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Annika Kleinhenz

Marcia Hughes

English Composition 1201

27 April 2022

Why Doesn’t Cancer Have a Cure?

Since cancer has affected millions of people across the globe for over 200 years

(Sharpless), it stands to reason that there would have to be some sort of cure. However, the

shocking truth is that no cure exists. Most people think that there is already an existing cure for

cancer, so when informed about this shocking information, people start to wonder why cancer

does not have a cure and what exactly makes it so hard to treat. Although many people think

cancer already has a cure, it has yet to obtain one due to factors such as unpredictable behaviors,

mutations forming, and its ability to spread.

Cancer, a term used to define the condition in which a person’s cells rapidly divide and

reproduce uncontrollably, has been around for countless years. However, research and studies on

it only started being conducted around the 1800s. During this era, people sought better treatments

and acquired a better understanding of its causes. In the late 1800s, advances in equipment like

superior microscopes allowed for a closer look at cell activity revealing new discoveries

covering the differences in behavior of an abnormal cell compared to a normal one. Skipping

further ahead to the 20th century, cancer treatments and support programs started to kick off. A

few examples of the accomplishments at this time were theories such as chromosomal

abnormalities as a possible cause for cancer, treatments like chemotherapy being formed and

treated as a scientific matter, and the passage of the National Cancer Institute Act which
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conducted and promoted research towards the origins of cancer and the viable solutions to how it

can be treated (Sharpless). Today, cancer research and treatments are still being perfected,

though they have come a long way. It is universally known that cancer is a consequence formed

as a result of a genetic mutation inside of a cell. The mutation takes effect on a cell’s ability to

control its reproduction rates, making it lose control and divide uncontrollably. During the

process of rapid cell division, healthy tissue is destroyed, leaving the body with failing organs

and sometimes tumors depending on the type of cancer. It was also determined around this time

that cancer can be triggered by outside factors like smoking, genetics, or purely out of chance

(Gentry).

How come with all the years of conducted research no one has found a cure yet? The

simple answer is that it is hard for doctors to say they have “cured” a patient of their cancer.

Most people think that being cured is just getting rid of or stopping something that is harming

one’s health, but that is only half of it. The definition of a cure is a disease, sickness, etc. that has

been rid of completely and is promised to never return (Bonvissuto). This means that for a doctor

to “cure” a patient from cancer they have to somehow guarantee that they will never encounter

their cancer again, which with today's technology, is not currently possible. There are, however,

a few examples that break the rules a bit (cancer being one of them) since it is impossible to

guarantee that someone will never come down with the same sickness again. For instance, if

someone recovered from a cold and is no longer feeling any symptoms, then they would be

considered cured even though they could catch another cold in the future. The same phenomenon

occurs with cancer, except it is a little stricter since it is extremely difficult to get rid of

completely. Someone is normally considered “cured” of cancer if they have remained in

remission for a couple of years on end.

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Remission is a term used to describe the state in which someone's symptoms from their

medical condition have disappeared (Bonvissuto). If a person who has carcinoma (a type of

cancer that starts in skin tissue or in internal organs) is no longer feeling any side effects, say

fatigue and nausea, then they would be in remission. Even though this sounds like someone is

cured, they are only in a state where they do not experience any side effects. Remission can

sometimes mean that someone is heading down the path of recovery, but it never guarantees

anything since side effects can easily come back at any time.

Other key terms like treatment are important when addressing cancer. A treatment is a

type of medication or medical process that is used in order to help someone recover from a

medical condition. There are innumerable existing cancer treatments, a few of them including

chemotherapy, surgery, radiotherapy, immunotherapy, photo thermal therapy, and over 100

others (Wu). Each of these cancer treatments work differently and have their own methods to

fight cancer. They do, however, share a common goal of shrinking the number of cancerous cells

or slowing them down in one way or another. For instance, chemotherapy is the use of

medication given through an injection, swallowed, applied on the skin, etc. which then hunts any

type of cell that rapidly divides. Once the medication finds the cells, it destroys them or prevents

them from further multiplying (Brinkman). Radiotherapy on the other hand, takes a completely

different approach. High doses of radiation are used to target cancer cells and change their DNA.

In doing so, cancerous cells can no longer divide or repair due to the damage inflicted upon them

by the doses of radiation (Ogasawara).

Well, so what if cancer treatments all work differently? How does that correlate to

finding a cure, and how come out of the hundreds of treatments there isn’t a cure? While there

are numerous treatments, each with its own massive subcategory of specific drugs and methods
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for fighting cancer, there is an equally considerable number of responses that someone’s cancer

can have because of each treatment. This is simply because out of the hundreds of cancers that

exist, each one acts differently and has its own unique side effects and behaviors. With those

different behaviors, there comes a messier issue when dealing with the interactions between

cancer and treatments. As a result, it becomes increasingly difficult to predict how well a

treatment will work against a specific type of cancer. A good example of this is OCCC (Ovarian

Clear Cell Carcinoma) which is a rare type of cancer that spreads throughout someone’s vital

organs. When dealing with this cancer, doctors usually prescribe radiotherapy or a combination

of optimal cytoreduction and chemotherapy as a treatment. Over time it was discovered that

OCCC tends to resist chemotherapy so the use of it alone as a treatment has decreased; however,

there is a suitable alternative for this specific cancer. Radiotherapy helps treat OCCC while also

having higher chances of avoiding recurrences, which is a relapse of someone's cancer

(Ogasawara, 3). This proves that cancer can have a unique reaction to different types of

treatments, but because cancer is unpredictable, this pattern is not how it plays out every time.

For instance, there are some instances where neither chemotherapy nor radiotherapy have

worked when treating OCCC. There are of course some treatments that work better than others,

but they can sometimes fail since there is no guarantee that a treatment will work every time. On

top of this, factors like age of the patient, age of the cancer, size of the cancer, gender of the

patient, etc. all are required to be accounted for before prescribing a treatment. With all this in

mind, it becomes extremely complicated and difficult for doctors to predict how someone's

cancer will react to a type of treatment. This leaves little room for doctors to find a cure, let alone

a new treatment that has a good success rate.

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. (Ragaz, Joseph. et al) Fig. 1.

This graph compares the number of relapses that occurred to patients treated with both

chemotherapy and radiotherapy and those treated with just chemotherapy. It shows how the

relationships between cancer and its many treatments can differ greatly.

As stated earlier, not a single cancer treatment is guaranteed to work, and depending on

the situation could even end up making someone’s cancer worse while also maintaining

unwanted side effects. An example of this is when someone develops a second cancer (someone

who is already diagnosed with cancer developing another unrelated type of cancer) because of

the treatment(s) they received. In fact, “Radiation therapy was recognized as a possible cause of

cancer many years ago.” This was theorized based off studies done on survivors of an atomic

bomb in Japan, people that work in jobs that expose them to radiation, etc. (Wyant). Of course,

radiation therapy has worked for some cancers that require smaller doses of radiation, but it is

definitely not meant for all types of cancer. Other treatments like chemotherapy and targeted

therapy can also cause second cancer, which can result in patients and doctors rejecting those

treatments depending on the patient's condition. Side effects are also a slight issue with

treatments. For instance, the drugs in chemotherapy target any cell that divides quickly, so hair
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and nail cells will slow or stop growing altogether. More serious side effects like anemia also

tend to occur when someone is given chemotherapy (Yale Professors). These are only some of

the side effects of chemotherapy, but they need to be taken into consideration or someone could

have a negative reaction that could have easily been avoided. For instance, someone who has low

blood pressure should not be prescribed a treatment that has anemia as a common side effect.

Treatments for cancer are constantly being improved, but despite the constant efforts,

there are still unwanted downsides in every treatment. There is not much a doctor can do about

side effects since every medication has them, but the efficiency of a medication can be improved.

Referring back to OCCC, phase 3 of the experiments conducted on targeted therapy for OCCC

“showed that addition of bevacizumab to conventional TC chemotherapy followed by

bevacizumab maintenance improved PFS significantly.” (Ogasawara, 4). In summary, when

bevacizumab (a medication used in chemotherapy and targeted therapy) is combined with TC

Chemotherapy (a treatment where chemotherapy medications are scheduled in a certain order in

the time span of 12 weeks), then the estimated success rate of the treatment working increases

since the amount of time that someone lives with cancer after or during the treatment being

prescribed decreases. While the improvements are slowly making cancer an easier fight to win,

they are still not enough and have a long way to go before being considered a “cure”. There is

also always the other side of the success rate where the treatment will fail for some patients,

moving them towards other treatments that also have a chance of failing. Additionally, the

improvements made for a single treatment might work on one type of cancer, but it will not

affect all of them. This, among other factors, is precisely why doctors have trouble creating a

“cure”.
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Recurrences are also a major issue when it comes to treating cancer, and it is one of the

main reasons why doctors cannot necessarily say they have “cured” a patient of cancer. The

basic definition of a recurrence (also known as a relapse) is when cancer that was thought to be

“cured” or was undetected returns (Ogasawara, 3); this places the patient’s healing process back

at square one. There are a few categories of relapses which depend on if the cancer appears in the

same spot as it was before, or if it shows itself in a completely new location. A local recurrence

is when the cancer reappears in the same spot it was before; a regional recurrence is near the

location it was before, and a distant recurrence is when the cancer appears in a completely new

location (Patel). Some cancers have a greater tendency to go into a relapse than others do, but it

can happen to anyone at any time. Recurrences can appear anywhere within a week to a couple

of years after the patient's primary cancer receives treatment (Patel). Usually when a relapse

takes place, doctors prescribe what is called a follow-up plan to help find out what treatments

would be suitable. It is possible to be “cured” of a recurrence, but it is equally possible that

someone does not ever recover.

Recurrences occur due to cancer cells hiding or relocating in a different part of the body

to then multiply enough to where the cancer and the symptoms return. Cancer cells can hide

from both the body’s immune system as well as prescribed treatments. The immune system

detects cell-surface molecules that will warn them if there is a possible threat to one’s health, but

“when cells called phagocytes and B cells recognize cancerous cells, they activate T cells, which

trigger events that destroy cancer cells. However, cancer cells that have reached the “escape”

stage no longer possess the molecules that show they are dangerous” (Beer). When this occurs,

the B cells fail to recognize the cancerous cells and no T cells are activated, causing later issues.

One of those issues is that it can cause a recurrence, as stated earlier, which increases the
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difficulty and effort it takes for treatments and doctors to clear every single cancerous cell. As a

result, it gives the few cancer cells a chance to relocate (or stay in the same location) and rapidly

divide, growing back in larger numbers and into a tumor depending on the type of cancer.

Essentially, cancer cells can avoid being attacked by the immune system by putting up a defense

against T cells from detecting their presence.

Cancer not only escapes the immune system, but it will also distract/inactivate it in order

to protect itself. Cancer cells are able to achieve this through many methods, one being that they

create molecules that shut down immune system’s ability to function. “They also change their

local environment, so it becomes a hostile place for immune cells to work. Once the tumors have

changed their environment, any circulating killer T cells that arrive in this space are rendered

inactive,” (Beer). In doing so, cancer is fighting back against the immune system, making it even

more difficult to get rid of completely.

However, the immune system is not entirely useless when facing cancer. If the number of

cells and or the size of a tumor are both small enough, then the immune system can hold its own

against cancerous cells. This unfortunately does not last forever, as the cancerous cells divide at

a faster rate than the immune system can handle. Luckily, there are treatments to help support the

immune system and fight back against cancer. Immunotherapy does just that; it works with the

immune system and helps detect and attack cancer cells. Immunotherapy accomplishes this by

“releasing the breaks” in the immune system’s cells so they can work more efficiently and faster

than before. The most common medication used for immunotherapy is checkpoint inhibitors.

Their job is blocking the proteins released by cancer that slow the immune system (Beer). Like

every other cancer treatment, checkpoint inhibitors cannot be used for every type of cancer and

only really specialize in treating a few types of cancers like melanoma type cancers, lung
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cancers, and sometimes kidney cancers. There are also greater restraints on all treatments,

including immunotherapy, which means that no treatments are guaranteed to work.

Immunotherapy helps T cells become more active, but it will not always go as planned and like

every other treatment, can fail.

Relating to how cancer has learned to attack the immune system, cancer has learned to

adapt in a way so it cannot only defend against treatments but fight against them as well. This is

another key issue and factor to why it is so hard for doctors to eliminate cancer. Cancer has

resisted various distinct types of treatments, some examples being chemotherapy, radiotherapy,

and targeted therapies, and it is hard to predict where and when resistance will occur. Resistance

can occur as a result of multiple causes, though the most common cause results from a slight

mutation in a small or large group of cells that then multiply, passing on the resistance genes to

other cells (Wu). After those cells grow in numbers, the treatment that was originally being used

is no longer of use. This means that the cancer cells and the tumor are now resistant to the

treatment that was being used. When a relapse/recurrence has occurred, it is common for the

original type of cancer to become immune to the treatment that was originally used. It can also

go the other way around; sometimes cancer can start resisting a treatment then go to reform

tumors to cause a recurrence (Glimcher).

Intrinsic resistance is another way that cancer can resist treatment. Intrinsic resistance is

the natural resistance to a certain type of antibiotic or treatment (Glimcher). When this happens,

doctors usually take note and avoid prescribing the type of medication or treatment that the

cancer is already resistant to (they will also do this during a relapse).

There are other methods for cancer to resist treatment besides mutations and intrinsic

resistance. In most cases of chemotherapy failure, it is due to resistance from long term
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administration also known as MDR (Wu). One of the many ways that cancer can resist treatment

is when cancer cells use p-glycoprotein to quickly push the administered drug out of the cell at

the same pace as which it was entering the cell (Brinkman). This can cause cancer to not have a

large enough effect on cancer (if any) for the treatment to damage cancer. There is also the

possibility that cancer cells shut down their protein that transports the treatment’s drug across the

cell wall, meaning that they don’t take the drug at all (Brinkman). When this happens, cancer

does not have the chance to feel the effects of the treatment, therefore rendering it useless against

cancer. Other methods of resistance are when “The cancer cells may learn how to repair the

DNA breaks caused by some anti-cancer drugs.” and “Cancer cells may develop a mechanism

that inactivates the drug.” (Brinkman). There are plenty of alternative ways that cancer can resist

all kinds of treatments, which gradually becomes a bigger problem the more times it occurs.

Usually when cancer starts to resist a treatment, the next step is to put that patient on a

different type of treatment. Although that problem might be solved in the future. Researchers are

currently figuring out ways to overcome or at least slow resistance. An example of a possible

solution is the method of combining cancer drugs. One method is to distribute drugs that use two

opposite molecular mechanisms (Glimcher). By doing this, the number of cells killed increases

while also minimizing the probability of resistance occurring. “Another approach is to treat

patients with drugs that block the particular mechanism of resistance their tumors have

developed, and then treat them again with the drug to which they grew resistant.” (Glimcher).

The goal is to re-sensitive the patient to their original treatment by combining drugs. Although

these experiments have yet to show a result, currently, patients with cancer are still facing the

problem of resistance to treatment.

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From the definition of a cure to the issue of resistance to treatment, there are multiple

reasons why doctors have yet to find a cure for cancer. When diagnosed with cancer, someone

must wait at least a couple of years before they can be considered “cured” and that is considering

how it bends the rules a bit. Recurrences and resistance also serve as a roadblock to finding a

cure since it is difficult to find a treatment that can destroy all cancer cells in one round while

also fighting back against cancer resistance. All these factors plus the complicated and unique

behaviors of each patient’s cancer have contributed to the difficulties of getting rid of a patient’s

cancer. There are many improvements in the making, and hopefully someday one of those

improvements involves a universal treatment or, better yet, a cure.

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Works Cited Page

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Cancer Research UK - Cancer News, 12 Apr. 2021,

https://news.cancerresearchuk.org/2019/02/28/science-surgery-why-doesnt-the-i

mmune-system-attack-cancer-cells/

Bonvissuto, Danny. “Is There a Cure for Cancer?” WebMD, 17 May 2020,

https://www.webmd.com/cancer/guide/cure-for-cancer

Brinkman, Curtis. et al. “How Can We Tell If Chemotherapy Is Working?” Chemocare, 2022

https://chemocare.com/chemotherapy/what-is-chemotherapy/how-to-tell-i

f-chemotherapy-is-working.aspx

Gentry, Marilyn. “Why Haven't We Cured Cancer Yet? Our Experts Have the Answers.”

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cured- cancer-yet/

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https://www.cancer.gov/about-cancer/treatment/research/drug-combo-resistance

Ogasawara, Aiko. et a l. “Current and future strategies for treatment of ovarian clear cell

carcinoma.” Wiley Blackwell, September 2020, Vol. 46,

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Sharpless, Norman E. “A Historic Perspective.” Cancer, 2022,

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treatment#:~:text=Some%20of%20the%20most%20common,all%20canc

ers%20and%20cancer%20treatments