Global Journal of Surgery and Surgical Research

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Cancer is a group of diseases characterized by the existence of an abnormal proliferation of malignant cells. What gives this cellular proliferation its malignant characteristic is its ability to invade organs and tissues and spread far from its origin.

Since the time of Hippocrates [1] and even before, ancient [2] Greek physicians clearly understood the ways in which a malignant tumor carries out its inexorable determination to destroy life. Based on what their eyes and fingers perceived, they gave a very specific name to the hard tumors and ulcerations that they so frequently saw in the breasts, protruding from the rectum or vagina of their patients. To distinguish these tumors from ordinary swellings, which they called oncos [3], they used the term karkinos or “crab.” Centuries later, “cancer,” the Latin word for “crab,” began to be commonly used.

Until the middle of the 19th century, it was thought that cancer killed stealthily and silently. Today we know that this is not the case because we have discovered a different personality in our old enemy when we see it through the microscope of contemporary science. Cancer, far from being a clandestine enemy, is revealed to be possessed of a malignant murderous exuberance. Spreading from a central point, the disease relentlessly carries out a scorched earth campaign in which no rules are respected, no orders are obeyed and all resistance is annihilated in an orgy of destruction. Its cells act, if we do not remedy it, like members of a frenzied horde of barbarians who, without leaders and without control, only pursue a single objective: to plunder everything within their reach. This is what doctors and researchers call autonomy [4,5]. Cancer is autonomous, it runs free. It is not controlled by the organism and it does not control itself. In the community of tissues and organs that make up the human being, the uncontrollable mob of cellular misfits that is cancer behaves like a gang of violent teenagers (due to their cellular immaturity). They are the juvenile delinquents of cellular society.

A tumor cell is one that at some point has lost its capacity for differentiation, a term we use to designate the process that cells go through to reach a healthy maturity. A fully mature cell of the intestinal epithelium, for example, absorbs nutrients from the intestinal cavity much more effectively than it reproduces; a thyroid cell fulfills its function by secreting hormones, but tends less to reproduce than when it was young. The analogy with the social behavior of the whole of an organism like ours is unavoidable.

The development of cancer cells stops at an age when they are still too young to have learned the norms of the society in which they live. As with so many immature individuals of all species, everything they do is exaggerated and without regard to the needs and limitations of those around them.

Because they are not fully developed, cancer cells do not participate in some of the more complex metabolic activities of mature, non-malignant tissues. A cancer cell in the intestine, for example, does not assist in digestion as its adult counterparts do; the same is true of almost all other malignant tumors. Malignant cells concentrate their energies on reproduction rather than on the tasks that a tissue must perform to sustain the life of an organism. The bastard children of their overactive (asexual) reproduction lack the resources to do anything other than cause trouble and constitute a burden on the industrious community they inhabit. Like their parents, they are reproducers, but not producers. As individuals they constitute a danger to the conformist, balanced, and peaceful society that constitutes the human body.

Cancer cells do not even have the decency to die when they must. All of nature recognizes death as the normal stage of the normal maturation process. Malignant cells do not reach that point: their longevity is not finite.

By not knowing and respecting the rules of human biology, cancer is amoral. By not having any other goal than the destruction of life, cancer is immoral. These misfit teenagers turn their anger on the society (human body) of which they are a product. They are a street gang with only one goal: to spread panic, destruction and self-destruction. If nothing or no one prevents them, they destroy the neighborhood that supports them and, therefore, themselves. Cancer is asocial.

Until the beginning of the 20th century, cancer was synonymous with death. This is no longer the case. We have known for some time that a large part of cancers are predisposed by genetic (family), social and environmental factors. We can influence primary prevention, that is, in those people predisposed by their family or socio-environmental background, follow them and control them to avoid its development or in early detection if cancer appears. Once cancer is detected, we have different medical-surgical arsenals for its treatment, depending on the type of tumor, its stage of development and dissemination. These weapons are surgery, immunotherapy, chemotherapy and radiotherapy; complementary and combined with each other. Today, in a significant percentage, we cure cancer. Cancer can be cured depending on the tumor stage at the time of diagnosis, the tumor strain, the age and morbidities of the patient. In those circumstances where the disease is in an advanced stage, we can try to make it “chronic”, to prolong human life, which until a few years ago meant certain death in the very short term. In the 21st century, when faced with cancer, we can give life and at the same time quality of life. The conceptualization of cancer is changing. We know that the solution lies in detecting risk groups for its development and through immunotherapy to prevent its appearance. Therefore, once this situation is reached, there will probably be no cancer. In the scientific community, we are clear that in future generations, terms such as surgery, chemotherapy, radiotherapy and palliative medicine will be obsolete and historical words in medicine related to cancer. This statement is not only a hope or a wish, but is based on the development of biological and medical science.

References

1. Littré MP (1861) Oeuvres complètes d'Hippocrates Baillière 1861.
2. Lonie IM (1981) Hippocrates the iatromechanist. Medical History 25: 113-150.
3. Tsiompanou E, Marketos SG (2013) Hippocrates: timeless still. Journal of the Royal Society of Medicine 106: 288-292.
4. Andre F, Ismaila N, Allison KH, Barlow WE, Collyar DE, et al. (2022) Biomarkers for adjuvant endocrine and chemotherapy in early-stage breast cancer: ASCO guideline update. Journal of Clinical Oncology 40: 1816-1837.
5. Zhou H-M, Zhang J-G, Zhang X, Li Q (2021) Targeting cancer stem cells for reversing therapy resistance: Mechanism, signaling, and prospective agents. Signal transduction and targeted therapy 6: 1-17.