis accordingly puts forward her view: we need a new definition of cancer, recognizing that multicellular life cannot completely escape it. We should strive to improve the internal environment rather than aggressively fight the cancer cells, work to prolong the patient's survival, and establish a new anticancer outlook.
This book is an excellent popular-science work on cancer biology. Reading it gives the reader a clear scientific understanding of the birth and evolution of cancer cells and shows how to coexist with them to the greatest extent. Modern medical research on cancer has a history of over a hundred years and has solved the cure of early-stage cancer, but it has achieved little in treating mid- and late-stage cancer; a great many cancer patients ultimately die of cancer.
People keep entering anticancer research with lofty ambitions, only to end up with nothing. Perhaps we have been wrong at the root: we treat cancer as an opponent to be eliminated, yet cancer cells are so similar to our normal cells. Trying to kill only cancer cells without harming normal cells is as difficult as finding a way to melt only the left ear but not the right. As Aktipis says, as long as multicellular life exists on this planet, cancer will not disappear. The sooner we recognize and accept this, the sooner we can use our knowledge to control it. Controlling cancer rather than curing it is a more realistic path.