So me and this Alkylating agent walk into a bar . . .

As this week's classes draw to an end (thankfully, we get a long weekend) and we finish our first foray into the science of cancer, I can't help but take a step back and contemplate the larger life lessons that cancer can teach us. Nearly two years ago I penned a short story which is still my favorite piece of writing that I've ever produced, even compared to this blog, unbelievable -- I know! It basically follows a world renowned cancer researcher  and his wife, who is dying of cancer. The researcher's lab wins the grant which allows him to get a new (fictitious) neutrino microscope which enables him to obtain resolutions much higher than an electron microscope. Of course, he peeks into the cancerous cells of his wife, only to find much more than he bargained for. (After finishing writing this post, I thought that it might be nice to include a link to the story. I copied the shortest, polished version (the published version) to a google document, so here is the link: Apoptotic Adventures While Whale Watching.) I hadn't read this story for quite some time. The last time was way before I made it into med school, and after revisiting it I'm glad that the science isn't completely incorrect -- with that being said, I'd change a couple of things if I were to get serious about it again.

This post isn't about a story I wrote, but rather, one of the issues I tried to touch (mostly unsuccessfully, but with short stories you really have to pick your poison) upon in the story. That is, the nature of cancer. Here is the thing, the more we learn and understand, the longer the list is for carcinogenic things. Chemicals, of course, but also bacterial and viral infections can cause cancer. Spontaneous genetic mutations or lack of exercise can all spur cancer's come-on. However, one thing all cancer in all parts of the body has in common is the refusal of at least one cell to die. And then, this cell recruits more cells in it's cause of selfish survival. In our bodies, at all times, cells are dying because that is the way things are supposed to go. Whether it be from old age, improper formation or some kind of injurious agent, the cell knows when it's time to go. A cell with cancer says "no way, I'm not sacrificing my life for the good of the organism" even though without the parent organism, the cell would've not existed and because of the refusal an immature death may befall the rest of the cells that comprise the whole organism. Does this attitude sound familiar to you?

Even though I am going to die, one way or another, I am willing to sink the whole ship in order to prolong my own life for a brief moment. This is despite the fact that the ship is a sound vessel and undoubtedly has many decades left of service. This is the attitude that the cancer cell has.

I'm sure you've been in a construction zone where one of the lanes merges with the other one. This is not a case of a last minute merge, we're talking about signs for at least a mile prior to the merge. Everyone who is driving knows there is a merge coming up. Most people take the first opportunity to get over into the lane that continues. However, we can all remember (I'm sure it has never been any of you!) the people who speed to the point of the merge and honk and force their way in, despite those who have been driving in a manner which benefits all those around them. These jerks are the cancer cells. I can remember a few times in these situations, where the backup was just horrible and a driver of a larger truck, who had been waiting in the through lane moved over so that the cancer cells couldn't speed to the front of the line anymore. I consider these large trucks to be the equivalent of anti-cancer drugs. Probably resembling the alkylating agents, as they don't destroy the car (cell) but just disable it from speeding to the front (metastasizing or invading surrounding tissue). I wish I could buy those alkylating agents a beer. I have a feeling I'll think of a better analogy when I'm trying to go to sleep tonight, but this is one I've actually had in mind for a long time, believe it or not.

There is no doubt that the signalling pathways, molecules and cancer drugs play a huge part in my education and I'll strive to know everything that I can about them. There are times, however, during my moments of introspection (which are of lesser quantity these days, but I think the quality has suffered less than I feared) that I have to wonder whether or not the cancerous cell is just mimicking the actions of the whole organism. Perhaps a question better left to the philosophers of our day, not the physicians. However, I've always hated the idea of being a one-trick pony.