Cancer diagnosis: no more death sentence

Cancer is often seen as a disease of modern times. Yet that is not so. Cancer has been described for thousands of years before Christ. And the first anti-cancer drugs, often herbal mixtures, also date from that time. The chemotherapy as we know it today, its advance begins in the 1950s.

In 1943 the Germans bombed the harbor of the Italian city of Bari. An American ship with mustard gas on board was damaged. People who became infected with the gas had a dramatic drop in white blood cell counts, while the rest of their tissue appeared unaffected. The doctor who observed this thought that mustard gas might well be used in the treatment of lymphoma and leukemia. With that, chemotherapy was born.

Since that first discovery, scientists and pharmaceutical companies have not been idle. Diagnosis techniques have improved enormously, as have medicines and treatment methods. At present, 5 years after diagnosis, nearly 60 percent of patients are still alive. About 50 percent of all people with cancer are cured!

1962 First official chemotherapeutic agent

The Swiss company Roche launched the very first ‘official’ chemotherapeutic drug: fluorouracil. “This drug against stomach and colon cancer is actually a very simple substance,” says Prof. Dr. Peter Huijgens of the VU Medical Center in Amsterdam. “It is very similar to uracil, a building block of our DNA. If you attach fluorine to it, you get a false brick, as it were. If it is built in during a cell division, the entire cell falls apart. This is particularly the case for rapidly dividing cancer cells. of. They can no longer reproduce and die.”

Numerous other chemotherapeutic agents were subsequently discovered. Nevertheless, according to Huijgens, we should not write off the old medicines: “In the past we often only knew that a certain medicine worked, but we did not know exactly why.” In recent years, it has become increasingly clear how these resources work, and that is precisely why they can still be used. Huijgens: “Now we know, for example, which dose and which frequency works best, whether or not in combination with other medicines. We can also better recognize and treat infections during treatment. This has ensured that the chance of survival in many cancers has increased enormously. In recent years.”

1976 new diagnostic techniques

Before the CT scan was introduced, doctors could only feel whether there were abnormal lymph nodes in the case of lymph node cancer, for example. The computed tomography (CT) changed this: it gives a picture of the internal body, and tells about the size and shape of organs and tumors. “A huge advance for the diagnosis of many forms of cancer,” says Huijgens. But the scan is not ideal. “Tissue that looks abnormal on a CT scan can contain cancer cells, but it can also be scar tissue. The PET scan introduced later can make that distinction.”

Positron Emission Tomography (PET) shows the metabolism of cells. Because cancer cells divide at lightning speed and therefore have a high metabolism, they can be clearly seen on a PET scan. “Over the years, the images from the CT and PET scans have improved enormously. The camera makes cross-sections of the body. In the beginning, those cross-sections were every few centimeters. Today, cross-sections are made every few millimeters, so that a much more accurate picture of the body.”

1994 The first blood vessel inhibitor

Meanwhile, other ways are also being discovered to make it difficult for cancer cells to keep dividing uncontrollably. Among other things by inhibiting new blood vessels around the tumor. It had been discovered long ago that tumors were able to grow blood vessels towards them and thus provide themselves with oxygen and nutrition. If this process could be stopped, cancer cells would die. “Because without food and oxygen, no cell can live,” says Huijgens.

The first blood vessel inhibitor was applied by a surgeon who had lung cancer patients who could no longer be operated on – too many metastases. He gave them the substance thalidomide, better known as softenone. The surgeon got the idea because of the softenon scandal: pregnant women who used this drug had children with short arms. According to the doctor, this was because the blood vessels were not properly constructed. The drug indeed appeared to make the metastases smaller.

“Entire series of these types of drugs were subsequently developed, the so-called angiogenesis inhibitors,” says Huijgens. “Well, sometimes successes are due to courageous people with seemingly insane ideas.” What the surgeon did by feel, the pharmaceutical industry did on the basis of research. At the time the surgeon administered thalidomide to his patients, several pharmaceutical companies were already busy developing angiogenesis inhibitors. This resulted in the first official drug in 2004.

1998 Immunotherapy for breast cancer

For more than a hundred years, attempts have been made to fight cancer by turning on the patient’s own defenses. In the beginning with often disappointing results. But improved diagnostics make it possible to better map the properties of a tumor. “Tumours are more and more accurately classified into groups,” says Huijgens. “In the past, the diagnosis was simply ‘breast cancer’. Today breast cancer divided into different types. And that makes a big difference to the treatment. We know more and more about which drugs do or do not help with which subtype of cancer, and in this way we can provide each patient with a tailor-made treatment.”

Huijgens mentions a well-known example from immunotherapy: the HER2 protein is found on the cancer cell in almost 15 to 20 percent of women with breast cancer. After the discovery of this protein and its aggressive behavior, agents have been developed that bind only to this specific protein and then cause the cell to die. In addition, new agents are on the way that attack this HER2 protein even more refined and more effectively.

2002 Longevity of lung cancer patients extended

When doctors saw remarkable reactions in some of the patients when testing a new lung cancer drug, it was cause for excitement. A small proportion of the exhausted patients who received the new drug walked and talked within days without needing additional oxygen. It was suspected that many lung cancer patients would benefit from it. But it led to significant tumor shrinkage in only 10 percent of patients.

A year later, researchers found that these patients had certain mutations in the so-called EGFR gene, which were not present in the other patients. These mutations occur in about 10 percent of all Westerners and 30 percent of people of East Asian descent. The tested drug is now on the market for this group of patients. It extends their lifespan and improves their quality of life.

2005 Irradiation in not three but four dimensions

Much has also changed in radiotherapy in recent years. The radiotherapist used to know ‘approximately’ where the tumor was, but thanks to the scans, that location can now be determined to the nearest millimetre. Huijgens: “This means that not only can the tumor be better targeted, higher doses of radiation can also be used. The radiation then damages less healthy tissue.”

A fairly new tool is four-dimensional irradiation. The PET and CT scan were already able to visualize the tumor in three dimensions. In the fourth dimension, movement, such as breathing, is also mapped. “For small lung cancer tumors, this means a chance of a cure. Something that was almost impossible before,” says Huijgens. “Because of the movement of the chest, you used to have to irradiate a large part of the lung in order to properly target the tumor. So you could not irradiate that large part of the lung heavily. Now we can make the device move along with the breathing, the radiation aim properly and thus increase the radiation dose.”

2006 Vaccination against cervical cancer

Vaccines will make it possible in the future to cure and perhaps even prevent cancer. That’s what leading cancer experts predict. However, not many successes have been achieved in this area yet. “So far, the results have been marginal. We see a small effect in certain types of skin cancer, for example. Tumors are getting smaller, but it is not the case that large groups of patients live much longer,” says Huijgens.

Vaccine research is mainly done for cancers in which a viral infection may play a role, such as cervical cancer. If an infection with the sexually transmitted human papillomavirus persists, there is a risk of cervical cancer. Since 2006, all girls between the ages of 9 and 26 can be vaccinated against this virus in the Netherlands to prevent the infection.

2010 Robotic surgery for prostate cancer

Surgery is the oldest treatment for cancer, and it also contributes the most to its cure. Obviously, much has also been improved in the field of surgical technique. A good example is robotic surgery for prostate cancer. The surgeon operates the robotic hands that can work in exactly the right place through a small hole in the skin. Because such an operation is much more accurate, impotence and incontinence can now be prevented much more often than in the past.

2012 Finally medicines against metastatic skin cancer

Metastatic melanoma, a form of skin cancer, has always been a difficult to treat, particularly aggressive cancer. Most patients died within two years. The available drugs had little effect. But that has changed this year. In 2012, two new drugs were launched on the market, which give hope and also form the basis for new, more effective treatments for this life-threatening form of cancer.

In the case of melanoma, it is also important that it is first investigated which type it is exactly. A test shows whether there is a common genetic abnormality, the so-called BRAF gene, and that in turn determines which medicine should be used.

This is called ‘personalized healthcare’: a treatment that is tailored to the special characteristics of the individual patient. Until recently, medical science had few (inadequate) weapons in the fight against cancer. In recent years, the knowledge of cancer has increased enormously. The causes are becoming increasingly clear and tests are increasingly showing which treatment is best for an individual patient. The moment when the diagnosis of cancer is no longer a death sentence at all is getting closer and closer.