CHAPTER 1
The Concept of Traditional Cancer Therapeutics ShouldRenew Thought and Change Conception
I. Cancer therapeutics should be established based on the understandingof the concept of cancer
After the Second World War, oncology has developed greatly at home and abroad for halfa century. The traditional three therapies and operative tumor therapy have a history of overone hundred years, while radiotherapy and chemotherapy have a history of 80 years and nearly60 years respectively. In 1980s, biotherapy and immunotherapy arose. Quite great progress hasbeen made in the curative effect of tumor and relatively better curative effect has been achievedfor many tumors, however, the curative effect of an abundance of tumors are still in extremelypoor state.
In 1985, the author made follow-up survey to over 3000 patients who had experiencedgeneral surgical and chest cancer operations performed by the author, and found that most thepatients experienced recurrence and metastasis within 2 to 3 years after the operation or evenwithin several months for some patients, from which I deeply realized that the operation wassuccessful and standard, but the long-term effective was unsatisfactory or even unsuccessful.
Since 1970s, in view of the extremely high recurrence and metastasis rate after operation,to prevent the recurrence and metastasis after operation, a series of assistant chemotherapyhas been adopted after operation or even before operation (such as mastocarcinoma), but theresults have been not satisfactory. Recurrence and metastasis still appear in or after the courseof assistant chemotherapy after operation or appear along with chemotherapy; I have observedfrom a great many of patients in our tumor special clinic that assistant chemotherapy afteroperation fails to prevent recurrence and metastasis and intensive recurrence and metastasiscauses the failure of immunologic function to some cases. The clinicians should seriously,calmly, objectively and practically consider, review, analyze and turn over to think the abovefacts. Many basic concepts and theories are still not clear and the curative effect is not high,therefore, we must make clinical fundamental research in depth and it will be difficult toimprove the clinical curative effect in case of no breakthrough in fundamental clinical research.
(I) Review of the history of traditional therapeutic method
The establishment of scientific basis of modern medicine for cancer only has a history ofover one hundred year. The traditional cancer therapeutics, i.e. three therapies, have taken shapegradually in the past one hundred years and is established on the basis of traditional modeconcept of cancer. We will briefly review the formation of traditional mode concept of cancerand cancer therapeutics of modern medicine and their contributions to anti-cancer achievementsof human beings.
The classical tumor mode concept was established based on the understanding of integratedlevel of cytology, pathology, cell biology, microbiology and anatomy and cellular level in theend of 19th century and the first half 20th century. In those days, the subjects concerning cellularlevel really accelerated the great development in medical science. They held that the tumorcells were converted from normal cells which would have abnormal formation, metabolism andfunctions after converted to tumor cells. Tumor cells grew vigorously and continuously, lackedcoordination with the whole organism of host, and disabled it from maturation to differentextent. They held that tumor originated from individual cell, that is to say, tumor was originatedfrom clone, cancer cells were able to regenerate autonomously and were divided and reproducedcontinuously, one to two and two to four, therefore, cancer cells were the arch criminal and theroot of canceration, and they must be killed. All of the cancer cells must be killed for therapy.The scientists at the beginning of 20th Century sought the method to kill cancer cells.
1. In 18th Century, distinguished doctors held that cancer was local disease and could be curedby surgical operation. In 1881, Billroth firstly performed the surgical radical operation ontumor, i.e. partial gastrectomy. In 1888, Langen Buch successfully resected pedicel bearingtumor on the left lobe of liver. In 180, Halsted performed radical mastectomy, illuminatedthe principle of en bloc resection for the first time, i.e. primary tumor was resected togetherwith local lymphatic vessel and lymph nodes, laying the foundation for the most moderntumor surgical operations. The technology of surgical tumor resection operation wasdeveloped along with the development of surgical medicines; after the middle period of20th Century, the range of tumor surgical operation became larger due to the progress inthe technology of surgical operation, a series of super radical operations, such as expandedradical mastectomy. It was proved by the practice over years that the expanded surgicalremoval range could not improve the tumor-free survival time and total survival time formost cancerous protuberances, such as lung cancer, liver cancer and cancer of pancreas.
2. In December, 1898, Curie found radium, a new trace element that she had been seeking fora long time, and obtained Nobel Prize in 1911, and radium had been extensively researchedand applied in medical science since then. However, radium had a certain lethal action. In1930s, the doctors observed that when the workers in clock and watch factories paintedthe radium pigment on the figures on dial plate, they had the habit of licking the stylus,and many of them caught bone cancer. Furthermore, Curie died of leukemia in July, 1934;unquestionably, this was the direct result of radiation of radium. It was proved by facts thatradium was quite effective to massive tumor, any tumor would shrink rapidly after injectionwith syringe needle painted with radium on the tip, and the "radium therapy" was themain method for cancer treatment for decades of years. 800-1000kV X-ray machine wasdeveloped in 1932 and cyclotron and induction accelerator were developed subsequently.Radicisotope was applied to tumor treatment step by step. At present, although theradiotherapy has certain effect on the treatment of various tumors, the effect is still notideal in general, and the main reasons of unsuccessful treatment include recurrence andmetastasis.
3. After the Second World War (1946), it is found that the cell toxicant (Nitrogen mustard) andits derivation in the chemical warfare have obvious inhibitory action on tumor, however, dueto its poor selectivity, it is called cytotoxic drug, it can kill cancer cells and kill the normalcells of host at the same time, so the toxic side effect is relatively large. The existing therapydesign is still established on the basis of logarithm value—cells—killing, which is derivedfrom growing mode of L1210 leukemia cell strain. It is embarrassing that the killing mode ofone logarithm only indicates the resistance of host rather than therapy. As to the vital cancercells, after each therapy, there are still some left and they can't be thoroughly killed.
The above-mentioned three therapies of traditional therapeutic method have madegreat accepted contributions to anti-cancer achievements of human beings. However, upto the beginning of 21st Century, cancer is still very rampant, the incidence rate of cancergrows continuously, the death rate is still quite high, and the recurrence and metastasis stillcannot be prevented, even though many patients receive normal and systematic radiotherapyand chemotherapy after operation. Why the traditional therapy cannot obviously reduce thedeath rate? Whether it is presented that the traditional therapy does not conform to the actualconditions of the biological characteristics of the carcinomatosis? What is the matter with thetraditional concept and the traditional therapy? What is the defect? How to correct the defect inconcept or understanding so as to make it more perfect and more coincidental with the actualconditions of molecular biological characteristics of the carcinomatosis?
In view that the concept of cancer therapeutics is established based on theunderstanding of the cancer concept, it is necessary to research the new progress in cancerconcept so as to research the concept of cancer therapeutics.
As to the understanding of the concept of carcinomatosis, Harvey Schipper had incisivelyelaborated it.
(II) Traditional mode of cancer
Fundamental principles of traditional mode: the contents of the traditional mode of cancercan be divided into five fundamental principles.
1. Cancer is of asexual reproduction (clone): the formation of carcinoma stems from thecanceration in the single cell, so no matter how the canceration is induced, the tumor isendowed with all characteristics of tumor by this cell.
2. Autonomy of malignant tumor: the cancer cells are continually divided and proliferated andthey do not obey the regulation and control, they are autonomous in behavior, the tumorcells grow as per the index, so it is thought that the growth rate is stable.
3. Irreversibility of canceration process: the canceration process has shown its irreversibility ina certain stage before clinic. The cellular aberration not only advances continually but alsoaccumulates, resulting in failure of treatment, as is the natural development of cancerationprocess.
4. Relation between tumor and host: the reaction of the host to the tumor is objective, however,its impacts on the natural disease process of the tumor is not inevitable.
5. It is required by the heal to kill the last cancer cell: if the canceration process is irreversible,autonomous and lethal, the only way to healing is to kill off all cancer cells. In case ofremained cancer cells, they will be proliferated again; in case of remained tumor orunapparent tumor, it is regarded that the treatment fails and the patient will meet with death.
(III) Concept of traditional cancer therapeutics
It is held by the traditional concept that cancinoma is the continual division and proliferationof cancer cells, so the treatment must target killing the cancer cells, so these three goals oftraditional cancer therapeutics are determined based on the concept of traditional mode ofkilling off the cancer cells.
The principle of current cancer therapeutics is based on the following precondition:in order to achieve the goal of heal, it is necessary to kill or eliminate the last cancer cells.As a result, people adopt the expanded operation and strengthen chemotherapy and radicalradiotherapy. However, the curative effects are not so satisfying. At the beginning of 1960s, theextent of surgical operation on tumor tended toward expansion and a series of super-radicaloperations had been developed. Subsequently, it has been proven by the practice for years thatthe expansion of extent of surgical removal of the cancer cells, such as breast cancer, lungcancer, liver cancer and pancreatic cancer, has not improved the cancer-free survival time andtotal survival time. In 1980s, the one receiving intensive chemotherapy and radical radiotherapycould not achieve the improvement of survival quality or elongation of survival time. Since thehematopiesis function and immunologic function of the bone marrow are seriously restricted,some complications endangering the life are coming out. Therefore, it is necessary to establisha new mode to probe into the cancer, strive for opening a new way and renew the concept fromthe clinical and experimental data.
The classic concept of tumor mode is derived from microbiology. Penicillin wasdiscovered by Fleming in 1929 and streptomycin was discovered in 1944. The clinicalapplication of antibiotics has played an important role in controlling or eliminating a few ofcontagious diseases and infectious diseases. Microbiology veritably protests at thoroughelimination of the exotic disease disseminators. When the patient suffers from the seriouslyinfectious disease, such as lobar pneumonia, acute tonsillitis and so on, it is necessary to killthe bacillus for treatment with antibiotics, if the curative effect is not so good, the antibioticssensitive to pathogenesis will be selected, the dosage will be increased or the combinedadministration will be adopted to thoroughly eliminate the pathogenesis. However, infection isquite another thing from tumor, the latter stems from the host body. When treatment of cancerwith radiotherapy and chemotherapy is not ideal, it is possible to increase the dosage as theanti-cancer cytotoxic drug differs from the antibiotics: (1) The anti-cancer cytotoxic drug killsthe cancer cells as well as the normal cells, inhibits hematopiesis function and immunologicfunction of the bone marrow and has the side effects on the liver and the kidney, if the dosage isincreased, the host cannot withstand it; (2) Generally, anti-cancer cytotoxic drug cannot be usedfor drugsensitive test or drug resistant test and it is only blindly administered by experiencewhile the antibiotics can be used for drugsensitive test so as to select the sensitive antibiotics.
To sum up, the concept of traditional cancer therapeutics holds the tumor is based on themaniac division and proliferation of the cells, so the cancer cells are the arch criminal, as aresult, the target of the treatment goal of the traditional cancer therapeutics is the cancer cell,namely killing-off of the cancer cells.
II. Heal shall be realized through regulation and control instead of killing
(I) Assumptive new mode of cancer therapeutics
The assumptive new mode of cancer therapeutics includes some new examples and itspredominant idea holds that cancer is a kind of disease, the regulation and signal transmissionamong the cells are disrupted instead of loss and the carcinogenesis is a continuous entity withpossibility of reversion.
The understanding of the cancer by the new mode is based on information transferand regulation and control. It is convinced that the canceration is a process of evolvementstep by step, however, it holds that they may be potentially reversed. The last step of healingthe cancer is to mobile the reappearance of the regulation and control role of the host instead ofeliminating the last cancer cells. This mode refers to the experience and phenomena of clinicallab and epidemiorlogy as well as the modern molecular biology and traditional concepts. Basedon the viewpoint of new mode, the mechanism that the cancer is healed through regulation andcontrol may be presented and other pending issues may be explained.
The cancer cells do not always differ from the normal cells greatly. It has been clearlyconvinced from the present and previous observation that autonomy of tumor is very limited.Through the clinical observation over one century and the analysis in the past 20 years, thebiological findings have definitely convinced that the cancerization course can be reversed. Wehad treated the cancer through killing off the cancer cells to the utmost extent, but we had notmade great achievements. When it looks as if the condition is controlled, new cancerization maytake place again. It has been proven by the past experience and the progress of modern sciencethat the cancer cells can coexist with the host and they do not always damage the host.
