It is said that anyone who plays sports, avoids the sun and does not smoke, protects themselves against cancer. Prevention is important, but that’s not all. In two-thirds of cancer cases, lifestyle does not matter. Prof. Mathias Heikenwälder from the German Cancer Research Center in Heidelberg explains how cancer develops and why promising therapeutic approaches often fail in practice.
- Cancer is such an insidious disease, according to one expert, that it will take decades for us to understand how it works and find effective ways to overcome it.
- Prof. Heikenwälder believes that in the case of about 30-40 percent. oncological patients the disease was influenced by an inappropriate lifestyle. However, as he emphasizes, there are always many factors that must be considered in conjunction with each other
- The researcher believes that one of the greatest challenges for medicine is treating liver cancer. «There are no pain-carrying nerves in the liver, so a sick liver does not hurt. By the time a tumor is found, it is usually advanced »
- More information can be found on the Onet homepage
Author: Birgit Herden / The World
Birgit Herden, Die Welt: Health Minister Jens Spahn announced in 2019 that cancer could be beaten in the next 10-20 years. He has been criticized for this by various scientists who fear it will give people false hope. What can cancer researchers realistically achieve in the next two decades?
Prof. Mathias Heikenwalder: In 10-20 years, we will certainly understand many things better and have better weapons to help more patients. We’ll also learn more about which preventive measures really work. It is assumed that one in three cases of cancer could be prevented by leading a healthier lifestyle. But cancer is an extremely heterogeneous and complex disease, there is no such thing as “cancer”. I think it is very unlikely that we will overcome many manifestations of the disease in the next 10 years.
The rest of the text below the video.
What happens in the body when a cancer grows?
A cell dividing in an uncontrolled way can cause a range of genetic changes. There are various security systems to prevent this from happening. For example, cells typically only divide when they receive a signal from growth factors. However, some mutations damage the signal transducer in the cell and thus permanently activate.
Another security system is programmed cell death – damaged cells commit suicide so as not to harm the body. However, this mechanism can also be obscured by errors in DNA.
Another control mechanism is our immune system, which recognizes “foreign” cancer cells, but these cells can also bypass them. If several mutations come together, a degenerate cluster of cells develops, becomes structured and supplied by blood vessels. It infiltrates healthy tissue, displacing it and even depriving it of some nutrients.
Do we know how such mutations take place?
We know some of the factors that contribute to this. These include carcinogens, environmental factors such as lifestyle. For example, in Germany, many people have fatty liver without even knowing it – and they can develop liver cancer from there.
Fatty liver can be caused by too much alcohol, but it can also be caused by an unhealthy diet and lack of exercise. The constant supply of nutrients causes oxidative stress in the liver, chronic damage and inflammation. Due to liver damage, continuous cell death occurs, which must be compensated for by increased cell division – chronic regeneration itself can lead to increased mutations.
In addition, other factors contributing to the development of cancer are also known – mainly smoking, excessive drinking of alcohol and viral infections, which can be prevented today by vaccination.
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Are people to blame for themselves if they develop cancer?
This is about 30-40 percent. all neoplastic diseases. We now know, for example, that about 50 years ago, the incidence of breast cancer associated with certain genetic defects was lower than it is today. Unhealthy lifestyle causes women with the same genetic risk to develop breast cancer more often and earlier. For some types of cancer, it is not always possible to clearly identify the causes. Basically, it is always a matter of the interaction of several factors.
Each year in Germany, nearly 500 people are diagnosed with cancer. people. Despite more and more effective therapies, every second person dies of it.
Research into liver cancer is part of your research work. Why is the prognosis for this type of cancer usually so bad?
There is no effective therapy for liver cancer. There are no pain-transmitting nerves in the liver, so a sick liver doesn’t hurt. By the time a neoplasm is found, it is usually advanced.
Mutations and pathways that can lead to cancer have been studied for decades. There has always been hope that, based on this knowledge, certain active substances could be used to target cancer cells in a targeted manner. Why doesn’t it work in practice?
In the treatment of liver cancer, there is an active ingredient in the late stage called sorafenib. It inhibits tyrosine kinases, cell growth signals that can be stably activated in cancer cells. Sorafenib therefore inhibits the growth of cancer cells and their supply to blood vessels. However, even targeted drugs can hit healthy cells in the body, so unwanted side effects occur. Sorafenib gives the patient an average of three to six months of extra life, but there is nothing to be said of a cure.
Why isn’t the drug helping in the long run?
Because cancer cells are constantly changing and adapting, as in an evolutionary process or when creating resistant pathogens. Most cancer cells can be caught in one treatment, but there are always a few that survive and then multiply again. This is also one of the reasons why the tumor is not always the same in the patient – instead we find different types of cancer cells with different resistance strategies.
In addition, we increasingly understand that cancer cells not only differ at the genetic level, but are shaped by their immediate environment and therefore have different properties. It is important to understand how this heterogeneous multicosm can be most effectively treated.
The great hope in treating cancer comes from immunotherapy, in which the body’s immune system is activated to kill cancer cells. Why doesn’t this method help with liver cancer?
Immunotherapy is a new weapon in the arsenal against cancer, but it is not a magic bullet. It has brought tremendous strides in the treatment of certain types of cancer in cases that were once hopeless. There is also some promising short-term research into liver cancer. However, like the brain, the liver is an “immunosuppressive” organ – this means that anti-cancer immune cells cannot penetrate here and work well.
Overall, there are still many unresolved issues with immunotherapy, and sometimes expectations are unrealistically high. An example of progress may be improvement in 30-40 percent. patients, where in the case of older therapies it was only 10-15 percent. However, we do not focus on how 60-70 percent are doing. patients who did not respond to therapy. In some cases, their quality or life expectancy may even deteriorate.
How can we predict which patients will and will not respond to therapy? How can we better match the type of therapy to the patient? These will be important questions over the next 10 years.
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