I’d like to think that cancer is ultimately caused by a single thing. It’s probably not that simple, but it’s also not necessarily so difficult.
My immediate family has had a surprising amount of cancer considering that cancer really doesn’t run in our family (as best as we can tell).
Uveal melanoma
I should know this because my brother died of metastatic cancer at the age of 32. He had uveal melanoma when he was 18, he was too poor to pay for health insurance, and he was diagnosed with, and eventually killed by, a softball-sized tumor in his liver.
Looking back on it now and…thinking about my own experiences…I can see why understanding the origin of cancer is such a difficult thing.
But while cancer as a disease goes by many names, I have come to believe that it is caused by only one thing.
Testicular cancer
I was diagnosed with stage I testicular cancer two months after I started a new job. I had actually felt the marble-sized lump in my testicles several months earlier, but I was too busy with my new digs to tell my wife my suspicions and schedule an appointment with my family doctor.
When I finally got the appointment that August, my doctor — who I now know is quite excellent — wasn’t sure there was a lump, but he scheduled an ultrasound anyways.
He called me several weeks later at 11:30am on a Monday. He asked where I was standing and asked me to take a few deep breaths. And then he explained why he had already scheduled an appointment with a local urological surgeon for the very next day. He also said I should immediately go home and prepare for the next few days.
I was intending to take the soonest ferry home, but I had already scheduled a lunch date with a former coworker, and I didn’t want to let her down. After lunch, I biked to the ferry and went home.
(By the way… …taking a ferry across the San Francisco Bay in the afternoon is a glorious experience)
The urological surgeon had an unusually brusque manner, but he seemed competent. He talked to me about the scan and worked with his office to schedule me for surgery two days later.
The morning of the surgery (6:30am to be precise) the nurse checked my heart rate. It was 42 beats per minute. She laughed and asked me if I work out. I laughed and said I run a few miles a week. (And no, I’m happily married). To be honest, it was the first time I could remember anyone suggesting that I have a naturally low heart rate.
On the operating table I was asked to count backwards from 100. I got to 98 and then the next thing I remember is that I was awake on a hospital bed with my wife next to me. A nurse came in and told me what was going to happen next.
I didn’t know it at the time, but later I came to suspect that a previous vasectomy and a heck of a lot of stress had caused my cancer. From time to time I look up the causal link between vasectomies and testicular cancer, but all I can find is speculation.
I also look up the genetic basis for uveal melanoma from time to time. Here I think there is a single known gene that acts in Mendelian inheritance fashion. But also only about 2% of uveal melanoma cases can be traced back to a particular causative allele.
From this I have concluded that testicular cancer and uveal melanoma have very few genetic drivers in common, and I at least didn’t get the cancer from my parents. It’s hard to explain this to them.
My mom always worried that my brother got uveal melanoma from walking around without sunglasses too much as a boy. Since my brother was 18 when he was diagnosed…and I was 20…I assured her at the time that no one really knows how cancer is caused, that it’s pretty much a random chance event, and that it was most certainly not her fault.
I’m not sure that calmed her down, but I think she trusted my answer.
Lung cancer and T-cell lymphoma
The thing is: I looked hard for many years for a genetic cause. I came to the conclusion that cancer most certainly does not run in my father’s family. I also noticed that cancer in my mom’s family was probably due to rampant alcoholism and rampant smoking.
I also am astonished that my dad was diagnosed with two cancers simultaneously during this particular plague year. I’m astonished because my dad started smoking unfiltered tobacco at the age of 18.
(Just now I asked my mom about this, and she says that he really got addicted to it when he was contemplating a promotion that would have required moving across the country)
Flash forward, and by December of last year (December 2020) my dad had a growth the size of a golf ball on his left cheek. He hates going to the doctor and apparently the doctors at his hospital couldn’t really see the golf ball very well over Zoom. My wife and I kept urging him to act with a little bit of intention, and once he listened, the better doctors said: “That’s not a staph infection. Or maybe it is. We should do a biopsy and a chest x-ray”
(I don’t think my parents noticed that this was a slightly odd set of tests to order)
So then all of a sudden he has T-cell lymphoma and lung cancer. They said that lymphoma was seldom seen in the lungs, but it’s not impossible. (When I heard this I laughed and said, “mom, dad has two cancers. That lung tumor has got to be a carcinoma.)
(I also looked up the relation of S. aureus and subcutaneous T-cell lymphoma. It’s a good read for some other time.)
Understandably I was pissed at my parents when the subsequent set of biopsies and scans couldn’t confirm the diagnosis of lymphoma in the lungs. I urged them to get a liquid biopsy to actually correctly differentially diagnosis the lung cancer, but I wasn’t talking to their physicians. (Would they have listened to me?)
Luckily subcutaneous T-cell lymphoma is extremely treatable, and my seventy-four year old dad is still alive today. With or without a lung carcinoma. What are the odds?
One cause?
My instincts say that cancer is ultimately caused by an aggregate amount of inflammation in the body. Whether that be 40 years of carcinogens or alcohol, a predisposition to any number of -itis’s, a build up of free radicals, or an intense burst of beta radiation.
(I do believe that’s it not just a disease induced by inflammation. Any loaded dice passed on to you from your parents — whether that be bad genes (alleles), epigenetic marks, or pre-natal hormone levels and so much more — create a predisposition to cancer, just waiting for the right level of environmental stress — or perhaps a wayward gene from a viral infection — to trigger the big C)
What I don’t understand yet is why my brother developed uveal melanoma at the age of 18. How is it possible that such a young kid could develop an exceedingly rare cancer? Did he really have so much inflammation in his body by the age of 18?
And I still believe that the crazy stress of a very fun startup caused my testicular cancer. Or the vasectomy. Or both.
And I can’t believe my dad is still alive. He weighs over 300 pounds. He has arthritis, he still smokes tobacco, and he hasn’t taken a decent walk in over a year.
So while I believe that a sustained excess of inflammation is causative of cancer, I really can’t predict the date at which someone will notice. Nor the date when the patient will die.
What I do know for a certain fact is that the current generation of cancer “cures” are hardly cures. It doesn’t matter if it’s CAR-T, kinase inhibitors, or gene therapy. Or homeopathic doses or rest and relaxation or a barely tolerable level of caloric intake.
If everyone could just calm down a bit, wear sunglasses, and switch diets we’d probably actually cure cancer.
For Stephen.
p.s. I forgot to mention that when my brother was dying he had an old PC in the garage with a screensaver that had only a single phrase – white text on a black background. It said “FUCK CANCER”. Actually I can’t remember now if it was in all caps, but does that particular detail really matter?
