The Cancer Chronicles Page 22
It had been January when he heard that scary cracking sound while he was eating. By mid-October he had finished the second round of treatment. During that time he exhausted his sick leave. His boss tried to get him another extension, but soon Joe was unemployed. You can fire someone because they have cancer. Joe said he understood. He was sure he would get his job back once he was well. More than a month passed before he felt a new soreness, this time around his collarbone. “Buckle your seatbelt,” he said. On Thanksgiving Day he wrote from the hospital:
“I have so much to be thankful for this year.…I had surgery yesterday, to help my breathing (by removing dead cells that were left over from radiation) and to biopsy the clavicle growth. Good news on both fronts. I am back to normal breathing! And the tumor close to the clavicle can be treated with radiation! I’m waiting to go home now.” There was no such thing to him as completely bad news.
But then came more tumors, too many now to radiate. A body can stand only so much. “We can shrink them as much as we can with straight chemo,” Joe reported, “but this will not kill them. I don’t know if I have 6 months or 6 years.” That was November 30. He didn’t even have six weeks.
He spent Christmas at home with his family. The chemo now was doing as much harm as the cancer, so the doctors had stopped all of his medications except for those to control pain. If he regained his strength, they said, treatment could always resume. We tried to believe that might really happen. He was lethargic and having convulsions, but just after Christmas he woke up clearheaded and feeling better than he had for days. He smiled at his wife and took her arm, looked in her eyes and said, “When?” Then he fell asleep. It was like in a movie, she later said. He reawoke and his daughters came into the room. They were all laughing together and he was telling them he loved them. He was Joe again. And before they knew it he was gone.
At his memorial service, the minister talked about the mystery of death, the love that cancer can never take away, the power of God to unbind and set free. He told how Joe had sent him an e-mail the morning before surgery. He said he felt like Commander Adama on the science-fiction series Battlestar Galactica. He was going in to remove the invader.
In my collection of old scientific instruments is a device called a spinthariscope, a name that comes from the Greek word for spark. It looks like a brass eyepiece from an old-fashioned microscope, and on the side is engraved “W. Crookes 1903.” That is the year William Crookes, the inventor, unveiled it at a gala held by the Royal Society. I doubt Crookes made this one—there are a number of spinthariscopes with the same engraving still floating around on the market. Maybe it was issued as part of some commemorative event. Inside the brass tube a piece of radium is mounted next to a screen of zinc sulfide—the phosphorescent chemical that was mixed to make the glowing paint that poisoned the Radium Girls. As the radium decays it shoots out alpha particles and they are registered as tiny flashes of light. Each flash is from the disintegration of the nucleus of a single radium atom, and you can watch the show through a lens on the other end of the instrument. The effect is mesmerizing. Crookes compared it to “a turbulent, luminous sea.” Sometimes when I cannot sleep I pick up the device from the bedstand and watch the random light bursts—these miniature nuclear explosions. I think about the randomness of the mutations that cause cancer, and about the fact that I am holding something radioactive so close to my eye. The alpha particles are safely contained inside the instrument, but if I scraped out a speck of radium and swallowed it, I might die. How can life be so robust and yet so delicate?
The flashes from the decaying atoms are the purest kind of randomness. According to a bedrock law of nature—quantum mechanics—there is no way to predict when a single nucleus will decay. As long and as hard as you look into the spinthariscope you will never discern a pattern. Nor can you find a reason why one particular radium atom shoots out an alpha particle at this particular moment and not the next. Two identical nuclei are sitting side by side, and suddenly one will decay for no reason whatsoever, leaving the second one to sit there for another thousand years. What can only be predicted is how a mass of radium—a population—will behave. Approximately half the nuclei will decay over a span of sixteen centuries. But we can never know which ones.
That is how it is with cancer. Given a large enough group of people, we can predict what percentage of them will be stricken but we cannot know who they will be. This is not irreducible randomness like that inside atoms. With enough information—demographic, geographic, behavioral, dietary—we can narrow the pool of those at risk for certain cancers. In the future genomic and proteomic scans and technologies not yet known may allow the pools to be narrowed further still. But there is only so far we can go. Whether any one person gets cancer or does not will always remain mostly random.
I place the spinthariscope back on the table. There is no way to turn it off. All night and all day the flashes continue, year after year unseen. The radium itself will continue decaying for centuries, but first the scintillation screen and the glass lens will wear out. Maybe the brass will survive for archaeologists to wonder over like ancient coins. I imagine how my yard will look by then if there are no people attending to it. First the weeds will take over, crowding out the less aggressive life. Leaves will blow onto the patio, slowly disintegrating to make soil in which more weeds will grow. Seeds of Siberian elm—the unkillable weed trees that have spread across the West (more Echthroi from Eurasia)—will become wedged into cracks in the concrete, slowly splitting it apart as they grow. The cracks will gradually widen and the roots will creep beneath the foundation of my house and eventually it will fall. I think of paintings in museums of grand Roman ruins covered with vegetation, slowly digested back into the ground.
Inside my body, 10 trillion cells (these tiny Maxwell’s demons) are battling the same inevitable slump toward entropy. It is eerie to think that inside each one—invisible to the eye—so much is happening. The cell doesn’t know it has DNA or RNA or telomeres or mitochondria. It doesn’t know that A fits with T and C with G. Or that CTG stands for the amino acid leucine, or GCT for alanine—these molecular beads strung together to make proteins. There are no labels, no genetic alphabet written anywhere. There are no instructions. Somehow it all just works. And when it doesn’t we rage against the machine.
Notes
The unwieldy Internet addresses called URLs (for “uniform resource locater”) were never meant to appear in print. They are behind-the-scenes directions for a computer mindlessly executing the click of a mouse on a hyperlink. I have excluded them from the notes section of the printed editions of this book. For almost every paper I have cited, the abstract and often the complete text can be found easily with an Internet search, which is much easier than typing, letter by letter, slash by slash, the precise URL. The webpages I refer to can also be readily located. All were accessible as this book was going to press. An online version of the notes, available through my website, talaya.net, will carry links to all of the references, as will the book’s electronic editions.
“We must never feel disarmed”: Primo Levi, The Periodic Table (New York: Schocken Books, 1984), 75.
“I wonder now, though, if the steady presence of music”: Reynolds Price, A Whole New Life (New York: Plume, 1995), 36.
Tuberculosis used to be called ‘consumption’: John Gunther, Death Be Not Proud (Harper Perennial Modern Classics, 1998), 78–79.
CHAPTER 1 Jurassic Cancer
1. the Dinosaur Diamond Prehistoric Highway: My road trip to Colorado and Utah was in September 2010. For a description of the Morrison Formation and Jurassic Colorado see Ron Blakely and Wayne Ranney, Ancient Landscapes of the Colorado Plateau (Grand Canyon, AZ: Grand Canyon Association, 2008); John Foster, Jurassic West: The Dinosaurs of the Morrison Formation and Their World (Bloomington: Indiana University Press, 2007); “Reconstructing the Ancient Earth,” Colorado Plateau Geosystems website, last modified July 2011 [http://cpgeosystems.com]; and Ron Blakely, e-mail message
to author, March 9, 2012.
2. Giant termite nests: Stephen T. Hasiotis, “Reconnaissance of Upper Jurassic Morrison Formation Ichnofossils, Rocky Mountain Region, USA,” Sedimentary Geology 167, nos. 3–4 (May 15, 2004): 177–268 (reference is on 222–23) [http://www.sciencedirect.com/science/article/pii/S0037073804000090] and Hasiotis, e-mail message to author, March 9, 2012.
3. Dinosaur Hill: The discovery of the Apatosaurus skeleton is described on two interpretative signs at the site.
4. it caught the eye of a doctor: The story of Raymond Bunge was told to me by Brian Witzke in an e-mail, August 3, 2010. Some details about Bunge’s life are in “Papers of Raymond Bunge: Biographical Note,” 2011, University of Iowa Libraries Special Collections and University Archives website. [http://www.lib.uiowa.edu/spec-coll/archives/guides/RG99.0002.htm].
5. an attractive chunk, 5 inches thick: Bruce M. Rothschild, Brian J. Witzke, and Israel Hershkovitz, “Metastatic Cancer in the Jurassic,” Lancet 354 (July 1999): 398. [http://www.ncbi.nlm.nih.gov/pubmed/10437878] More details were provided in e-mails from Rothschild in June 2010, October 2010, November 2010, and July 2011.
6. layered, onion-skin look: Rothschild, Witzke, and Hershkovitz, “Metastatic Cancer.”
7. scattered references … to other dinosaur tumors: Rothschild, Witzke, and Hershkovitz, “Metastatic Cancer.”
8. “This observation extends recognition”: Rothschild, Witzke, and Hershkovitz, “Metastatic Cancer.”
9. tumors that arise from misguided germ cells: See, for example, Naohiko Kuno et al., “Mature Ovarian Cystic Teratoma with a Highly Differentiated Homunculus: A Case Report,” Birth Defects Research. Part A, Clinical and Molecular Teratology 70, no. 1 (January 2004): 40–46. [http://www.ncbi.nlm.nih.gov/pubmed/14745894]
10. With a portable fluoroscope: B. M. Rothschild et al., “Epidemiologic Study of Tumors in Dinosaurs,” Die Naturwissenschaften 90, no. 11 (November 2003): 495–500. [http://www.ncbi.nlm.nih.gov/pubmed/14610645]
11. a picture of him wearing a dinosaur T-shirt: John Whitfield, “Dinosaurs Got Cancer,” Nature News 21 (October 2003), published online October 21, 2003. [http://www.nature.com/news/2003/031021/full/news031020-2.html]
12. may have been more warm-blooded: Rothschild’s “Epidemiologic Study of Tumors in Dinosaurs” cites the work of Anusuya Chinsamy, including A. Chinsamy and P. Dodson, “Inside a Dinosaur Bone,” American Scientist 83 (1995): 174–80.
13. Edmontosaurus “mummies”: Phillip L. Manning et al., “Mineralized Soft-Tissue Structure and Chemistry in a Mummified Hadrosaur from the Hell Creek Formation, North Dakota (USA),” Proceedings of the Royal Society B: Biological Sciences 276, no. 1672 (October 7, 2009): 3429–37. [http://rspb.royalsocietypublishing.org/content/276/1672/3429.short]
14. Rothschild considered the odds: L. C. Natarajan, B. M. Rothschild, et al., “Bone Cancer Rates in Dinosaurs Compared with Modern Vertebrates,” Transactions of the Kansas Academy of Science 110 (2007): 155–58. [http://arxiv.org/abs/0704.1912]
15. Rothschild and his wife: Bruce M. Rothschild and Christine Rothschild, “Comparison of Radiologic and Gross Examination for Detection of Cancer in Defleshed Skeletons,” American Journal of Physical Anthropology 96, no. 4 (April 1, 1995): 357–63. [http://www.ncbi.nlm.nih.gov/pubmed/7604891]
16. Autopsies at the San Diego Zoo: M. Effron, L. Griner, and K. Benirschke, “Nature and Rate of Neoplasia Found in Captive Wild Mammals, Birds, and Reptiles at Necropsy,” Journal of the National Cancer Institute 59, no. 1 (July 1977): 185–98. [http://www.ncbi.nlm.nih.gov/pubmed/577508]
17. paleontologists in South Dakota: They were at the Black Hills Institute of Geological Research.
18. “a weird mass of black material”: John Pickrell, “First Dinosaur Brain Tumor Found, Experts Suggest,” National Geographic News, November 24, 2003, published online October 28, 2010. [http://news.nationalgeographic.com/news/2003/11/1124_031124_dinocancer.html]
19. “It certainly would take a bizarre event”: Pickrell, “First Dinosaur Brain Tumor.”
20. 300-million-year pile of geology: That is approximately when the bottommost layers of the plateau, the Morgan Formation and Weber Sandstone, were formed. See Halka Chronic and Lucy M. Chronic, Pages of Stone: Geology of the Grand Canyon and Plateau Country National Parks and Monuments (Seattle: Mountaineers Books, 2004), 90. I also referred to Halka Chronic’s book Roadside Geology of Colorado (Seattle: Mountaineers Books, 2004) and to Annabelle Foos and Joseph Hannibal, “Geology of Dinosaur National Monument,” Cleveland Museum of Natural History (1999), published online by the National Park Service. [http://www.nature.nps.gov/geology/education/foos/dino.pdf.] Two pamphlets written and illustrated by Linda West and published by the Dinosaur Nature Association (Jensen, Utah) were also used as sources: Journey Through Time: A Guide to the Harper’s Corner Scenic Drive (1986) and Harper’s Corner Trail (1977).
21. jawbone of a primitive armored fish: Luigi L. Capasso, “Antiquity of Cancer,” International Journal of Cancer 113, no. 1 (January 1, 2005): 2–13. [http://www.ncbi.nlm.nih.gov/pubmed/1538951]
22. Laramide orogeny: For a beautiful account, see John McPhee, Rising from the Plains (New York: Farrar, Straus and Giroux, 1986), 43–55.
23. ancient elephants, mammoths, and horses: Capasso, “Antiquity of Cancer.”
24. Hyperostosis, or runaway bone growth: Capasso, “Antiquity of Cancer”; and Raúl A Ruggiero and Oscar D Bustuoabad, “The Biological Sense of Cancer: A Hypothesis,” Theoretical Biology & Medical Modelling 3 (2006): 43. [http://www.ncbi.nlm.nih.gov/pubmed/17173673]
25. an ancient buffalo and an ancient ibex: Capasso, “Antiquity of Cancer.”
26. cancer in the mummy of an ancient Egyptian baboon: Alexander Haddow, “Historical Notes on Cancer from the MSS. of Louis Westenra Sambon,” Proceedings of the Royal Society of Medicine 29, no. 9 (July 1936): 1015–28. [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2076239]
27. Even a lone single-celled bacterium: Jules J. Berman, Neoplasms: Principles of Development and Diversity (Sudbury, MA: Jones and Bartlett Publishers, 2009), 67–69.
28. A bacterium called Agrobacterium tumefaciens: M. D. Chilton et al., “Stable Incorporation of Plasmid DNA into Higher Plant Cells: The Molecular Basis of Crown Gall Tumorigenesis,” Cell 11, no. 2 (June 1977): 263–71. [http://www.ncbi.nlm.nih.gov/pubmed/890735]
29. A remarkable paper: Philip R. White and Armin C. Braun, “A Cancerous Neoplasm of Plants. Autonomous Bacteria-Free Crown-Gall Tissue,” Cancer Research 2, no. 9 (1942): 597–617. [http://cancerres.aacrjournals.org/content/2/9/597.short]
30. larval cells can give rise to invasive tumors: Berman, Neoplasms, 69–70.
31. carp, codfish, skate rays: Capasso, “Antiquity of Cancer.”
32. Trout, like people, get liver cancer: Berman, Neoplasms, 71.
33. sharks do get cancer: Gary K. Ostrander et al., “Shark Cartilage, Cancer and the Growing Threat of Pseudoscience,” Cancer Research 64, no. 23 (December 1, 2004): 8485–91. [http://cancerres.aacrjournals.org/content/64/23/8485.abstract]
34. parathyroid adenoma in turtles: Capasso, “Antiquity of Cancer.”
35. Amphibians are also susceptible: Berman, Neoplasms, 71.
36. a strange variation on the theme: Charles Breedis, “Induction of Accessory Limbs and of Sarcoma in the Newt (Triturus viridescens) with Carcinogenic Substances,” Cancer Research 12, no. 12 (December 1, 1952): 861–66. [http://www.ncbi.nlm.nih.gov/pubmed/13009672]
37. Could this be another clue: Richmond T. Prehn, “Regeneration versus Neoplastic Growth,” Carcinogenesis 18, no. 8 (1997):1439–44. [http://carcin.oxfordjournals.org/content/18/8/1439]
38. Mammals appear to get more cancer than reptiles or fish: See, for example, Effron, Griner, and Benirschke, “Nature and Rate of Neoplasia.”
39. Domesticated animals seem to get more cancer: Capasso, “Antiquity of Cancer.”
40. a close relationship between size and life span: See, for example, John R. Speakman, “Body Size, En
ergy Metabolism and Lifespan,” Journal of Experimental Biology 208, no. 9 (May 2005): 1717–30. [http://www.ncbi.nlm.nih.gov/pubmed/15855403] For a deeper look at scaling phenomena see James H. Brown and Geoffrey B. West, Scaling in Biology, Santa Fe Institute Studies on the Sciences of Complexity (New York: Oxford University Press, 2000).
41. Peto’s paradox: R. Peto et al., “Cancer and Aging in Mice and Men,” British Journal of Cancer 32, no. 4 (October 1975): 411–26. [http://www.ncbi.nlm.nih.gov/pubmed/1212409]
42. The mystery was succinctly posed: John D. Nagy, Erin M. Victor, and Jenese H. Cropper, “Why Don’t All Whales Have Cancer? A Novel Hypothesis Resolving Peto’s Paradox,” Integrative and Comparative Biology 47, no. 2 (2007): 317–28. [http://icb.oxfordjournals.org/content/47/2/317.abstract]
43. roughly a billion heartbeats: I first wrote about this in “Of Mice and Elephants: A Matter of Scale,” New York Times, January 12, 1999. [http://www.nytimes.com/1999/01/12/science/of-mice-and-elephants-a-matter-of-scale.html] For a detailed analysis see John K.-J. Li, “Scaling and Invariants in Cardiovascular Biology,” in Brown and West, Scaling in Biology, 113–22.
44. sensible that mice might get more cancer: Naked mole rats, however, appear to never succumb, possibly because of their ability to lower their metabolisms. They also live nine times longer than mice. See Sitai Liang et al., “Resistance to Experimental Tumorigenesis in Cells of a Long-lived Mammal, the Naked Mole-rat,” Aging Cell 9, no. 4 (August 2010): 626–35. For a popular account by two researchers see Thomas J. Park and Rochelle Buffenstein, “Underground Supermodels,” The Scientist, June 1, 2012. [http://the-scientist.com/2012/06/01/underground-supermodels] Daniel Engber wrote about naked mole rats and cancer in “The Anti-Mouse,” Slate, November 18, 2011. [http://www.slate.com/articles/health_and_science/the_mouse_trap/2011/11/naked_mole_rats_can_they_help_us_cure_cancer_.html]