The Cancer Code: A Revolutionary New Understanding of a Medical Mystery

by Jason Fung

This is one of the fatal flaws of the somatic mutation theory. Mutations were accumulating, but their occurrence was anything but random. Given that hundreds of mutations were working closely together to create cancer, those mutations looked purposeful and coordinated.

Figure 8.3: Root cause, proximate cause and outcome showing root causes of cancer with connection to genetic mutations unknown.

There is yet another fatal flaw in the SMT. If all the mutations of cancer are accumulated randomly, then why do all cancers share so many of the same hallmarks? To become cancer, cells must gain a number of special new abilities. We’ve discussed the four hallmarks of cancer: it grows, becomes immortal, moves around, and uses the Warburg effect. How can every cancer in history randomly develop all these wondrous abilities from scratch?

If those typing monkeys produce one hundred copies of War and Peace but no other classic novel, then it is not random. Those monkeys were trying to write War and Peace. The cell is trying to develop into cancer.

If one airline suffers hundreds of crashes every year, where other airlines have none, then there is nothing random about it. In cancer, asbestos causes DNA damage, genetic mutations, and also a cancer called mesothelioma, but not breast or colorectal cancer. Almost nothing else in the world causes...

These hallmarks of cancer are carefully selected. Something is pushing these oncogenes and tumor suppressor gene mutations toward growth, movement, immortality, and the Warburg effect. The next great leap forward in cancer...

PREPOSTEROUS REDU...

The somatic mutation theory is simple, compelling, elegant, and largely incorrect. In 2002, cancer researchers Hahn and Weinberg published an article in the New England Journal of Medicine observing, “The actual course of research on...

Genetic mutations may explain the mechanism of how cancers keep growing, but they do not explain the fundamental question of why these genes mutated.

The SMT fails because it is entirely inward-looking, toward our genes, instead of outward-looking, toward the environment.

But so many different environmental attributes obviously affect cancer risk. The seed is importan...

Cancer paradigm 2.0 treats cancer as a genetic lottery, but cancer is not mere...

It’s the last great frontier of cancer medicine, one that is little explored: diet. The good news is that these factors are largely within our control.

Insisting that cancer is a disease of collected genetic mutations is like insisting that the Declaration of Independence is a collection of letters. True enough, but so what? How does it help us understand cancer?

CONCLUSION

The somatic mutation theory did advance our understanding of cancer, but not in t...

9 A FALSE DAWN

SURROGATE OUTCOMES

Figure 9.1: Progression-free survival and overall survival.

RAISING PRICES

By 2016, a year’s worth of this miracle drug cost more than $120,000. By this time, the drug had already been on the market for fifteen years. That’s ancient history in medical science. It wasn’t cutting-edge stuff anymore; it was medical school stuff. The actual cost of manufacture, even after adding a 50 percent profit margin, is estimated at $216 a year.

LOSING THE WAR

PART III TRANSFORMATION (Cancer Paradigm 3.0)

10 THE SEED AND THE SOIL

IT WAS THE English surgeon Stephen Paget (1855–1926) who first compared cancer to a seed. In 1889, he wrote, “[S]eeds are carried in all directions; but they can only live and grow if they fall on congenial soil.”1 Plants grow when the seed, the soil, and the conditions are amendable to growth.

EPIGENETICS

The emerging field dedicated to the study of how an environment can change an organism without alterations to its DNA is called epigenetics.

Gene regulation occurs at the level above the DNA, hence the name epigenetics.

Epigenetics affects the packaging of the genes rather than the genes themselves. The details of this process are outside the scope of this book, but the simple version is this: one of the main mechanisms of epigenetic changes is known as DNA methylation.

Changes to the DNA methylation of tumor suppressor genes can silence those genes,2 which favors growth and cancer.

This change to gene expression, and therefore risk of cancer, occurs withou...

Figure 10.1: Root cause, proximate cause and outcome showing root causes of cancer with connection to genetic mutations unknown.

DEVELOPING NEW PARADIGMS

In 2009, the National Cancer Institute (NCI), in an uncharacteristic move, reached out beyond the expected cadre of researchers to ask other scientists for help in the war on cancer. The call went out not to cancer biologists or cancer researchers, but to theoretical physicist Paul Davies and astrobiologist Charley Lineweaver. With no prior knowledge of cancer and, most important, no preconceived notions, these two would usher in the next chapter in our understanding of cancer.

When he was called upon by the NCI, Dr. Paul Davies confessed that he possessed no prior knowledge of cancer. Good, said the NCI. That was exactly what they were looking for. Davies was interested primarily in astrobiology and had never really thought about cancer. This gave him the freedom to start with perhaps the two most basic questions: What is cancer? Why does it exist?

We had no satisfactory answers to these questions. What initiates the cancerous transformation of a cell? Why shouldn’t all cells turn into cancer? Cancer cells originate and mutate from our own cells. But under what environment?

An even more profound question about cancer’s origin had yet to be addressed: why can virtually every cell in ...

Every single cell of our body contains the seed of cancer. Why?

This mystery goes deeper still. Cancer is not just a human disease. Davies noted that “What struck me from the outset is that something as pervasive and stubborn as cancer must be a deep part of the story of life itself.

Sure enough, cancer is found in almost all multicellular organisms, suggesting its origins stretch back h...

The origins of cancer are found at the origins of all multicellular life itself. This may have seemed obvious to a cancer outsider, but not to an insider with the curse of knowledge.

“Cancer,” Davies astutely noted, “is very deeply embedded into the way multicellular life is done.”

Most medical researchers and doctors view cancers as some kind of crazy genetic mistake. But to the outsider Davies, the behavior of cancer cells seemed anything but berserk. Instead, cancer appeared to be a highly organized, systematic technique for survival. It’s no accident that cancer survives everything the body throws at it. It’s no accident that cancer survives everything modern medicine throws at it.

11 The Origins of Life and the Origins of Cancer

ACCUSTOMED TO THINKING about life on other planets, cosmologist Paul Davies wondered how cancer fit into the story of life on Earth. Because cancer is as old as multicellular life itself, the origins of cancer, he reasoned, must lie in the origins of life.

The earliest cells were created when self-replicating molecules called ribonucleic acids (RNA) were enveloped in a membrane called a phospholipid bilayer, which is still the basis for all modern human cell membranes. This bilayer protected the RNA from the harsh outside environment, allowing self-replication. These early cells lived in a sea of nutrients, obtaining food and energy directly from their environment. As long as nutrients were available, they survived, but they were always on the edge of extinction. The prime directive of life, even at this early stage of evolution, was to replicate.

THE JUMP TO MULTICELLULARITY

To be successful, a single-cell organism competes with surrounding cells for resources. But cells working together have a huge advantage over cells working alone.

Multicell organisms evolved about 1.7 billion years ago, likely beginning as simple aggregates or colonies of single-cell eukaryotes.

Over time, mutually beneficial collaboration between cells permitted specialization, which then led to...