Cancer does not have to be cured, and 70% of cancer patients need to live with tumors.
February 4th is the 17th World Cancer Day, and this year’s theme is "WE CAN, I CAN". The member of the Standing Committee of Cancer Radiotherapy Committee of China Anti-Cancer Association and the president of Cancer Hospital said: At present, 70% of cancer patients in our city are in the middle and late stage when they are diagnosed, so it may be a better choice for them to eliminate the fear of cancer and realize coexistence with cancer.
70% of cancer patients need to live with tumors.
Mr. Luo, who lives in Yubei District, is 55 years old. He is used to working from nine to five every day. If no one tells him, no one will think that he is actually a cancer patient. Five years ago, he suddenly felt that he was always urinating, but he couldn’t urinate. At first, he thought he was getting angry. But a pile of heat-clearing drugs didn’t improve after eating, and the more urgent the urine, the less smooth it was, and sometimes it was accompanied by pain. At this time, he thought about going to the hospital for examination.
I didn’t want to be diagnosed with prostate cancer and have bone metastasis. I have lost the best opportunity for surgery and can only use antiandrogen drugs to control my condition. In the face of cancer, he did not intend to give up, but actively cooperated with the treatment. After one year, his condition gradually stabilized, and Mr. Luo began to plan to go to work in the unit.
Professor Dean of the Municipal Cancer Hospital said that according to the "2015 China Cancer Statistics" issued by the National Cancer Center, there were 4.3 million new cancer cases in China in 2015, and the number of cancer deaths exceeded 2.8 million; In Chongqing, there were about 80,000 new tumors and more than 50,000 cancer deaths in 2014. Because the incidence of tumor is relatively concealed, more than 70% of cancers are found in the middle and late stages, and the best opportunity for surgical treatment is lost. For them, survival with tumor may be a better choice.
Unfortunately, in real life, there are not many patients who can scientifically understand the survival with tumors like Mr. Luo. As soon as many patients heard that they could not operate, their spirits suddenly collapsed and they thought they were hopeless. In fact, surgical treatment is not the only treatment for all tumors; Even if we miss the best opportunity for surgical treatment, it doesn’t mean that there is no cure. At present, tumor treatment advocates comprehensive treatment, which includes surgery, chemotherapy, radiotherapy, endocrine therapy, traditional Chinese medicine treatment and other ways. Experienced specialists will choose the appropriate treatment according to the results of tumor pathological examination, course of disease and development trend.
"It is very important for cancer patients and their families to accept" survival with tumor ",which is a more pragmatic method for treating advanced cancer." Dean said that cancer is essentially a genetic disease, and all cancers come from genetic mutation, which is caused by genetic mutation and epigenetic regulation. At present, human beings can’t use drugs to reverse this genetic mutation and "kill all cancer cells" in the body.
It is also a pragmatic choice for patients in the middle and late stage to realize long-term "survival with tumor" and "peaceful coexistence" with tumor. Everyone should treat it as a medical disease with disease, and treat tumor as a chronic disease such as hypertension, diabetes and coronary heart disease, which is more conducive to treatment.
The misunderstanding of survival with tumor needs to be vigilant
There may be many people who don’t understand that living with a tumor is not cured. There is a tumor in the body, and the condition may deteriorate at any time. Can this be safe? Dean Wu Yongzhong said that in fact, survival with tumor is not to let it go, but to choose a suitable treatment model, which is also the core of "individual medicine" developed from "evidence-based medicine" in recent years. First of all, we should recognize the fact that the dream of conquering tumor has not been realized.
WHO has regarded tumor as a chronic disease, because its condition has a process of development, which can not be cured and exists for life, just like diabetes, hypertension and coronary heart disease. Secondly, sometimes over-active treatment is also a kind of injury. In clinic, some elderly cancer patients are often encountered. When children hear that they can have surgery and treat at all costs, they have not achieved good results. This is because the elderly, especially those over 80 years old, have degraded their physical functions and cannot tolerate surgery and chemotherapy at all.
At this time, you don’t have to think about eliminating the tumor at all. You can choose radiotherapy alone or other treatments, so as to survive with cancer. Advocating survival with tumor again also means waiting for treatment conservatively. If it can be cured by surgical resection, radiotherapy and other treatment methods, tumor patients should still be encouraged to actively treat.
Age-related macular degeneration (AMD) mostly occurs in people over the age of 50, and it is one of the main blinding diseases of the elderly in the world. According to statistics in 2010, there are more than 23 million AMD patients worldwide. The patient’s chief complaint is decreased vision, which is characterized by the absence of central visual field (see schematic diagram).
Normal visual field (left), central visual field damage caused by AMD (right)
Age-related macular degeneration can be divided into Dry AMD and Wet AMD. Dry amd is characterized by no vascular proliferation, while wet amd is characterized by obvious vascular proliferation in macular area. There is almost no treatment for dry age-related macular degeneration, while wet age-related macular degeneration is mainly aimed at vascular proliferation. For vascular proliferation, Genentech’s Ranibizumab (trade name: Lucentis) is a fragment antibody against VEGFA, and it costs two thousand dollars for a shot. However, many places bypass Ranibizumab and choose Avastin (Avastin), which is also anti-VEGF, for only fifty dollars. It can be seen that there are policies and countermeasures, which are available to people at all times and all over the world, but the interests are accelerating. In addition, laser therapy is also aimed at vascular proliferation. Although there is symptomatic treatment for vascular hyperplasia, it is also a temporary solution, because macular degeneration itself has not improved.
A core problem of macular degeneration is degeneration of retinal pigment epithelial cells (RPE). These cells are close to the interlayer between Choroid and optic nerve cells in retina, and are responsible for bringing blood nutrition to optic nerve cells. If this layer of cells degenerates, the optic nerve cells will not get nutrition, so the vision will decrease. There’s an old saying in China, what can I do without fur? Is the image explanation of this disease.
A remarkable pathological feature of macular degeneration is yellow sediment distributed on the retina, which is a mixture of protein and lipid, but its source is unknown, and it may be an inflammatory product, and its pathological function is to destroy retinal pigment epithelial cells (RPE). See the figure below.
Since it is a degenerative disease, the research and development of drugs lacks molecular targets, which are a bit like Alzheimer’s disease and neurodegeneration, and there are not many effective targets. In contrast, the stem cell technology that surfaced in the past ten years is an ideal choice. Stem cells are induced to differentiate into retinal pigment epithelial cells (RPE), which provides a feasible and effective method for the treatment of macular degeneration.
Can normal retina replace diseased retina? A few decades ago, someone replaced the diseased retina with the baby’s retina (of course, the source was the baby who died in a car accident under two years old), and the success rate was very low, because the source of newborn retina was difficult, the protection was difficult, and the operation was difficult, which were all restrictive factors. However, some people have gained some vision (such as light perception and figure) through retinal replacement. This scheme can at least prove that infant retinal replacement is a direction that can be improved. However, it is not successful to replace the bad eye retina with the good eye retina of the same adult, which shows that the physiological age of retina is an important reason. Nowadays, retinal pigment epithelial cells (RPE) can be produced from stem cells, whether from embryonic sources (hESC) or from self-induced sources (iPSC), and they can be made into Sheet, which is beneficial to surgical implantation. Of course, there are many technical problems, mainly the problem of eye surgery and the problem of ensuring the survival of cells after implantation. A positive factor is that the eye is an immune escape, so don’t use immunosuppressants, immune rejection should be small, which is conducive to survival.
Regenerative medicine is a new field, and big pharmaceutical companies are unwilling to take this risk. Seven years ago, the author worked in the world’s largest ophthalmic pharmaceutical company (Allergan) and once recommended this project, but the decision makers are interested in Miu Miu. At present, several small companies have pushed the application of regenerative medicine in senile macular degeneration into the clinical stage. Although I dare not predict when it will be approved by the FDA, it is still expected as a promising direction. After all, there is no other way at present. Although the experiment of regenerative medicine is still in the "primary stage of socialism", the AMD market is very large, and there are still some large and medium-sized pharmaceutical companies to follow up. Not long ago, Astra, the second largest pharmaceutical company in Japan, bought Ocata Therapeutics LLC to jointly develop this method for treating AMD, which mainly focuses on hESC inducing retinal pigment epithelial cells (RPE).
Regenerative medicine is not only dedicated to age-related degenerative macular degeneration (AMD), but also can be used to treat another cause of blindness, Retinal pigmentosa. It also damages retinal pigment epithelial cells (RPE), but retinal pigment degeneration damages peripheral visual field, and other eye diseases such as glaucoma and corneal burn. In order to give you a big picture of regenerative medicine in treating ophthalmic diseases, the author summarizes the general situation of some companies entering clinical trials at present. I sincerely hope that these companies can succeed in regenerative medicine and bring good news to patients with ophthalmic diseases.
Table 1. Summary of Clinical Trials of Regenerative Medicine in Treating Ophthalmic Diseases