What IS Cancer?

It may seem like a silly question. But a lot of people don't know.

I remember thinking of cancer as this vague mysterious thing. An oozing cloud seeping through the body. A kind of creeping death. When we grew up, cancer was hidden behind whispered voices (as in the memorable dinner scene from St. Elmo's Fire), shrouded in tense mystery.

The problem with mystery is that the unknown is intimidating to all of us. Lack of knowledge leads to guessing, forecasting and positing based on emotions (in this case, fear) instead of facts.

Jodes and I have always felt we were better fighters when we were armed with the facts. In our first go-round in 2001, we studied countless web pages. Jody read 7 or 8 books, maybe more. I read a couple as well. We got multiple opinions from different doctors at every stage of the process. We felt (and still feel) that being well-versed in the actual mechanics of the thing was going to help us immeasurably. And day-to-day, I find that the ability to name the beast, the familiarity with its tendencies, the knowledge of its weak points....these things give me hope. Because it's no longer a mystery. It's just a problem to be solved.

So what is cancer?

Cancer is, essentially, a cell that divides without stopping. It's a cell that doesn't know when to quit.

Most cells which divide have "instructions" built into them that let them know they can stop replicating. For example, when you get a cut, your blood cells coagulate and create a scab over the area. But when the area is covered to a depth of a layer or two, they slow way down. They don't spread over other parts of your skin or form a tower on the surface. Evenutally, as dead cells flake off the outside of the scap, new ones are being built underneath. And when the area is healed, they stop replicating altogether.

That's what normal cells do. They stop. Cancer is different because it doesn't stop.

I first learned this years ago when I auditioned for the part of the doctor in Margaret Edson's excellent play, Wit. This was the scene I had to prepare:

JASON: (agreeing) It is. It is awesome. How does it do it? The intercellular regulatory mechanisms—especially for proliferation and differentiation—the malignant neoplasia just don't get it. You grow normal cells in tissue culture in the lab, and they replicate just enough to make a nice, confluent monolayer. They divide twenty times, or fifty times, but eventually they conk out. You grow cancer cells and they never stop. No contact inhibition whatsoever. They just pile up, just keep replicating forever. (Pause.) That's got a funny name. Know what it is?

VIVIAN: No. What?

JASON: Immortality in culture.

VIVIAN: Sounds like a symposium.

JASON: It's an error in judgment, in a molecular way. But why? Even on the protistic level, the normal cell-cell interactions are so subtle, they'll take your breath away. Golden-brown algae, for instance, the lowest multicellular life form on earth—they're idiots—and it's incredible. It's perfect. So what's up with the cancer? Smartest guys in the world, with the best labs, funding—they don't know what to make of it.

So there you have it. Cancer, more than anything, is a mistake—one we haven't figured out how to correct yet. What it isn't is some malicious beast hiding behind the closet door or under the bed, breathing, waiting to take us down. It's just a bunch of stupider-than-normal cells.

Knowing this has helped me a lot. It has made the problem seem more solvable, logical. Because there are lots of ways to kill a cell, and lots of ways to inhibit a live cell from replicating. We just need to find the right ones.