Known as one of the most feared diseases, cancer is the result of an abnormal growth of cells which proliferate in an uncontrolled fashion, without giving the cell enough time to self-repair. This may eventually give rise to metastasis, making it harder to successfully cure entirely.

Although everyone is susceptible to this disease, both genetic as well as environmental risk factors may increase the risk. Location of disease, cell types, the grade and stage of the tumour will all affect the survival of the individual.

Owing to today’s advancements in medicine, prognosis has greatly improved, however, a complete recovery is not always possible. In fact, recurrence is a rather common occurrence.

Although certain types of cancer are generally known to be relatively treatable (i.e. the symptoms are alleviated yet the disease is not fully eradicated), in a significant number of cases it is also curable (approximately 50-60 per cent of cases). Cancers which have the greatest probability of being completely cured (i.e. permanently free from the disease) owe to a higher sensitivity to treatment as well as the relative “ease” to diagnose the disease in its early stages.

With approximately 200 types of cancer, the incidence and survival rates of each vary accordingly. Although cancer is the second leading cause of death in Malta, it is heartening to note that survival rates are on the increase. This is especially due to the implementation of screening programmes, which aid in early detection and subsequently improve treatment outcomes.

Nevertheless, in Malta, the risk of developing cancer in a lifetime is one in three, while the risk of dying from cancer is one in four. It has also been shown that men are more likely to develop cancer than women and that most cancers are diagnosed in people who are 55 years or older.

The optimal treatment is typically selected based on the cell type, grade and extent of the tumour. Starting off, surgery is one of the main ways to treat solid, localised tumours. However, treatment is usually multi-modal to ensure sufficient eradication of the disease.

Chemotherapy is an effective, drug-based treatment containing toxic chemicals, yet is a double-edged sword. Although it successfully kills the cancerous cells, it brings along with it unpleasant side effects such as hair loss, nausea and fatigue.

Around 50 per cent of patients diagnosed with cancer will eventually receive radiotherapy. Radiotherapy aims to give a high dose of ionising radiation to the tumour while keeping the dose to the surrounding healthy tissues as low as possible, diminishing the side effects.

While a cure for all cancers is not yet within our reach, advances are continuously being made, especially for the most common cancer types

Typically, when normal tissues mutate and transform into cancer-precursor cells, the immune system detects this and eliminates the affected cells, thereby preventing the development of cancer. However, a number of mechanisms may allow for the abnormal cells to remain undetected. This is termed ‘immune evasion’, which is where the cancerous lesion is not recognised by the immune system and is, therefore, allowed to progress and grow.

Several mechanisms are involved in immune evasion. The cancer may have little to no cell surface receptors by which the immune system cells could recognise the abnormal cells. Alternatively, the cancer may have these receptors, however, still leads to a limited immune response. The lesion may also cause immunosuppression, which would limit the response of the immune system to the lesion.

Moreover, the lesion may create what is termed a ‘privileged site’, which prevents immune system cells from reaching the cancer.

Furthermore, although individuals may have the same form of cancer, the response to treatments may vary drastically. This may be due to different genetic mutations, which may make certain cancers resistant to treatment. Genetic mutations may occur spontaneously or due to environmental stresses, such as viruses. This is one of the reasons why cancer treatment is not a ‘one-size-fits-all’ solution. In addition, although a cancer may initially respond to a treatment, genetic mutations may result in a diminished response as the treatment progresses.

Alternative regimens and treatments may be attempted when this occurs, however, this phenomenon is a key reason why eradicating cancer is challenging. It is not uncommon for a specific cancer lesion to contain more than one cell type. Due to this, while one cell type may respond to treatment, another cell type in the same lesion may not. This issue may be solved by combining several therapies, with the consequence of more side effects.

Advanced therapies may be utilised for certain types of cancers, used as an adjunct to standard therapies in order to improve the outcome. Immunotherapy makes use of the individual’s immune system to fight off cancer. Cancer vaccines are one of the latest developments in immunotherapy, which can be used to counter immune evasion. Gene editing is a novel approach to cancer treatment, which adds a new gene into the cancer cells’ genome, with the purpose of halting growth or killing the cell. In addition, nanoparticles may be an alternative approach to administering chemotherapy agents. Nanoparticles are microscopic capsules which may contain chemotherapy, delivered only to the cancer cells.

The benefits of such advanced therapies include improved survival with a reduction of side effects. However, such therapies are highly specific, therefore, may not be suitable for many cases. Moreover, hormone therapy may be used with certain cases such as in prostate and breast cancer, with the aim of regulating the growth-promoting hormones.

In conclusion, while a cure for all cancers is not yet within our reach, advances are continuously being made, especially for the most common cancer types. Cancer can now be classified as a chronic disease, where although patients are not fully cured, they are able to live long and comfortable lives.

Amy Xuereb is a second-year radiography student as well as MHSA’s international officer and Robert Pisani is a final-year student currently reading for the Bachelor of Science (Honours) in radiography.