Cancer: the Changing Landscape in 2019

Doc Gumshoe catches up on Cancer

By Michael Jorrin, "Doc Gumshoe", August 6, 2019

The publicity material for M. D. Anderson in Houston, Texas, which is perhaps the leading cancer treatment center in the United States, frequently includes a statement to the effect that they are committed to “ending cancer.”

That statement puts me in mind of maps dating from the first century AD, in which large unexplored areas were tagged with the phrase “hic leones sunt.”   Meaning, “here there be lions.”   Or, sometimes “hic dragones sunt.”   Even when the Roman Empire extended to the eastern shores of the Mediterranean, including Egypt and Palestine, there were vast stretches of the planet about which the map makers had not the slightest clue, so they tagged the unknown territory with those phrases, indicating unknown perils.   

“Cancer” as a generic phrase has some of that same connotation – a large scary area filled with dire threats.   But the cancer map has been filled in to a very great degree.   The National Cancer Institute has a list of cancer types that runs to about 200 items.   Granted, there’s a certain amount of overlap.   For instance, Kaposi Sarcoma is listed as an AIDS-related cancer and also has its own separate listing.   However, breast cancer gets a single listing; the several distinct types of breast cancer such as HER-2 and triple-negative breast cancers do not get separate listings.   And while the Mayo Clinic lists vestibular Schwannoma as a type of acoustic neuroma, the NCI list includes neither.   I did not do an item-by-item comparison of those two lists, and there are other lists besides those two.   But, as you can see, the number of distinct cancer types grows.

Evidently, the cancer map has become highly detailed, like one of those atlases that show every little village and all the interconnecting roads.   And that’s what you need to really explore the country.   If all you do is whiz by on the interstate, you’re missing a great deal.   That’s what cancer treatment was like when all that could be done is attack “cancer” as a single entity.            

No more.   For example, on the roads in our town there are little signs in front of people’s houses with the exhortation “Beat DIPG” under the name of a young child, to which is affixed the motto “We Believe.”

DIPG stands for diffuse intrinsic pontine glioma, which I had never heard of until I did some sleuthing.   Gliomas are brain tumors; pontine means that these tumors are located in the pons, which is part of the brain stem.   Intrinsic means that the tumors generally stay within the pons, but diffuse means that the tumor cells travel within the pons and sometimes into the spinal column, which is below the pons.   You may remember that what brought Senator McCain to his end was a glioma.   However, diffuse intrinsic pontine gliomas mostly affect children, including quite young children.   The child in our town who was diagnosed with DIPG is eight years old.   As things now stand, her chances of surviving longer than two years are less than 10%, and her chances of five-year survival are less than 1%.   

Nevertheless, the “Beat DIPG” slogan is not howling at the moon.  The Weill-Cornell Brain and Spine Center has established a Children’s Brain Tumor project, and clinical trials are under way in an effort to at least identify promising lines of research.   Several other research centers are investigating combination treatment using chemotherapy in combination with radiotherapy, and the National Institute of Neurological Disorders and Stroke, part of NIH, is conducting a trial of an experimental drug for the treatment of DIPG.