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Why cancer is so difficult to treat?

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We have sequenced the human genome, eradicated smallpox, and even found a vaccine for emerging diseases like Covid-19 in record time. But after billions of dollars in research, we haven't found a solution for a disease that affects more than 14 million people and their families at any given time. 

Why is it so difficult to cure cancer?

Cancer arises as normal cells start to mutate. Most of the time, cells can detect mutations or DNA damage and either fix them or self-destruct. However, mistakes happen; some mutations allow cancerous cells to grow unchecked, invade nearby tissues, or even metastasize to distant organs. Cancers become almost incurable once they metastasize, And cancer is incredibly complex. It's not just one disease!

There are more than 100 different types, and we don't have magic meds that can cure all of them. For most cancers, treatments usually include a combination of surgery to remove tumors and radiation and chemotherapy to kill any cancerous cells left behind. Hormone therapies, immunotherapy, and targeted therapies tailored for a specific type of cancer are sometimes used. In many cases,  these treatments are effective, and the patient becomes cancer-free. But they're very far from 100% effective 100% of the time. 

So what would we have to do to find cures for all the different forms of cancer? 

We're beginning to understand a few of the outstanding problems scientists would have to solve. First of all, we need new, better ways of studying cancer. Most cancer treatments are developed using cell lines grown in labs from cultures of human tumors. These cultured cells have given us critical insights into cancer genetics and biology, but they lack much of the complexity and microenvironment of a tumor in an actual living organism. 

"Down to their innate molecular core, cancer cells are hyperactive, survival-endowed, scrappy, fecund, inventive copies of ourselves."

                 ~ The Emperor of All Maladies: A Biography of Cancer 

It's frequently the case that new drugs, which work on these lab-grown cells, will fail in clinical trials with actual patients. One of the complexities of aggressive tumors is having multiple populations of slightly different cancerous cells. It makes treatment difficult because a drug that works on one population may not affect another. 

Here's another challenge. A tumor is a dynamic, interconnected ecosystem where cancer cells constantly communicate with each other and with healthy cells nearby. They can induce normal cells to form blood vessels that feed the tumor and remove waste products (angiogenesis). They can also interact with the immune system to actually suppress its function, keeping it from recognizing or destroying cancer. If we could learn how to shut down these lines of communication, we'd have a better shot at defeating a tumor permanently.

Additionally, mounting evidence suggests we'll need to figure out how to eradicate cancer stem cells. These are rare but appear to have unique properties that make them resistant to chemotherapy and radiation. In theory, even if the rest of the tumor shrinks beyond detection during treatment, a single residual cancer stem cell could seed the growth of a new tumor. Figuring out how to target these stubborn cells might help prevent cancers from coming back.

Even if we solve those problems, we might face new ones. Cancer cells are masters of adaptation, constantly altering their molecular and cellular characteristics to survive stress. Malignant cancers are complex systems that continuously evolve and adapt. To defeat them, we need to find experimental techniques that match the tumor microenvironment and complexity and monitoring and treatment options that can adjust as the cancer changes. 

But the good news is we're making progress. Even with all, we don't know, the average mortality rate for most kinds of cancer has dropped significantly since 1970 and is still falling. We're learning more every day, and each new piece of information gives us one more tool to add to our arsenal.

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