Cancer has ceased to be an incurable disease
Fix the gene
Cancer has moved from fatal fatal diseases to the rank of chronic, treatableIrina Krasnopolskaya, Rossiyskaya Gazeta
Last year, almost 300 thousand Russians and more than 7 million people in the world died of cancer. Researchers predict: in developed countries, cancer will overtake heart disease and become the most common cause of death. Every third woman and every second man will get cancer sooner or later.
Is everything really so gloomy? The RG columnist talks about this with the director of the Dmitry Rogachev Federal Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, Academician Alexander Rumyantsev.
Alexander Rumyantsev: In essence, cancer is "stitched" in our genome. This is not one disease, but many different diseases. And they all have a common property – a violation of cell division and the program of cell death. The biology of these processes is well studied. Cancer is a consequence of mutations of vital genes. Genes regulating cell division and resulting from damage to nucleic acids by carcinogens. Or is it a consequence of an accidental or virus–induced copying error before cell division. And it is impossible to eradicate the error based on cell division – be it development, aging, regeneration, healing, and so on.
– It turns out that cancer threatens each of us?
Alexander Rumyantsev: No, of course not. Not everyone lives up to it. This is especially true for those who die from heart and vascular diseases. Or such a paradox: those who develop severe atherosclerosis do not suffer from cancer.
- why?
Alexander Rumyantsev: I can't answer. Don't know. In the four-thousandth history of cancer, described in Sumerian clay tablets, the last seventy years were highly productive. In 1947, Sidney Farber, the son of an emigrant from Russia, a pathologist at the Children's Hospital in Boston, who spent 10 years studying the effects of chemicals on an incurable tumor of the hematopoietic and immune system – children's acute lymphoblastic leukemia, introduced the first chemotherapy drug P ametopterin (methotrexate) into the treatment of cancer patients. Anti-vitamin, a folic acid antagonist. From that moment on, cancer in its most aggressive form began to be treated with chemicals.
Today, clinical oncologists have more than a hundred effective chemical and biological drugs in their arsenal. And cancer has moved from the category of fatal fatal diseases to the rank of chronic diseases that can be treated. Chemotherapy, or rather, biological cancer therapy, came out on top in combined treatment (surgery and radiation therapy). There are currently 2.5 thousand medicinal molecules under consideration in the world with a point (targeted) effect that interferes with the genetic breakdowns inherent in each tumor. We are facing a new stage of cancer treatment – personalized medicine. According to experts, already in this decade cancer will be put under the control of medicine in full.
– We constantly say: "Cancer is curable if..." That is, if it is detected at an early stage and treatment is started on time.
Alexander Rumyantsev: According to the constitution, everyone is obliged to take care of their health. How? Starting from the age of 33, he must pass control every year, and after 45 years – twice a year. 90 percent of this control is a meeting with a doctor. It is necessary to discuss with the doctor those disorders that have arisen by this time: be it the condition of the teeth, the work of the intestines, sleep disorders, and so on. And the doctor should carefully examine the person, talk to him in order to focus on his complaints, the results of a visual examination. And only after that, on the basis of them, assign laboratory tests.
First of all, a general blood test is the main participant in all screening processes. Blood sampling is not from a finger, but from a vein. In separate test tubes, material is taken to control the level of sugar, cholesterol, lipoprotein. This is a mandatory component of screening. It should include a study on cancer-ebrionic antigens. There are several of them for the main cancer locations.
After such an examination, the doctor may prescribe additional studies – ultrasound, mammography, and so on. And mass, general studies, on–stream studies - whether fluorographic or mammographic, do not give a true picture of the body.
– The ill-fated cancer does not bypass children either.
Alexander Rumyantsev: In 2012, we celebrated the 50th anniversary of the organization of the first pediatric oncology department in the USSR. This year is the 50th anniversary of the opening of the first department of pediatric hematology. Both of them were born in the Morozov Children's Clinical Hospital in Moscow. That is where the roots of our center and the Research Institute of Pediatric Oncology are. Today, the clinic of the Morozov Hospital is the largest regional center of pediatric hematology/oncology. Here are the latest technologies, extra-class employees. The Moscow clinic and our center together solve the most "sick" problems of pediatric oncology. The hospital performs up to ten bone marrow transplants per year.
– But not only in Moscow?
Alexander Rumyantsev: Not only. Now there are more than 80 centers and departments of pediatric hematology/oncology in Russia, eight of which are under federal subordination and are still working within the framework of the VMP and SMP with budget funding. All others are funded by the CHI. Yekaterinburg, St. Petersburg, Nizhny Novgorod, Krasnodar, Novosibirsk, Tatarstan and Vladivostok are the last in the ranking after Moscow. In the next two years, specialized clinics in Moscow, Kaluga, Orenburg, and a number of other regions will be developed.
All centers and specialists are united in the National Society of Pediatric Hematologists/Oncologists, whose members have prepared clinical recommendations, protocols and medical and economic standards for the diagnosis and treatment of children and adolescents with hematological and oncological diseases. These are important tools for unifying the treatment of children throughout Russia, ensuring the availability and high quality of treatment for children. In the next two years, these protocols and standards should be fully funded. Doctors, public organizations of parents, patients and Public councils for the Protection of Patients' Rights are working on their tariffs.
The participation of public organizations is necessary. This week, the VII Forum of the interregional public organization "Movement against Cancer" was held in Moscow. The issues of helping children were specially highlighted. After all, their treatment programs are fundamentally different from adult treatment programs. For them, it is recovery, not prolongation of life, achievement of child development, not quality of life. By the way, this topic will also be discussed at the next congress of the Union of Pediatricians of Russia on February 18-20 in Moscow.
– Alexander Grigoryevich, in a conversation with you, there is no way to get around the topic of the Dima Rogachev center, opened in 2011.
Alexander Rumyantsev: This is the world's largest center of our profile, where more than 7000 patients receive high-tech care a year. Operations are performed here in endoscopic, microsurgical techniques under the control of visualization using the latest reconstructive materials, artificial joints. More than 200 bone marrow transplants, peripheral and umbilical cord blood stem cells are performed per year. All transplants are unrelated, using donor and family material.
Sick children receive highly effective chemo- and radiation therapy and immunotherapy. In May last year, the center was given a sanatorium near Moscow, on the basis of which the medical and rehabilitation scientific center "Russian Field". In it, rehabilitation and further treatment will be provided to young patients, patients with brain and bone tumors, those who have undergone bone marrow transplantation.
– You mention cellular technologies, you talk about bone marrow transplantation operations. I know that they have been practicing in your clinic for a long time. What is your attitude to cellular technologies?
Alexander Rumyantsev: I treat them very positively. Although so far this is scientific research, experimental technologies that require development. There is still much to discuss. I am ready, but the law on them has not yet been adopted. And he is very much needed.
– Bone marrow transplants, the use of peripheral and umbilical cord blood stem cells in oncological, immunological, hematological diseases that you conduct extensively – these are cellular technologies.
Alexander Rumyantsev: Of course. There are currently 22 blood stem cell and immune system transplantation centers in Russia. 6 of them are children's. The most difficult transplantation is from unrelated donors. But usually, these are parents, sisters, brothers or their own stem cells obtained by taking their own bone marrow or using a blood separator.
The main question– Hand on heart: is the level of treatment of children suffering from cancer in Russia comparable to the world?
Alexander Rumyantsev: Let's compare.
– I didn't ask by chance. Requests often come to the editorial office: to help raise funds for the treatment of a child suffering from cancer abroad. You have seen one of these letters – from the mother of a four-year-old girl. The girl lives far from Moscow, was treated at your center, and now her mother is asking to raise money for treatment in England, because the girl is getting worse...
Alexander Rumyantsev: Yes, this girl suffers from a generalized brain tumor with metastases to the spinal cord, skull bones and vertebrae. This is a rare and, unfortunately, incurable large-cell anaplastic medulloblastoma. During the year, pediatric oncologists at the place of residence and our center fought for the child's life. The girl received three courses of chemotherapy, including the international HIT protocol, a course of radiation therapy. Without effect.
Escalation of therapy is dangerous for the child's life, and therefore the girl receives supportive therapy, which, unfortunately, is palliative in nature. The offer of English colleagues to come to England for treatment, in my opinion, has exclusively commercial purposes. However, this proposal forced the parents to seek financial assistance for a trip to England.
– This is not the only letter. Is it justified to raise funds for treatment abroad?
Alexander Rumyantsev: Extremely rare. Not everyone knows that there is a certain procedure for providing assistance in treatment abroad. Including children.
"Which one?"
Alexander Rumyantsev: The family or the patient himself submits to the Ministry of Health of Russia an extract from the medical history and a personal letter requesting such assistance abroad. The patient undergoes a special examination in a federal institution and receives a specialist opinion on the feasibility of such treatment. It is provided in cases when it is not carried out anywhere in Russia. The Ministry of Health contacts the foreign clinic that can receive and provide assistance to such a patient. The Ministry of Health participates in co-financing.
– So, in any case, public assistance and fundraising are necessary?
Alexander Rumyantsev: Yes. But I will add: miracles, as a rule, do not happen. Although they still believe in them. And this faith cannot be shaken. Especially the faith of parents. The child we are talking about has undergone all types of treatment. The right of parents to make decisions about his future. The Ministry of Health will not give its consent in this case, since this is not realistic. But people, especially parents... They can be understood. And you need to understand.
Portal "Eternal youth" http://vechnayamolodost.ru07.02.2014