Think of Cancer Like a Forest…
Exploring the ecological approach of two Moffitt Cancer Center influencers to understand tumor progression in cancer patients
Just What Are We Up Against?
The order and movement of physical bodies, both earthly and celestial, has maintained its throne at the center of scientific mystery since the early days of humanity. Though the wave of modern science has brought with it plenty of innovations in its swell, we still seem to struggle to conquer certain physical sciences.
Cancer treatment is a great example of such a looming mystery.
2016 brought with it an unhealthy heap of new cancer cases, at 1,685,210 separate new cases, according to the National Cancer Institute. Keep in mind, this whopping number does not even include patients who went into remission, only to experience the return of their cancer.
To combat this plague of the new era, we have poured money into research for Cancer treatments, prevention and research globally. The US alone is estimated to have spent about $125 Billion in 2010 and is slated to spend around $156 Billion in 2020 [NCI].
The resources are there. So where are the results?
There certainly are results, but to say that we are where we want to be would be a massive overstatement.
To start with an idea on just why this problem is so difficult to solve, here’s a snippet from Time’s 2011 article on the 40 year anniversary of the National Cancer Act, signed into law by (who other than…) Richard Nixon:
The disease that doctors thought they knew then is very different from the cancer they’re studying today. For one thing, scientists have a much better understanding that cancer isn’t simply one disease in which cells suddenly start to grow out of control, but rather hundreds of different diseases. In fact, according to the American Association for Cancer Research (AACR) Cancer Progress Report, cancer is actually more like 200 distinct diseases, each spurred on by slightly different causes and requiring different treatments.
- Alice Park, Time Magazine
200 distinct diseases. So how do we even start to approach a solution to such a complex problem? Or, more accurately, such a complex set of problems?
A couple prominent researchers at the Moffitt Cancer Center in Tampa, FL decided it was time to get creative with not only how we approach this complexity, but how we view cancer itself.
Getting Creative
David Basanta and Alexander R.A. Anderson explore an ecosystems approach to cancer in their publication, “Exploiting ecological principles to better understand cancer progression and treatment” for Moffitt.
This approach seems a bit reminiscent of psychology great B.F. Skinner’s approach to psychological theory, in which he explored behaviors in the animal kingdom in order to unlock underlying theories on human psychology and sociology.
Basanta and Anderson’s tactic is to think of human cell biology from the standpoint of an ecological system in nature:
The context in which genes operate is ultimately the ecosystem. An ecosystem is made of individuals (plants, animals, bacteria, independent cells,…) and the physical environment they inhabit (water, soil, oxygen, food, etc). Survival and proliferation, the only things that matter at the evolutionary level, depend on how well a cell competes for the existing resources and cooperates with other cells to produce new ones. Even a simplified ecosystem should showcase the interdependence of species and how important the interactions between them are.
- Basanta and Anderson
Noticing Both The Forest & The Trees
Taking this scope of understanding, of the interactions of life as a whole, we may understand how cells interact and ultimately survive within the human body, which acts as their surrounding environment, their forest.
The idea behind their proposal is that cells interact in the same way that animals, plants and other life forms interact within an ecosystem.
For example, in a forest, if one species experiences an inflated success rate in its survival, that species can throw off the entire ecosystem. We see this particularly with invasive species, but this can also happen with native species.
Cancer would be a native species to the body. Cancer and tumor growth is essentially otherwise healthy tissue experiencing an overgrowth which spreads and causes major problems in the body.
The body is, under normal circumstances, supposed to experience a normal, healthy ebb and flow of cell birth and cell death. But if certain types of cells become too successful, they can distort the natural order of the surrounding and related cells throughout various regions of the body.
Basanta and Anderson explain that it is now becoming widely accepted that cancer is not only based on the genetics of its victim, but on evolutionary principles. Certain cells fail to survive their environment and ultimately go extinct. Other cells, however, avoid the natural life cycles of their ecosystems and can become predatory, metastasizing regions of the body. This leads to circumstances that favor tumor growth.
What Can We Do With This?
If cancer cells metastasize in the same way as a population experiences inflated growth in an ecosystem, we can use mathematical game theory to experiment with ways to disrupt this systematic growth.
As Basanta and Anderson describe: “[Game Theory] was initially introduced to understand human and sociological behaviour. With GT we can study games in which the outcome affecting a player depends, not only on the strategy used, but on the strategies employed by the other players. A key aspect is that a game strategy is not good or bad considered in isolation. Only when compared with the strategies employed by other players can we make that call.”
If we look at tumor cells not just as isolated problems to be directly dealt with, but as parts of a complex ecosystem that we can influence in a variety of ways, then we may grant ourselves more options to preventing or stopping the growth of metastasis.
This approach is beyond using a metaphor. It extends into the nature of the body and bodies at large in natural systems. From its new perch, it unlocks a large storehouse of possible strategies that can make effective headways into combatting all types of cancer in ways that would otherwise be unexplored.
“One crucial lesson, especially when used to understand cancer evolution, is that focusing on indiscriminately destroying as many cancer cells as possible is not necessarily the best thing to do for a patient. In EGT, the long term (equilibrium) outcome of a game depends on the interactions between the players, not on the size of the population.
A treatment based exclusively on indiscriminately removing most (but not all) cancer cells may have only a temporary effect as in most cases the original number of tumour cells will eventually be restored and exceeded”.
The battle against cancer is anything but a one dimensional fight. If you clear out the cells of a tumor, they can often grow back, quickly. By focusing on just cutting down on the population of cancer cells, we also might be inadvertently affecting the evolution of the local system where the tumor was.
If we kill all of the weak members of that species, then only the strong survive, and grow back with a vengeance, causing even more problems in future treatments.
Instead of simply killing as many cancerous cells as we can, conclude Basanta and Anderson, we have to disrupt and dismantle their connections with their surrounding environment. We need to approach treatment for each example of cancer in a targeted and effective way. This would involve moving away from the “reductionism” approach, which is only trying to understand isolated, specific aspects of tumor cells.
We could take a step back and take a more, as Basanta and Anderson say, “holistic” approach to treatment and prevention, by evaluating interactions of cells from a wider scope.
It is within this larger scope that we may come to understand the behavior of these disastrous ecosystems inside of us, so that we can alter, prevent and change these interactions, to better benefit the whole ecosystem, the body.
“ We need to properly understand the trees (e.g. every leaf, twig and branch) before we can understand the forest but we cannot afford to ignore the forest because the trees are so interesting on their own.”
-Basanta and Anderson
Interested in keeping up with innovations and trends in precision medicine and health technology? You’ll get a kick out of the Health Technology Forum. Speakers for the Stanford Conference this year include many leaders throughout the precision medicine field and the panels will dive into effective, cutting edge ways to really put a dent in cancer, both in our current state and in looking towards the future.
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