Cancer Research Campaign: We've seen the future - and it could work

If war is an appropriate metaphor for cancer, then researchers are the strategists sitting in the bunkers planning various modes of attack. Every so often they come up with a bright idea for a shiny new weapon that will wipe out the enemy, but when the troops test it, it is found to be useless.

That's the common perception of cancer research. Yet cancer researchers and oncologists are more positive about the future than they have been for decades and disappointed that the inroads they have made in terms of prevention and treatment are not more widely known.

"There's a widespread belief that cancer deaths are going up but this belief is wrong. Cancer deaths are going down. It may seem more people are dying of cancer but this because heart and respiratory disease are going down even faster," says Richard Peto, professor of medical statistics at Oxford University.

Although tobacco consumption has plummeted from an annual consumption of 135 billion cigarettes a year after the war to 80 billion now, seasoned smokers are now developing lung and bladder cancer and will continue to do so, even though deaths from lung cancer have gone down by half since their peak in 1965. Tobacco-related cancers account for a third of all cancer.

"The figure for cure rates for cancer in adults has improved year on year for the last 14 years," says Professor McVie. "On average 5,000 fewer people have been of dying of cancer each year since 1990. If you take non-tobacco cancers out of the equation there is a very satisfactory improvement.

"We've notched up a 12-14 per cent increase in cure rates in breast cancer and that's all treatment related. And in children's cancer, treatment is wildly successful."

Breakthrough treatments have been in rare cancers, such as testicular cancer, childhood leukaemia, Hodgkin's disease and lymphoma. Unless the cancer is localised it is still difficult to treat. But cancer researchers predict that within 10 to15 years new drugs, based on molecular biology, should be available that will tackle the three big cancers - lung, colon, breast. In other words, doctors will be able to treat cancers that have spread.

Scientists now understand, in far more detail than ever before, the structure of a tumour and the way in which it grows and are devising ways of blocking tumour growth and destroying cancer cells through gene therapy, the development of molecules that can block cancer pathways or drugs that can home in on specific cancer cells.

Tumour vaccines are being developed, as are drugs to cut off the blood to tumours which will shrink to a manageable size. Chemotherapy and radiotherapy are being refined, as are surgical techniques.

"We've never had a more exciting time, more avenues to go up and more combinations of therapies to look at," says Professor McVie. "At the very basic level, a treatment such as ADEPT (see below) represents the chance to do something for people with advanced bowel cancer. But if it does something for bowel cancer it will certainly do something for breast cancer, and probably lung and bladder cancer. It will then be applicable to umpteen other cancers and there will be an explosion of clinical trials.

"I predict that in the near future patients will not only have a pathology report describing the cancer but also a genetic report describing the gene abnormalities in that specific cancer," he continues. "The gene information will tell you how aggressive the cancer is, whether it's likely to spread, whether or not it is sensitive to drugs and whether it would be suitable for gene therapy."

Large inoperable tumours will increasingly be treated with chemotherapy to shrink them and make it easier to operate on them. There will be less disfigurement and a better chance of reconstructive surgery. The type of chemotherapy used will be determined by the outcome of genetic tests, for certain genes make some tumours more resistant to drug treatment and radiotherapy.

But it seems unlikely there will be a "magic bullet" that will wipe out the disease. "It won't be a quick fix," says Karol Sikora, professor of Clinical Oncology at the Hammersmith Hospital, London. "You won't go to a nice shiny building and come out cured - that may never happen. Diabetes is the best analogy. Someone with diabetes has to have injection for the rest of their life and if it's well controlled your life span in pretty normal. That will be the same for cancer. You can live quite happily with a malignant tumour in you. The drug may not cure you but it will mean that sentence `I'm sorry there's nothing more we can do for you' will become a thing of the past."