Why Did Cancer Develop?

Why did cancer develop? This question needs answers. Why did only two people out of three in my family develop cancer? I must admit that we were both of the same age, just three months apart; but genetically totally different-one was of North Indian descent, the other a Maratha-Kerala combination. It was certainly not genetic-no one in either family had had similar cancers. So what had gone wrong? What were the common factors we shared, besides age?

This discussion may be in the realm of speculation, but it needs scrutiny and awareness. Neither of us smoked, drank or was obese. So where had we transgressed? Was it the food we ate? Was it the environment we lived in? A combination of these factors? Or was it simply a coincidence? The human body is made up of millions of cells with many different functions. Similar cells come together to form tissues, these tissues form organs, and different organs work together to form organ systems. There are many such organ systems that work in agreement with each other, in perfect equilibrium with the mind, to form a healthy functioning body. It is much like an orchestra, where different sounds from the various instruments blend together to produce the perfect euphony that is so uplifting. Somehow, this harmony can be lost and a disease like cancer can take root.

The Development of Cancer

Cancer is, possibly, the unfortunate by-product of evolution. Our complicated structure makes us vulnerable to disease. Human development begins from a single cell . Exponential cell divisions result in the formation of our complex anatomy. The formation of organ systems requires many signals, along with the natural trimming of unwanted cells by the process of 'cell death' or apoptosis, to arrive at the final product-a human. It is a miracle how a single cell first becomes a mass of cells and then forms a hollow structure that will form all the organs of the body. Nine months later, a formed baby emerges with all its organs in place—all from that original, single cell. The organs may be the tube-like structures of the gastrointestinal system or the heart and blood vessels, or the diverse group of solid organs such as the liver, kidney, spleen or brain-each distinctly different in structure and function. The entire process is controlled by the many biological signals from the cells that operate like clockwork, controlling the size, shape and placement of the various developed organs of the body.

All these structures, once completely developed, require maintenance to deal with the regular wear and tear that occurs during life. The various bodily functions are maintained at a constant rate by a process of cell division that replaces non-functional or senescent cells by functional ones, as and when required. This process is complex. A pathway of signals 'switch on the multiplication. During this ‘switch on', for whatever reason, some cells may get corrupted during cell division, leading to the development of abnormal or mutated cells. These are autonomous cells—completely out of control, and not influenced by the 'switch off' signals from the surrounding normal cells. They continue to multiply even after all the necessary replacement has been completed It is the proliferation of these abnormal cells over a long period of time which leads to the development of cancer. Cancer cells are a law unto themselves.

They have an unstoppable momentum, enabling them to multiply in an unrestrained manner. One of the genes that control accidental cell growth, p53, undergoes change in its genetic structure in many types of cancers. The p53 gene is also known as the ‘guardian of the genome' and is one of the most common targets for genetic alterations. A little over fifty percent of human cancers have a mutation of this gene. The p53, the ‘molecular policeman' that prevents the proliferation of corrupted cells and regulates several hundred genes, either thwarts the cell cycle (see p. 32) or triggers cell death (by apoptosis). Loss of the function of the p53 results in DNA damage that goes unrepaired, and mutations accumulate. Usually, the biological surveillance of our body protects us by destroying the corrupted cells and keeping us out of harm's way. Failure of this biological surveillance leaves a tiny number of wayward cells that continue to grow unchecked. When these damaged cells multiply repeatedly, they produce a clone of abnormal cells which may march towards cancer formation.

To begin with, the cancer cells in a given tumour are similarly mutated. However, over time, as the tumour continues to grow unchecked, more and more mutations take place as all controls are lost. The resultant tumour is not only larger, but it has cells which are genetically more diverse, making it difficult to target during treatment. This may also be a factor responsible for the development of drug resistance during treatment (see p. 38 in ‘Drug Resistance'). The main concern which began this chapter was that two members of the same family had developed cancer in organs sensitive to hormones, suggesting that somehow extraneous hormone-like substances played a role. These extraneous hormone-like substances are called xenoestrogens and are widespread in the environment.

The Causes

Doctors treat the cancer but do little to determine why responsible? Xenoestrogens from pesticides affect us when we consume chemically-grown, non-organic fruits and it occurred. What were the toxic chemicals present in our body at the time of diagnosis that may have been directly released vegetables, from farm animals fed contaminated foods, and from plastics used in packaging. These toxins were virtually non-existent before World War II. Now they seem to be everywhere.

Man-made chemicals are all around us—from pesticides to cosmetics to baby bottles to computers and cell phones. It is impossible to determine how many of us are contaminated by these bio-accumulative and toxic substances! During their manufacture and use, these chemicals are into the environment and absorbed by animals and humans alike. Due to slow degradation (or no degradation at all), they accumulate in our bodies, particularly in the fat. They are 'endocrine disruptive' chemicals which interfere with hormone systems in animals and humans, causing cancer, reproductive problems and damage to the DNA.

This is a bit like the DDT story. Dichloro-diphenyl- trichloroethane or DDT is a chlorinated hydrocarbon that remains in the environment for an indefinite period of time, without loss of potency. It was a synthetic insecticide first manufactured in 1940, and widely used to combat malaria, typhus and other insect-borne human diseases, as well as pests in crops, livestock and homes. Compounds such as DDT have reportedly caused massive loss to bird life, adversely affecting reproduction in some species. We belong to the generation which was overtly exposed to this chemical. It was considered the wonder solution that controlled mosquitoes by regular, liberal sprays both outside and sometimes inside the house. It even briefly eliminated malaria from India in the late 1980s. At that time, no one was aware of its toxicity.

However, a high concentration of this compound has been found in the tissues of individuals exposed to it. DDT breaks down slowly. Today, it is banned in many countries for being carcinogenic. The rising incidence of cancer may be linked to many factors. In 2014, the WHO suggested three important causes: environmental pollution, pesticides and excessive consumption of refined and processed foods. 11 Overnight, it may not be possible to change the environment we live in, or remove the pesticides completely from our food chain. After all, the soil is contaminated by them. But we can control and modify our diet.

The extent of this contamination is far-reaching. Polar bears eat large fish and seals. These, in turn, eat smaller fish, which eat even smaller fish. When the smallest fish have been contaminated by pesticides, so have the polar bears, even though they never left their pristine environment. They are at the top of the food chain just as we are, and like us, they have also been hit by pesticides.

Till not so long ago, Kanpur, Faridabad and Varanasi were among the most polluted cities in the world, and the situation is worsening every winter. 12 Therefore, there is no doubt that the air we breathe is foul, full of sulphur dioxide, carbon monoxide, ozone, nitrogen dioxide, lead and particulate matter.

What about our water supply? Even our most sacred river, the Ganges, is nothing but an open drain. Its waters are contaminated by sewage, chemicals, heavy metals and pesticides. What percentage of these substances remain in the water we drink? Or in the water we use for irrigation- which further contaminates our crops? The answer remains unknown. There is no check on the chemicals contaminating the soil, which are used for the cultivation of crops. Despite overexposure to many more carcinogens in our environment, the incidents of lung, colon, breast and kidney

cancers are much lower in India than in the West. Something is clearly working for us. Is it the thousands of gods we have or is it the food we eat? Could something in our diet, something which we haven't given much thought to, be protecting us?