Why Scientists Need Darwin To Win The Cancer War

Cancer is cleverer than scientists have given it credit for. This is not exactly encouraging to hear, but accepting this "fact" might just help them find their way out of the cancer quagmire.

This is an exciting and important piece because it is the latest in a series of articles that talk about how treatment and diagnosis of various diseases needs to be fundamentally re-categorised based on evolutionary science and genetics. A growing group of scientists believe cancer too is a disease of evolution. Yes, cancer is not a "being", but it evolves and adapts to new challenges and environments. Come to think of it, this is typical of the beast. You believe a tumour has been tackled, but more often than we like, it recurs—many times stronger than before.

Scientists are now discovering that the traditional view of cancer, where a cell picks up mutations, divides uncontrollably and turns into a tumour, is too linear to be true. In reality, tumours are a “seething mass of varied cells, all with their own mutations”. Cancer is diagnosed by a biopsy, but a single sample can and does miss mutations with different implications just centimetres away. When tumours are hit by radiation or drugs, artificial selection may occur, creating a breeding ground for tougher tumours. And thus, a relapse. Over time, the fittest of these produce descendants and dominate again. This is the very core of Darwin’s natural selection.

A better visual to imagine cancer is that of a tree with many branches, believes oncologist Charlie Swanton who, along with his team, is following 850 patients as part of the ambitious TRACERx (Tracking Cancer Evolution through Treatment).

Cancer, as the author puts it, is a target with many bulls-eyes that shift position whenever struck. For scientists, accepting this incredible complexity is half the battle won. Winning it entirely depends on how well new techniques, such as "liquid biopsy", that aim to understand (and curb) cancer's evolution work.