FAQs about cancer: What is it and why is it so hard to cure?

There’s currently an overload of information online and it’s difficult to figure out what’s true and what’s not. After discussing this topic with friends, family and patients, I thought it would be helpful in this blog to clarify some frequently asked questions surrounding cancer and while I’m at it, I might also debunk a few myths. To bring you up to speed, I will avoid going into too much scientific detail in this first cancer-related blog post. I have to add that as a cancer researcher I always tend to err on the side of caution and don’t like making sweeping statements or conclusions. Let me know if you think this was helpful or whether you’d rather want a different question answered.

What is cancer?

Our body is made out of billions of cells. Usually, these cells are working for us and operate on a ‘biological programme’ that makes them obey certain rules. This biological programme makes sure that cells with too many mistakes stop growing, are flagged up in the body and are cleaned up by our immune system. As we age there’s more time to accumulate mistakes. Normally this isn’t worrying since an excess of mistakes usually triggers the ‘stop growing programme’, preventing a future cancer from ever developing. However, when the perfect combination of mistakes occurs in 1 particular cell, this can damage the ‘stop growing programme’, allowing the cell to keep on growing without a brake. In other words, cancer originates from your own body and (generally) stems from a single cell gone wild that disobeys the checks and balances encoded in its biological programme.

That said, when we talk about cancer, we are actually referring to the whole collection of known cancers that can arise from the many different tissues that are present in a human body. For example, lung cancer has very different properties compared to brain cancer. You can therefore imagine that the different types of cancers arise through different ways (mechanisms) and are therefore often treated differently by medical doctors.

I have to admit this is a very crude explanation, but if it’s helpful, another post can go over this in more detail.

If we can put a man on the moon, why can we still not cure cancer?

The challenge of tackling cancer is to kill the cancer cells without killing the patient. Unfortunately, cancer cells are in many ways, highly similar to our other healthy cells in our body. An additional difficulty is that a cancer exists out of millions of cells that each can be slightly different from each other, creating groups of cancer cells with different properties and sensitivities to cancer treatments. A particular treatment might eradicate a large proportion of the cancer, but that minority of cancer cells resistant to the treatment can grow back and kill the patient. In other words, the cancer evolves according to the treatment, essentially creating a moving target.

There are many specific ways through which a cancer might defy (resist) a particular cancer therapy. Over the decades, cancer researchers have uncovered several hundreds of these different routes to resistance. I’m thinking of writing a bit more about how cancer can become resistant to therapies in several upcoming posts. Stay tuned if that might interest you!  

Note to myself: Setting goals doesn’t work, set systems instead

Setting goals does not work, it just produces frustration. Instead set systems in place in order to succeed.

Conventional wisdom states goal setting helps you stay focused, however if you don’t attain them you have failed. Scott Adams, cartoonist of the Dilbert comic strip and author of “How to fail at almost everything and still win big”, blew my mind when he proposed setting goals is futile, instead he is in favour of setting systems. With systems you aim to acquire the habit of cultivating skills rather than hunting down a specific goal. For example, people who want to become fit (or simply put want six-pack abs), shouldn’t just go to the gym and keep checking whether they are getting closer to that goal. Most people will get discouraged by not seeing a difference after 2, 3 or even 6 weeks and will ultimately give up altogether. Rather, try to cultivate the habit of working out regularly, ideally daily. The difference between systems and goals might be somewhat confusing at first. Scott Adams explains that if you’re waiting to achieve it someday in the future, it’s a goal but if you do something every day, it’s a system. He mentions that many human endeavours can be categorised into goal-oriented or system-oriented thinking. For example, losing 10kg is a goal, but working out every day is a system. Trying to get a promotion is a goal, but aiming to consistently deliver a little bit more than expected is a system.  Trying to ace a test is a goal, but devoting an extra hour in the morning before going to school on understanding the subject is a system. Trying to get a master’s degree or a PhD is a goal, but daily dedicating time on understanding and researching your topic of interest is a system.

In this way, you know what to do, just show up, do the workout and you’ve succeeded for the day. Perhaps after 6 weeks, you will not notice a difference in your body, however it is likely you will have acquired the habit of working out regularly. Eventually, you may add new exercises to the daily workout and who knows one day you’ll actually start to see a difference but remember that’s not the goal. Simply show up every day and follow the system you have set out. Just get started.

The exciting part of setting a system is that you don’t know where it may take you. Several months after diligently following the system, you might actually blow past your initial goal (that you didn’t set). And since you are following the system, you won’t look back and decide to slow down or stop because you reached your goal. The risks of setting a goal is that 1) you fail and get discouraged, 2) you hit the goal and you slow down or stop altogether and 3) you delay your happiness until you reach your goal. In contrast, pursuing your system every day, gives you the instant gratification that you are on the correct path. Let me give an example from my own experience. I believe in challenging myself and voluntarily making yourself suffer. Since I hated running, I decided to run each day, for 30 days, up to Primrose Hill and back which equates to around 5.5km. You could perceive completing a 30-day challenge as setting a goal, however I like to see it as “tricking the brain to start a system.” At the beginning I thought to myself “why am I doing this again?” and really disliked the activity. It was boring and it tired me out. However, after a few days of running I started to research literally “how to run”. I started listening to audiobooks about running and approximately midway the 30-day challenge I thought to myself “perhaps I should run a marathon?”. My initial plan was to just do this annoying 30-day challenge and then never look back on running again. Now 1 month after completing the challenge, I am still running regularly and I’m thinking to myself “why stop at a marathon, 50km sounds like a fun challenge”. I hope this illustrates, setting a goal from the get-go might limit yourself. Not in my wildest dreams, would I have set out to attempt a 50km run. I simply just started to run regularly and afterwards imagination took over. Don’t mistake me setting out to run 50k as my goal, it’s simply another step in the system I have set.

Note to myself: Break the resistance; the battle for creation

Procrastination, fear, self-doubt and much more are all different materialisations of ‘THE RESISTANCE’. Identify it, acknowledge it and defeat it every day.

Art is a battlefield, whatever you consider to be art, it’s a carnage. Bodies all around, wounded people, the hurt, the pain. Yet, here we are not giving up, picking up our weapons, charging to the frontline. Whatever your weapon is, everyone is fighting their own battle. For me it is a pipette, and medicine is my battlefield. Everyone is struggling with their own inner demon, trying to bring their gift to the world. I’ve struggled countless times pushing past doubts and many times I’ve given into it. It feels like there’s an inner fog or force field that is trying to stop me from reaching the next level, fulfilling my potential. I am guessing that if you’re reading this, you’ve felt the same.

Steven Pressfield has given this negative force a name, ‘THE RESISTANCE’. The identification/naming/revealing of this enemy, which has been elusive yet in plain sight at the same time, has been Pressfield’s greatest gift to me. In his book ‘the WAR of ART’, he details how ‘THE RESISTANCE’ keeps us from starting to work on our creation. As one of the great writers of this age, he has almost struggled decades to get his first break as a writer. The reason being is that he stopped himself from even starting. One of the first few pages in ‘the WAR of ART goes as follows: ‘There’s a secret that real writers know that wannabe writers don’t, and the secret is this: It’s not the writing part that’s hard. What’s hard is sitting down to write. What keeps us from sitting down is Resistance.’

I couldn’t agree more, my toughest battle is not to produce the work, the experiment, the article or the presentation. For me the resistance is the strongest when my alarm goes off. Doubt starts creeping in, voices that whisper it won’t make a difference, it doesn’t matter whether you start your day early. Many days ‘THE RESISTANCE’ wins, I snooze for another 30 minutes, maybe an hour. I am guessing that this blog post is an attempt to materialise my inner enemy ‘THE RESISTANCE’ in order to gain an upper hand. I’m honestly sick and tired of this doubt… Pressfield has written 3 books centred on the experience of the artist, namely: the war of art, turning pro and the artist’s journey. The war of art is the first book of this trilogy and it’s by far the most powerful. Every sentence seems to matter in this book, to the point that I want to quote every sentence, unfortunately I’m forced to highlight snippets that have impacted me most. Every time I hit that snooze button, every time I procrastinate by watching a mindless video, ‘THE RESISTANCE’ materializes. Like a devil on my shoulder, it watches my actions, and cheers me on. As Pressfield states, ‘Procrastination is the most common manifestation of Resistance.’

In the first chapter of this book, Pressfield defines our fiercest enemy ‘THE RESISTANCE’. Procrastination is just one materialization of it. ‘THE RESISTANCE’ also masquerades as fear, victimhood, unhappiness, self-doubt, criticism and rationalization of poor decisions. Fortunately, there’s a way out of the grip from ‘THE RESISTANCE’. Pressfield calls this, ‘turning pro’. He describes how the amateur gets defeated by ‘THE RESISTANCE’, whereas the pro defeats his immortal, reincarnating foe day after day. What I’ve experienced is that after I slay ‘THE RESISTANCE’ by starting my day or starting the work I’ve procrastinated, it has been defeated… for the day. Unfortunately, ‘THE RESISTANCE’ in my experience does not weaken. It’s always there lurking behind the corner waiting to pounce whenever you feel weak. I’m sorry if this is not what you wanted to hear. As Pressfield states, ‘the most important thing about art is to work. Nothing else matters except sitting down every day and trying.’ My hope is that reminding myself of the existence and powerful nature of ‘THE RESISTANCE’ allows me to focus my mind to not give in.

My hope for you is that you do the same, either by reading Steven Pressfield’s book ‘the War of Art’ or just even thinking about how ‘THE RESISTANCE’ materializes in your life. Let me finish with Pressfield’s message ‘Creative work is not a selfish act or a bid for attention on the part of the actor. It’s a gift to the world and every being in it. Don’t cheat us of your contribution. Give us what you’ve got.’ In other words don’t give in to ‘THE RESISTANCE’.

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