In Depth | Medicine
A few patients have made rare and unexpected recoveries leaving doctors scratching their heads, says David Robson. Can these cases provide vital clues for tackling cancer?
It was a case that baffled everyone involved. The 74-year-old woman had initially been troubled by a rash that wouldn’t go away. By the time she arrived at the hospital, her lower right leg was covered in waxy lumps, eruptions of angry red and livid purple. Tests confirmed the worst suspicions: it was carcinoma, a form of skin cancer.
The future looked bleak. Given the spread of the tumours, radiotherapy would not have been effective; nor could the doctors dig the tumours from the skin. Amputation was perhaps the best option, says Alan Irvine, the patient’s doctor at St James’ Hospital, Dublin – but at her age, she was unlikely to adapt well to a prosthetic limb. After a long and frank discussion, they decided to wait as they weighed up the options. “We had a lot of agonising for what to do,” says Irvine.
Then the “miracle” started. Despite receiving no treatment at all, the tumours were shrinking and shrivelling before their eyes. “We watched for a period of a few months and the tumours just disappeared,” says Irvine. After 20 weeks, the patient was cancer-free. “There had been no doubt about her diagnosis,” he says. “But now there was nothing in the biopsies, or the scans.”
Somehow, she had healed herself of arguably our most feared disease. “Everyone was thrilled, and a bit puzzled,” Irvine says, with some understatement. “It shows that it is possible for the body to clear cancer – even if it is incredibly rare.”
The question is, how? Irvine’s patient believed it was the hand of God; she had kissed a religious relic just before the healing set in. But scientists are instead looking to the underlying biology of so-called “spontaneous regression” to hunt for clues that could make these rare cases of self-healing more common. “If you can train the body to do this on a broader scale, you could have something that’s very widely applicable,” says Irvine.
Knowing how to trigger an immune response may help beat cancer (SPL)
In theory, our immune system should hunt out and destroy mutated cells before they ever develop into cancer. Occasionally, however, these cells manage to sneak under the radar, reproducing until they grow into a full-blown tumour.
By the time the cancer has reached the attention of doctors, unaided recovery is highly unlikely: overall, just one in 100,000 cancer patients are thought to shed the disease without treatment.
Within those scant reports, though, there are some truly incredible stories. A hospital in the UK, for instance, recently reported the case of a woman who had experienced long-lasting fertility problems. She then discovered that she had a tumour between her rectum and her uterus, but before doctors could operate, she finally conceived. All went well and a healthy baby was delivered – only for the doctors to find that the cancer had mysteriously vanished during the pregnancy. Nine years later, she shows no sign of relapse.
What was it about the body of one pregnant woman that beat cancer? (Thinkstock)
Similarly spectacular recoveries have now been recorded in many different kinds of cancer, including extremely aggressive forms like acute myeloid leukaemia, which involves the abnormal growth of white blood cells. “If you leave the patient untreated, they usually die within weeks, if not days,” says Armin Rashidi at Washington University in St Louis. Yet he has found 46 cases in which acute myeloid leukaemia regressed of its own accord, although only eight avoided a relapse in the long term. “If you find a random oncologist and ask if this can this happen, 99% would say no – it makes no sense,” says Rashidi, who worked with colleague Stephen Fisher on the paper.
In contrast, dramatic recoveries from a childhood cancer called neuroblastoma are surprisingly frequent – offering some of the best clues about what might trigger spontaneous remission. This cancer arises from tumours in the nervous system and hormonal glands. If it then spreads, or metastasises, it can lead to nodules on the skin and growths in the liver, with swelling in the abdomen that makes it difficult for the infant to breathe.
Neuroblastoma is very distressing, yet it can sometimes disappear as quickly as it came, even without medical intervention. In fact, for infants less than one year old, regression is so common that doctors tend to avoid starting chemotherapy immediately, in the hope that the tumour will shrink by itself. “I can remember three cases with rather impressive skin metastases and an enlarged liver, but we literally just observed them – and they did well,” says Garrett Brodeur at the Children’s Hospital of Philadelphia.
The decision to sit and observe can be difficult, though: although the chance to avoid harrowing treatment comes as a relief to some parents, others find inaction and helplessness difficult to stomach. The agony of that period is one of the reasons that Brodeur wants to understand the mechanisms behind the cancer’s vanishing act. “We want to develop very specific agents that might initiate regression – so we don’t need to wait for nature to run its course or for ‘god’ to decide,” he says.
So far, Brodeur has some strong leads. For instance, unlike other nerve cells, the cells in neuroblastoma tumours seem to have developed the ability to survive without “nerve growth factor” (NGF) – allowing them to flourish in the wrong parts of the body where NGF is absent. Spontaneous remission may be triggered by a natural change in the neuroblastoma tumour cells, perhaps involving the cell receptors that NGF binds to. Whatever the change is, it might mean that the cells can no longer survive without the essential nutrient.
If so, a drug that targets those receptors could kick-start recovery in other patients. Brodeur says that two drug companies already have some candidates, and he hopes trials will begin soon. “It would selectively kill tumour cells that are sensitive to this pathway, so it could spare patients from chemotherapy, radiotherapy or surgery,” he says. “It wouldn’t make them sick or their hair fall out, or cause their blood cell count to fall.”
Unfortunately, unexpected recoveries from other kinds of cancer have been less well studied, perhaps because of their rarity. But there are some clues, and they could come from the pioneering work of a little-known American doctor more than 100 years ago.
It was the late 19th Century, and William Bradley Coley was struggling to save a patient with a large tumour in his neck. Five operations had failed to eradicate the cancer. Then the patient caught a nasty skin infection with a scorching fever. By the time he’d recovered, the tumour was gone. Testing the principle on a small number of other patients, Coley found that deliberately infecting them with bacteria, or treating them with toxins harvested from microbes, destroyed otherwise inoperable tumours.
Could infection be the key to stimulating spontaneous remission more generally? Analyses of the recent evidence certainly make a compelling case for exploring the idea. Rashidi and Fisher’s study found that 90% of the patients recovering from leukaemia had suffered another illness such as pneumonia shortly before the cancer disappeared. Other papers have noted tumours vanishing after diphtheria, gonorrhoea, hepatitis, influenza, malaria, measles, smallpox and syphilis. What doesn’t kill you really can make you stronger in these strange circumstances.
It’s not the microbes, per se, that bring about the healing; rather, the infection is thought to trigger an immune response that is inhospitable to the tumour. The heat of the fever, for instance, may itself render the tumour cells more vulnerable, and trigger cell suicide. Or perhaps it’s significant that when we are fighting bacteria or viruses, our blood is awash with inflammatory molecules that are a call to arms for the body’s macrophages, turning these immune cells into warriors that kill and engulf microbes – and potentially the cancer too. “I think the infection changes the innate immune cells from helping the tumours to killing them,” says Henrik Schmidt at Aarhus University Hospital in Denmark. That, in turn, may also stimulate other parts of the immune system – such as our dendritic cells and T-cells – to learn to recognise the tumorous cells, so that they can attack the cancer again should it return.
Schmidt thinks that understanding the process of spontaneous remission is vital, since it could help refine the emerging class of “immunotherapies” that hijack our natural defences to combat cancer. In one treatment, for instance, doctors inject some cancer patients with inflammatory “cytokines” in order to kick the immune system into action. The side effects – such as high fever and flu-like symptoms – are typically treated with drugs like paracetamol, to improve the patient’s comfort.
But given that the fever itself may trigger remission, Schmidt suspected that the paracetamol might sap the treatment’s potency. Sure enough, he has found that more than twice as many patients – 25% versus 10% – survive past the two-year follow-up, if they were instead left to weather the fever.
There could be many other simple but powerful steps to improve cancer treatment inspired by these insights. One man experienced spontaneous remission after a tetanus and diphtheria vaccination, for instance – perhaps because vaccines also act as a call to arms for the immune system. Along these lines, Rashidi points out that a receiving standard vaccine booster – such as the BCG jab against tuberculosis – seems to reduce the chance of melanoma relapse after chemotherapy.
Catching a cure
Others are considering a far more radical line of attack. For instance, one approach aims to deliberately infect cancer patients with a tropical disease.
Should we infect cancer patients with tropical diseases? (SPL)
The technique, developed by American start-up PrimeVax, involves a two-pronged approach. It would begin by taking a sample of the tumour, and collecting dendritic cells from the patient’s blood. These cells help coordinate the immune system’s response to a threat, and by exposing them to the tumour in the lab, it is possible to programme them to recognise the cancerous cells. Meanwhile, the patient is given a dose of dengue fever, a disease normally carried by mosquitoes, before they are injected with the newly trained dendritic cells.
Under the supervision of doctors in a hospital, the patient would begin to develop a 40.5C fever, combined with the widespread release of inflammatory molecules – putting the rest of the immune system on red alert. Where the tumour was once able to lurk under the radar, it should now become a prime target for an intense attack from the immune cells, led by the programmed dendritic cells. “Dengue fever crashes and regroups the immune system, so that it is reset to kill tumour cells,” says Bruce Lyday at PrimeVax.
Infecting vulnerable patients with a tropical illness may sound foolhardy, but dengue fever is less likely to kill the average adult than the common cold – making it the safest choice of infection. Importantly, once the fever has subsided, the programmed immune cells will remain on the lookout for the tumour, should it reappear. “Cancer is a moving target. Most therapies attack from just one side – but we’re trying to put it in a lose-lose situation, now and in the future,” says Lyday.
No one could fault the ambition behind this kind of therapy. “Our mission is to replicate spontaneous remission in as standardised way as possible,” says Lyday’s colleague Tony Chen. Even so, they are keen to emphasise that their idea is still at a very early stage of development – and they cannot know how it will play out until they begin a clinical trial. The first tests, they hope, will begin with advanced melanoma patients, perhaps by the end of the year.
Clearly, caution is necessary. As Irvine points out: “Spontaneous remission is a little clue in a big complicated jigsaw.” But if – and that is a massive if – they succeed, the implications would be staggering. A rapid, relatively painless recovery from cancer is now considered a miracle. The dream is that it might just become the norm.
Just one in 100,000 cancer patients shed the disease – but why?
Hence, glucose starvation sensitizes cancer cells against various stresses and may induce apoptosis in cancer cells. Studies reveal that 72 hours of starvation reduces glucose levels by 41% and IGF-1 levels by 70%, while IGFBP1 increases 11.4-fold.What shrinks tumors fast? ›
Radiation. This treatment uses high-energy rays to kill cancer cells or shrink tumors.Has anyone survived stage 4 cancer? ›
Although the overall prognosis may be poor based on cases with previous patients and older treatments, many patients with stage 4 cancer can live for years. A few factors to keep in mind: Many treatments are available to help fight cancer. The body's response to treatment may differ from that of others.What is the longest someone has lived with Stage 4 cancer? ›
“Stage 4 cancer for 18 years. Seventeen different treatments.What foods do cancer cells hate? ›
There are many different foods you can eat to kill cancer cells; here are some of the most effective: legumes, flaxseeds, tea, garlic, whole grains, and more. All of these foods have been studied and shown to have beneficial effects at inhibiting the growth of cancer cells in the body.What stops tumors from growing? ›
Tyrosine kinase inhibitors (TKIs) block chemical messengers (enzymes) called tyrosine kinases. Tyrosine kinases help to send growth signals in cells, so blocking them stops the cell growing and dividing. Cancer growth blockers can block one type of tyrosine kinase or more than one type.What diet shrinks tumors? ›
Ketogenic diets selectively starve tumors by providing the fat and protein that otherwise could not be used by glucose-dependent tumor cells. In KDs, the 4:1 ratio of high fat to low carbohydrates mimics the metabolic effects of starvation (Figure 2).Can a tumor go away naturally? ›
Tumours have been known to disappear spontaneously, in the absence of any targeted treatment, usually after an infection (bacterial, viral, fungal or even protozoal).What not to say to a cancer patient? ›
- “Really you have cancer? ...
- "Just live in the moment."
- “I read about this new diet that cures cancer!”
- “I know you will get better!”
- “I know what you're going through. ...
- “I can't stop worrying about you.” Please don't add another burden to my already heavy heart!
- Chronic lymphocytic leukaemia.
- Chronic myeloid leukaemia.
- Pleural mesothelioma.
- Secondary brain tumours.
- Secondary breast cancer.
- Secondary bone cancer.
- Secondary liver cancer.
- Secondary lung cancer.
Staging varies with the type of cancer. The term stage 5 isn't used with most types of cancer. Most advanced cancers are grouped into stage 4.Which cancers have the shortest life expectancy? ›
Cancer survival rates by cancer type
The cancers with the lowest five-year survival estimates are mesothelioma (7.2%), pancreatic cancer (7.3%) and brain cancer (12.8%). The highest five-year survival estimates are seen in patients with testicular cancer (97%), melanoma of skin (92.3%) and prostate cancer (88%).
Is stage 4 cancer always terminal? Stage 4 cancer is not always terminal. It is usually advanced and requires more aggressive treatment. Terminal cancer refers to cancer that is not curable and eventually results in death.Has anyone beat Stage 3 cancer? ›
These categories are usually determined by the size and number of tumors and how far the cancer has spread. There are effective treatments for many stage 3 cancers. Some stage 3 cancers can be cured, but they are more likely to return after going away.What is the number 1 cancer fighting food? ›
The list is usually topped with berries, broccoli, tomatoes, walnuts, grapes and other vegetables, fruits and nuts. "If you look at the typical foods that reduce cancer risk, it's pretty much all plant foods that contain phytochemicals," says Wohlford.
The bottom line. Processed meat, overcooked foods, and fried foods may increase your risk of some types of cancer. That's because these foods may contain carcinogens, or compounds that cause cancer. Alcohol produces carcinogens when it's metabolized by your body.Do blueberries fight cancer? ›
Importantly, molecular analysis showed that blueberry consumption altered expression of genes important to inflammation, cancer and metastasis (spread of cancer) in way that would lower cancer risk.What natural supplements fight cancer? ›
- Suspect: Fish Oil. Charge: Fish oil contains omega-3 fatty acid, which helps the body absorb nutrients and fend off inflammation. ...
- Suspect: Flaxseed. ...
- Suspect: Ginger. ...
- Green Tea. ...
- Suspect: Lycopene. ...
- Suspect: Melatonin. ...
- Suspect: Selenium. ...
- Suspect: Turmeric.
When cells grow old or become damaged, they die, and new cells take their place. Sometimes this orderly process breaks down, and abnormal or damaged cells grow and multiply when they shouldn't. These cells may form tumors, which are lumps of tissue.What cell kills tumors? ›
A type of immune cell that can kill certain cells, including foreign cells, cancer cells, and cells infected with a virus. Killer T cells can be separated from other blood cells, grown in the laboratory, and then given to a patient to kill cancer cells.
Exercise may be a cancer fighter
A study published in 2021 found that exercise may help halt or slow the growth of tumors. The study raises the possibility that exercise kills cancer cells. Exercise causes your body to release proteins called myokines into your blood.
A starch found in bananas can reduce some cancers by more than half, according to a 20-year trial. The international study, which included researchers from the University of Leeds, has shown a major preventive effect from resistant starch among people with high hereditary risk of cancer.Do eggs feed tumors? ›
What Explains The Egg-cancer Connection? Eggs are high in choline. Choline is converted in the gut into trimethylamine (TMA), which, after being oxidized by our liver into TMAO, may promote inflammation and result in cancer progression.How can you shrink a tumor without chemo? ›
- Treatment 1: Surgery. ...
- Treatment 2: Immunotherapy. ...
- Treatment 3: Targeted therapies. ...
- Treatment 4: Active surveillance. ...
- Treatment 5: Supportive care.
Some cells of the immune system can recognise cancer cells as abnormal and kill them. But this may not be enough to get rid of a cancer altogether. Some treatments aim to use the immune system to fight cancer.How long can you live with a tumor without knowing? ›
If you're wondering how long you can have cancer without knowing it, there's no straight answer. Some cancers can be present for months or years before they're detected. Some commonly undetected cancers are slow-growing conditions, which gives doctors a better chance at successful treatment.What do cancer patients want to hear? ›
“Let me help you with…”
Instead of hearing “What can I do?” cancer patients want to hear that you already have a specific task in mind. Many cancer patients will decline needing help when they are asked the broad question “What can I help with?” Choose something specific and get started on it.
Don't ask about their odds. If they want to bring it up, they will. Don't call their cancer “the good kind.” They're all hard to deal with, even if the outlook is good. Don't ask if they ever smoked, what they ate, or other lifestyle habits that could provoke shame or guilt.How do you make a cancer patient happy? ›
- Take care of the grocery shopping, or order groceries online and have them delivered.
- Help keep their household running. ...
- Bring a cup of tea or coffee and stop by for a visit. ...
- Give the primary caregiver a break. ...
- Drive the patient to appointments.
1. Breast cancer. The 5-year relative survival rate for stage 0 and 1 breast cancer is 99–100 percent . Therefore, people with this stage and type of cancer are almost 100 percent as likely to survive for at least 5 years as people without the condition.
- brain (glioblastomas)
- cells that give your skin color (melanomas)
Bone cancer is one of the most painful cancers. Factors that drive bone cancer pain evolve and change with disease progression, according to Patrick Mantyh, PhD, symposium speaker and professor of pharmacology, University of Arizona.What cancer is terminal? ›
Cancer that cannot be cured and leads to death. Also called end-stage cancer.Why is cancer so hard to cure? ›
The difficulty in treating cancer is that it's not a single disease, but rather a group of diseases. In total there are more than 100 different types of cancers. Cancers are also caused by different things, so no one strategy can prevent them.What stage of cancer means death? ›
Cancer that cannot be cured and leads to death. Also called terminal cancer.What are the slowest spreading cancers? ›
Acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) Certain breast cancers, such as breast cancer inflammatory forms (IBC) and triple-negative breast cancer (TNBC) Large B-cell lymphoma Lung cancer Rare prostate cancer such as small cell carcinoma or lymphoma Non-fast-growing cancer This means that the ...What are the top 3 deadliest cancers? ›
Lung and bronchus cancer is responsible for the most deaths with 130,180 people expected to die from this disease. That is nearly three times the 52,580 deaths due to colorectal cancer, which is the second most common cause of cancer death. Pancreatic cancer is the third deadliest cancer, causing 49,830 deaths.Which cancers are most likely to recur? ›
Some cancers are difficult to treat and have high rates of recurrence. Glioblastoma, for example, recurs in nearly all patients, despite treatment. The rate of recurrence among patients with ovarian cancer is also high at 85%.Can you live 10 years with Stage 4 cancer? ›
Although the overall prognosis may be poor based on cases with previous patients and older treatments, many patients with stage 4 cancer can live for years.What is the new cancer pill? ›
The compound, designated EBC-46 and technically called tigilanol tiglate, works by promoting a localized immune response against tumors. The response breaks apart the tumor's blood vessels and ultimately kills its cancerous cells.
Patients diagnosed in stage 4 who decide against treatment live an average of six months. Those diagnosed with stage 1A disease who elect no treatment live an average of two years. Survival without treatment depends on stage, health and tumor growth. Traditional therapies have the most impact on stage 4 survival.What stage of cancer is the hardest? ›
That will describe the size of the cancer and how far it's spread. Cancer is typically labeled in stages from I to IV, with IV being the most serious. Those broad groups are based on a much more detailed system that includes specific information about the tumor and how it affects the rest of your body.Can you win Stage 4 cancer? ›
Stage 4 cancer usually can't be cured. In addition, because it's usually spread throughout the body by the time it's diagnosed, it is unlikely the cancer can be completely removed. The goal of treatment is to prolong survival and improve your quality of life.What is worse stage 3 or stage 4 cancer? ›
stage 3 – the cancer is larger and may have spread to the surrounding tissues and/or the lymph nodes (or "glands", part of the immune system) stage 4 – the cancer has spread from where it started to at least 1 other body organ, also known as "secondary" or "metastatic" cancer.What stops cancer cells from growing? ›
Tyrosine kinase inhibitors (TKIs) block chemical messengers (enzymes) called tyrosine kinases. Tyrosine kinases help to send growth signals in cells, so blocking them stops the cell growing and dividing. Cancer growth blockers can block one type of tyrosine kinase or more than one type.What keeps cancer cells from dying? ›
Cancer cells can ignore the signals that tell them to self destruct. So they don't undergo apoptosis when they should. Scientists call this making cells immortal.What is the most active in fighting cancer cells? ›
CD8+ T cells are the most prominent anti-tumor cells.Which nuts fight cancer better? ›
In both cell and animal studies gamma-tocopherol decreases cancer cell growth. Pecans, pistachios and walnuts are especially rich sources. Selenium is an essential component of several antioxidant enzymes and is super-concentrated in Brazil nuts.What triggers cancer cells to grow? ›
Most cancer-causing DNA changes occur in sections of DNA called genes. These changes are also called genetic changes. A DNA change can cause genes involved in normal cell growth to become oncogenes. Unlike normal genes, oncogenes cannot be turned off, so they cause uncontrolled cell growth.Where do dead cancer cells go? ›
Everything gets recycled, all the proteins and sugars, the nucleic acids, the energy-containing components, all of it gets re-used by other cells. Nothing goes to waste. Dead cancer cells are as tasty to a phagocyte as any other type of dead cell.
The main reasons are genetics and certain environmental or behavioral triggers. The tendency to develop some types of cancer is believed to be inherited — that is, the genes you were born with might carry a predisposition for cancer.