[tansey]

PI at a cancer center here. These two ideas are not mutually exclusive. Cancer is indeed not 1 disease but many countless ones. At the same time, cancer diagnoses are based on site of origin and histology (how it looks under a microscope). But often what drives a cell of one tissue toward pathogenesis is the same mutation or other molecular malfunction as a cell of another tissue type. In those cases, we can develop drugs that target that specific component and it may work across both cancer types.

Unfortunately, there are countless ways things can go wrong in cells. There are also rarely drugs that truly span a large swath of cancer types effectively. That's because even though two cancers from different sites may have the same driver, how they respond to treatments can differ. The difference in cell state may allow one of the two cancers to adapt to the treatment, such as by activating an alternative growth pathway, whereas the other cancer type's cell of origin may not have such an easy road to therapeutic escape.

[BobbyJo]

Also, maybe, the fact that what cancer cells have in common, they tend to also have in common with cells that aren't cancer, and therefore make poor targets for therapies.

[caymanjim]

That's kinda a defining characteristic of cancer. It's your own cells, so your immune system doesn't recognize it as foreign and take care of it. Just about anything that targets cancer targets the non-cancerous cells it started in. Most chemotherapy boils down to "kill it all and hope the cancer dies before the non-cancer, and leaves enough non-cancer behind to keep you alive". There have been a lot of advances in targeted cancer treatments, but even most of them just selectively target the type of cell (healthy or not) that became cancerous, and do less collateral damage to "innocent" cells. It's incredibly hard to target an individual cancer, and so far impossible to target cancers broadly.

[ijidak]

So, my question is why isn't fasting a partial solution?

It's kind of the same idea as chemo. (Non-selective cell stress/death)

But won't cancer cells always starve first, as they don't have a way to go dormant?

Or is that a myth?

[bart__]

I'm no expert, but I know cancer cells promote adding blood pathways towards them, so it might be that they have an "uneven share" of the nutrients transported to them, and thus die out later than the healthy tissue.

[caymanjim]

I don't know anything about cells going dormant as a result of fasting. That sounds questionable to me. There's been some research on fasting and cancer, but there haven't been a lot of studies, and results are inconclusive. Some of the ideas sound sensible. Cancer cells are incredibly greedy and slurp up glucose as they constantly divide. The thinking is that you can starve them and slow progression, in conjunction with chemotherapy and other treatments. It's not widely supported or practiced and more study is warranted. It's hard to find real information on it, because the idea that you can miraculously cure cancer and other diseases by changes in diet is embraced by millions of anti-science crackpots, so there's a ton of disinformation and speculation out there.

[Terry_Roll]

> So, my question is why isn't fasting a partial solution?

With a statement like that, it would seem that you know a thing or two!

Care to elaborate?

[ramraj07]

So what you’re summarizing is that cancer is definitely a single disease with multiple types but there are commonalities. Which makes sense. Which is why I never bought this “we can’t cure it because it’s not one disease”. We can’t cure it because we aren’t smart enough.

[thaumasiotes]

> Which is why I never bought this “we can’t cure it because it’s not one disease”.

Really, in an important sense, cancer isn't one disease because cancer isn't a disease at all. It's a mechanical malfunction, kind of like having a cleft palate.

On the other hand, it is more disease-like than most mechanical malfunctions.

[projektfu]

Perhaps you have an overly narrow definition of the word disease? Cleft palate is, in my opinion, a congenital disease. A fractured bone is also a disease.

I have a cancer, a basal cell carcinoma. Like other cancers, it's a transformed cell type with dysregulated growth. But, it's likely to be completely excised surgically, unlike pancreatic adenocarcinoma, which would likely kill me in a few months.

[thaumasiotes]

> Perhaps you have an overly narrow definition of the word disease?

I'm intentionally highlighting here a definition of 'disease' that is much narrower than the norm, yes.

> A fractured bone is also a disease.

On the other hand, you're trying way too hard to correct that. Nobody considers a broken bone to be a disease. A broken bone in your leg is not fundamentally different from a broken rock outside your leg, and -- more importantly -- this lack of difference is easily understood by everyone.

But while e.g. diabetes is not caused by external agents, it looks from the outside just like other types of problems that are. This leads to both types of problems being called "disease", even though the radical difference in how the problem occurs means that the treatments and ways of thinking that apply to one type are not appropriate for the other type.

Diabetes is purely mechanical, and if you take measures against it, you can suppress its effects. It will never fight back or attempt to circumvent your efforts. Malaria is purely external, and if you take measures against it, it will take countermeasures.

Cancer is an intermediate phenomenon. It is not caused by external agents. But it is alive and may respond to measures taken against it -- it consists of part of yourself 'going rogue' and becoming as malicious as an external agent.

This intermediate status suggests that approaches from either end of the "disease" spectrum might be fruitful. One of the biggest problems we have in dealing with cancer is that we want to treat it as a malign external agent to be removed from the body, as would be appropriate if it were really a disease. But while there are many effective tools to do that for diseases, they all fail badly in a couple of different ways when the "disease" is indistinguishable from the rest of your self.

[projektfu]

I think you should maybe come up with a new word. You're heavily overloading terms that have medical definitions with your own meanings, and expounding an alternative philosophy of medicine, which is fine but shouldn't depend on semantics, perhaps.

[thaumasiotes]

> and expounding an alternative philosophy of medicine

What?

[hervature]

No, they wrote:

> Cancer is indeed not 1 disease but many countless ones.

[ramraj07]

No, they do what most cancer researchers do, which is wrap the truth around so much bullshit that you can read it however you please. I’m also not an amateur, I spent most of my PhD studying cancer drugs.