Why does Cancer Reoccur? The Puzzle!


Why does cancer reoccur? This was the question I always asked everyone I met in the scientific group. There was a dearth of fear from it as I had seen my Jethu (elder Uncle) suffer the pain and at last death seemed to be the most peaceful thing that happened in his life.


There were many answers which were given to me by many but no answer fitted well with my thoughts. Then somewhere from the blue I met Dr Bikul Das (MD, PhD, Associate Research Investigator, The Forsyth Institute Cambridge, MA and the founder of KKL, at GBP, IIT-Guwahati) who had visited India to set up his research laboratory at IIT-Guwahati. He was supposed to take our interview for the same purpose. A short structured man with a lively face and a smile that wore an aura of positivity all around.


In our very first interaction with him, he had confronted me and my best friend Dr Sorra Sandhya why we wanted to work in this field of research, basically on Cancer. Our very answer was because we wanted to eradicate it and help people get treated.


That day he had said, “Probably this is the first answer which every researcher thinks of when they work on cancer, but then you know there’s a super Nova which rules everything some call it God and scientists like us call it Energy, tricks every time and brings new puzzles in your path to solve them”. I and Sandhya were just like, “What is he talking about?”


My research was all about “reprogramming of mesenchymal stem cells by cancer stem cells”. During these five years of research the whole research team of ours evolved and we were able to introduce a new mechanism responsible for the recurrence of cancer where the cancer stem cells reprogrammed the mesenchymal stem cells. This mechanism was termed as, “Altruism-पारार्थ्यम्”.


Readers, now the question that would arise in your mind is, “What is Altruism?” Altruism is-the quality of unselfish concern for the welfare of others. Now, this is interesting because nature and ancient culture is the mother of all inventions and discoveries. We had to crawl back to ancient Vedas to get the answer and we did find it in its womb. This termed was first coined in science for cancer by my mentor Dr Bikul Das where he had given a hint that this mechanism of selfless act might be somewhere responsible for cancer recurrence. This study was however completed to some extent for oral cancer model in my thesis.


In our body not all cells have the capacity of self-renewal and self-survival except a few. And these special types of cells with self-renewal and self-sustainability capability are termed as Stem Cells. These stem cells have pluripotency (capable of giving rise to several different cell types) capability but then this requires special environment to help them differentiate into various other forms of cells.


Similar is the case in terms of Cancer Cells. According to the recent theory on cancer recurrence it has been stated that there are some cells within the cancerous region that share these special stem cell like properties. They have been termed as “Cancer Stem Cells (CSCs)”. However, only a few of these CSCs have the capability to survive during the treatments procured for cancer (Operation, Radiation, or Chemotherapy). The treatments create oxidative stress (a condition which results in deficiency of the amount of oxygen reaching the tissues leading to cell death). However, some special CSCs are capable of surviving in these oxidative stress conditions by over-expressing Hypoxia-inducible factor-2α (Hif-2α) that helps them to get a decrease in p53 (the gene responsible for programmed cell death) and thus help them to survive in these extreme conditions.


These surviving CSCs thus transfer their mantra of survival during these extreme oxidative conditions to the Mesenchymal Stem Cells (MSCs) (those stem cells that have the capability to develop into the tissues of lymphatic and circulatory systems, as well as the musculoskeletal system).The MSCs basically home in the bone-marrow microenvironment but have a quality of rushing to injured places for healing. Now, any sort of treatment for cancer leads to injury to the cells and to heal this injury the MSCs rush to the area. During this period the survived CSCs reprogram the MSCs to this higher altruistic phenotype where they receive the mantra of surviving during the extreme conditions.


So, we all are puppets in the hands of the Nova energy that abides us to exhaust and transform the energy within us to a different form. Same occurs here. These reprogrammed MSCs which have received the altruistic phenotype mantra of survival during excessive oxidative stress might in future result in cancer relapse where they self-sacrifice themselves but transfer the reprogramming mechanism to the nearby non-cancerous cells in their contact.  These reprogrammed non-cancerous cells under favorable or suitable condition might re-proliferate into malignant tumors thus leading to cancer recurrence. This is all about in jiff about the study done by me on the reprogramming of MSCs by the CSCs in oral cancer model.


Today, now after the completion of Ph.d we have understood what he was talking about which reminds me of the song, “I have a long long way to go before I say goodbye” by Def Leppard. Somewhere this even embarks the enthusiasm within us to carry our research on this field and to get our queries answered.


Now we, both me and my friend Sandhya, have learnt that the solution to a complex problem isn’t so easy to find out but then to walk in the path which many forbid is itself a courageous job. It’s not always possible to find solutions to the puzzles but then trying to solve it is itself a big step. Research has two phases – a positive result and a negative one but in both ways they are results and a researcher should be content to every findings they get during doing it. No matter what, one should never stop trying.

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Dr. Joyeeta Talukdar

Dr. Joyeeta Talukdar is a PhD in Cancer Stem Cell Research. A blogger and classical dancer, she loves to write on the experiences of life and spread positivism.
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