Abstract

Keywords:Neuroendocrine prostate cancer; Prostate cancer; Small Cell Neuroendocrine Carcinoma; Computed Tomography; Prostate

“The future has many names. For the weak, it is unattainable. For the fearful, it is the unknown. For the brave, it is the opportunity” (Victor Hugo)

Cancer is a group of diseases characterized by the existence of an abnormal proliferation of malignant cells. What confers the characteristic of malignancy on this cellular proliferation is its capacity to invade organs, tissues, and spread distantly from its origin. From the time of Hippocrates and even earlier, Greek physicians of Antiquity clearly understood the ways in which a malignant tumor carries out its inexorable determination to destroy life. Based on what their eyes and fingers perceived, they gave a very specific name to the hard tumors and ulcerations they so frequently saw in the breasts, or protruding from the rectum or vagina of their patients. To distinguish these tumors from ordinary swellings, which they called oncos, they used the term karkinos or crab. Centuries later, cancer, the Latin word for crab, began to be used habitually [1].

The Nature of Cancer: Malignant Exuberance and Autonomy

Until the middle of the 19th century, it was thought that cancer killed furtively and silently. We now know this is not true because we have discovered a different personality in our old enemy when viewing it through the microscope of contemporary science. Cancer, far from being a clandestine enemy, reveals itself as possessing a malignant, murderous exuberance. Spreading from a central point, the disease relentlessly carries out a scorched-earth campaign in which no rule is respected, no orders are obeyed, and all resistance is annihilated in an orgy of destruction.

If we do not remedy it, its cells act like members of a frenetic horde of barbarians who, without leaders and without control, pursue only one objective: to plunder everything within their reach. This is what doctors and researchers call autonomy. Cancer is autonomous; it acts independently. The organism does not control it, and it does not control itself. In the community of tissues and organs that form the human being, the uncontrollable mob of cellular misfits that is cancer behaves like a band of violent adolescents (due to their cellular immaturity). They are the juvenile delinquents of cellular society [2].

Cellular Immaturity and Asocial Behavior

A tumor cell is one that has, at some point, lost its capacity for differentiation, a term we use to designate the process by which cells pass to reach a healthy maturity. A fully mature cell of the intestinal epithelium, for example, absorbs nutrients from the intestinal cavity much more effectively than it reproduces; a thyroid cell fulfills its function by secreting hormones, but it tends to reproduce less than when it was young. The analogy with the social behavior of an organism, such as ours, is unavoidable. The development of cancer cells stops at an age when they are still too young to have learned the norms of the society in which they live. As happens with so many immature individuals of all species, everything they do is exaggerated and without regard for the needs or limitations of those around them [3].

Because they are not fully developed, cancer cells do not participate in some of the most complex metabolic activities of mature, non- malignant tissues. A cancer cell in the intestine, for example, does not collaborate in digestion like its adult counterparts; the same can be said of almost all other malignant tumors. Malignant cells concentrate their energies on reproduction rather than on the tasks a tissue must carry out to maintain the life of an organism. The bastard children of their hyperactive (asexual) reproduction lack the resources to do anything other than cause problems and constitute a burden on the industrious community they inhabit. Like their parents, they are reproducers, but not producers. As individuals, they pose a danger to the conformist, balanced, and tranquil society that constitutes the human body.

Cancer cells do not even have the decency to die when they should. All of nature recognizes death as the normal stage of the normal maturation process. Malignant cells do not reach that point: their longevity is not finite. By failing to know and respect the rules of human biology, cancer is amoral. By having no other objective than the destruction of life, cancer is immoral. These maladjusted adolescents vent their rage on the society (the human body) of which they are a product. They are a street gang with a single objective: to sow panic, destruction, and self-destruction. If nothing or no one stops them, they finish off the neighborhood that supports them and, therefore, themselves, cancer is asocial.

Hope and Cure in the 21^st Century

Until the beginning of the 20th century, cancer was synonymous with death. This is no longer the case. We have known for some time that a large part of cancer is predisposed by genetic (familiar), social, and environmental factors. We can influence its primary prevention, which means following and monitoring those people predisposed by their family or socio-environmental history to prevent its development, or through early detection if cancer appears. Once cancer is detected, we have different medical-surgical arsenals for its treatment, depending on the type of tumor, its stage of development, and its dissemination.

These weapons are surgery, immunotherapy, chemotherapy, and radiotherapy; they are complementary and combined with each other. Today, we cure cancer in a significant percentage. Cancer can be cured depending on the tumor stage at the time of diagnosis, the tumor lineage, and the patient’s age and comorbidities. In those circumstances where it is at an advanced stage, we can attempt to chronify it, prolonging a human life that, until a few years ago, implied certain death in the very short term.

In the 21^st century, in the face of cancer, we can provide both life and quality of life. The concept of cancer is changing. We know that the solution lies in the detection of risk groups for their development and, by means of immunogenotherapy, avoiding its appearance. Therefore, once this situation is achieved, cancer will possibly not exist. In the scientific community, it is clear to us that in future generations, terms like surgery, chemotherapy, radiotherapy, and palliative medicine will be historical and disused words in medicine related to cancer. This statement is not just hope or a wish but is based on the inherent progress of biological and medical science.

References

1. Hippocratic Oath, Michael North (2002) Hippocrates National Library of Medicine
2. Hippocrates Collected Works (1868) Hippocrates. Ed.: W. H. S. Jones. Cambridge Harvard University Press.
3. Celsus, Aulus Cornelius; Spencer, Walter George (1935) De Medicina. Spencer. Cambridge, Massachusetts Harvard University Press 1971 (Republication of the 1935 edn).