Before you can follow in Danielle’s footsteps to help cure cancer, you should seek a deeper understanding of what cancer is and how it works. Then, we’ll take a look at how you can support the world’s most innovative cancer researchers, the steps you can take to prepare for a career working to find cures, and what you can do right now to start searching for a breakthrough yourself.

In developed countries, cancer is the number two cause of death, behind heart disease. It is common wisdom to say that cancer is not a single disease but rather a family of more than 200 diseases. However, there are common threads to all cancers. For one thing, when cancer is deadly, it is due to metastases, which are cancer colonies, that develop throughout the body. It is rarely the original tumor that causes the most destruction.

Another commonality to virtually all cancers, according to the cancer stem cell hypothesis, is their origin from cancer stem cells. Chemotherapy drugs are effective at killing cancer cells, but according to the cancer stem cell thesis, the cancer tumor returns because chemotherapy drugs are not effective at killing the cancer stem cells which created the cancer cells in the first place. Cancer stem cell research has been an active focus of cancer research since the early 2000s.

A stem cell is characterized by being able to undergo both symmetric reproduction (to create a copy of itself and therefore another stem cell) and asymmetric reproduction (to create a differentiated cell, such as a colon cell or a lung cell). In the case of cancer stem cells, asymmetric reproduction creates cancer cells which then form the bulk of a cancer tumor. They are the originators of cancer. Moreover, there appears to be a link between the growth of organs in a fetus and the growth of cancer.

MIT scientists Elena Gostjeva and Bill Thilly wrote in a 2006 paper:

For more than a century, cancer researchers have seriously considered tumors to reflect characteristics of embryos … Adenocarcinoma [such as colon cancer] looks as if it were embryonic tissue simply growing at the fetal rate to form embryonic colon. In addition, metakaryotic nuclei can divide both symmetrically and asymmetrically, a capacity generally reserved for stem cells.

In other words, it appears that due to certain genetic errors and mutations, cancer tumors are actually fetal organs growing inappropriately in a grown person. For more information, please see the entry for Cancer Stem Cell in the companion book, A Chronicle of Ideas: A Guide for Superheroines (and Superheroes).

See these links for more information about the nature of cancer:

• Informative TED-Ed video explainer¹ on what makes cancer cells different from healthy cells.
• Answers to key questions about how cancer works,² from the Science Museum in the United Kingdom.

The mutations that cause cancer stem cells to create cancer cells can have a variety of causes. Sometimes the cells are damaged by external radiation, like from ultraviolet rays in sunlight, x‑rays, or a nuclear reactor leak. This radiation sends high-energy particles through the body, where they smash into the DNA inside cells and corrupt the genetic instructions for how the cells should replicate. In other cases, viruses, which are essentially pieces of DNA or RNA, can cause cancerous mutations. Toxic chemicals can get into cells and disrupt their normal reproduction processes. Genes can affect the way cells are copied during their reproduction, making certain types of errors more likely. Drugs and alcohol can irritate the body’s tissues, forcing them to repair themselves such that errors—mutations—occur. For more detailed explanations of how these mechanisms work in the body, see:

• What happens when cells start reproducing uncontrollably.³
• The effects of failure of apoptosis,⁴ or programmed cell death.
• The action of tissue invasion,⁵ where a tumor generates “pioneer cells” that spread to nearby structures and start new cancerous growths; a process called metastasis.
• How angiogenesis,⁶ or growth of blood cells to feed tumors, lets cancers establish themselves more firmly in the body.

We’ve made progress on combating cancer in recent decades. In America for example, the cancer death rate has dropped about 25 percent since the early 1990s, and millions of cancer deaths have been prevented, both through treatments and prevention programs like anti-smoking campaigns and environmental regulations. Yet, so far, the progress has not been evenly distributed among cancers. For example, leukemia was a death sentence sixty years ago, but now the great majority of patients survive it. By contrast, other forms like pancreatic cancer are almost as deadly today as they were back then. In the novel, this motivates Danielle to search for a more complete way of curing cancer. Here’s more on the challenges of achieving major cures:

• Hank Green of SciShow with a clear, fast-paced video⁷ on why we haven’t cured cancer yet.
• A short guide by the Cancer Treatment Centers of America⁸ on how to understand cancer and why it’s so challenging to treat.

Today, most cancer treatments still focus on surgery, radiation, and chemotherapy. Surgeries cut tumors out of the body, but damage healthy tissue and might leave tiny remnants of cancer behind. Radiation shrinks tumors but can cause cancer to recur later. Chemotherapy puts powerful drugs in the body that suppress production of fast growing cells—slows cancer growth—but also harms normal tissues like the hair, skin, and digestive tract. More significantly, they do not work against cancer stem cells. Some chemotherapy drugs actually create conditions (called anaerobic conditions, which means “without oxygen”) that encourage the growth of cancer stem cells.

Newer approaches involve creating drugs with specially engineered molecules that can target cancer cells more specifically, without causing so much collateral damage to the rest of the body. A very exciting emerging trend in cancer therapies involve treatments that actually reprogram the body’s immune system, which ordinarily is not effective against cancer, to target the cancer cells and destroy them.

The challenge for doctors is to kill all the cancer cells as soon as possible. If the first round of treatment just kills 99.99% of these mutated cells, the surviving .01% will be those with a natural resistance to the treatment. The cancer can then come roaring back, stronger than before. This is known as the asymptoting logarithmic response curve. Also, as discussed above, cancers get their start with malfunctioning stem cells. These work differently from other cancer cells, so treatments that kill most cancer cells leave cancer stem cells unharmed. An MIT team working on cancer stem cell treatments has discovered several drugs that appear effective at killing cancer stem cells or preventing them from reproducing. In the novel, Danielle succeeds in curing most cancers with two cocktails of drugs, one attacking cancer cells, and the other attacking cancer stem cells.

Here are some helpful explanations of a range of new approaches to fighting cancer:

• A video by the science journal Nature about immunotherapies,⁹ which stimulate a patient’s immune system to fight cancer more effectively.
• Another explanation by Nature, on approaches that fight cancer by targeting the metabolism¹⁰ that cancer cells use to get the energy they need.
• A summary of the cancer stem cell theory¹¹ and how these cells serve as starting points for cancer.
• An explanation of therapies¹² based on cancer stem cell theory, including anti-cancer vaccines, from Oxford cancer researcher Robert Rees.
• William Li on the role of angiogenesis in cancer, and how diet¹³ can suppress it.
• More TED Talks¹⁴ to help you understand different theories about cancer and proposed treatments.

One way you can help cure cancer is by supporting organizations doing innovative research into the therapies above. You can volunteer to help them raise money, or if you’re old enough and have the right skills, you might be able to get an internship assisting in their research. Otherwise, you can start a fundraiser in your school or community—showing people videos about why this work is so important and why their donations can have a big impact. You might organize athletic activities to fight cancer, where people make donations to participate, or where they get sponsorship from friends and family who pledge to donate a certain amount of money for every mile run, lap swum, or pushup completed. Take a look at these organizations to see what kind of mission you’d most like to support:

• Memorial Sloan Kettering Cancer Center,¹⁵ one of the top cancer research hospitals in the world, with an extremely broad range of therapies being tested.
• The MD Anderson Cancer Center¹⁶ at the University of Texas supports several ambitious “moon shot” programs aimed at achieving breakthroughs with approaches like immunotherapy, genomics (therapies related to genes), and proteomics (related to proteins).
• The Cancer Research Institute¹⁷ has been widely praised for the effectiveness of the research they support, and for the very high percentage of total donations that goes directly to research.
• The Breast Cancer Research Foundation¹⁸ is ranked as one of the most effective cancer charities in America. It funds research into new ways of preventing, detecting, and treating the cancer that kills more women than any other.
• Jude Children’s Research Hospital¹⁹ provides care for young people with cancer, especially those with rare cancers who can’t get treated anywhere else. These treatments provide researchers with valuable information into how pediatric cancers work and what approaches are most effective at beating them.
• Resources from the American Lung Association²⁰ on how to quit smoking. The research they support is shedding new light on the science of addiction, and how people can stop using tobacco more easily. This can greatly reduce deaths from the lifestyle-related cancer that kills more than any other.
• Action on Smoking and Health²¹ (ASH) does similar things in the UK. ASH opposes the tobacco industry and supports more regulations on their activity.

In addition to supporting organizations working toward cures and prevention, you can also have a positive impact by supporting campaigns to fight pollution from cancer-causing substances. For example, the particles emitted as smoke from coal-burning power plants can get trapped in people’s lungs and cause cancer. Citizens working together in local communities can help minimize the presence of these chemicals in the environment. Technological innovation can also save lives indirectly, by finding ways to make emissions cleaner, so fewer people get cancer in the first place.

If you are interested in a career as a cancer researcher, you should seek the most challenging biology, chemistry, and math courses your school offers. In addition, you can get a head start on college-level study with online courses about cancer medicine:

• Introduction to the Biology of Cancer,²² a college-level Coursera course from Johns Hopkins University. Takes one to four hours per week for six weeks.
• Another Johns Hopkins course focusing on how cancer spreads, Understanding Cancer Metastasis.²³ Takes 1.5 hours per week for three weeks.
• Genomic and Precision Medicine,²⁴ from the University of California, San Francisco, about personalized approaches to fighting cancer that are tailored to the patient’s individual genetics. Takes about two hours per week for seven weeks.
• Understanding Clinical Research: Behind the Statistics,²⁵ a University of Cape Town course that can help you understand published medical studies as you research more about cancer and how it can be cured. Takes two to three hours per week for six weeks.

But you don’t have to wait until you have a PhD or medical degree to work directly on curing cancer. Even young people are able to work on experiments that can save lives. For inspiration, here are some teens who have done meaningful cancer research already:

• At 17, Lauren Bendesky²⁶ interned at the MD Anderson Cancer Center research lab to help analyze the same cancer that she had beaten.
• A TED Talk by Eva Vertes²⁷ on how research she did at 17 started with curiosity, and led her to emailing research professors with questions, making connections between ideas, and forming promising theories about how cancer might be defeated.
• While in high school, Angela Zhang²⁸ became curious about new methods of fighting cancer, and started reading papers and attending talks about the subject. This led her to design a nanoparticle targeting system for delivering drugs to cancer cells.
• A group of high school students calling themselves Burlingame Cancer Research,²⁹ who get together to study the latest science on cancer from journal articles and other sources. The group used its knowledge to organize a conference to bring together a variety of researchers on blood cancers and stimulate new ideas about potential cures.
• A TED Talk by Jack Andraka,³⁰ a teen who invented a potentially useful new test for pancreatic cancer, which would make it easier and cheaper to detect in the early stages, when it can still be treated successfully.

These stories show that there are several common ingredients to success for young people who want to help cure cancer:

• Read academic journals about medicine, and look for a novel way to connect the problems you read about to ideas from other subjects, like chemistry, biology, or engineering.
• Build your skills at doing lab experiments. MIT OpenCourseWare offers helpful online courses on experimental biology³¹ and laboratory chemistry.³²
• Look for professors or labs in your area who can mentor you. Ask them questions based on your reading, and suggest ideas for experiments they could help you with.
• Think about whether you have skills not usually applied to treating cancer, which might be an opportunity for innovation. For example, if you’ve learned computer programming in areas like artificial intelligence and machine learning, consider how those techniques might make it easier to detect or treat cancer.

For more information, please see the following entries in the companion book A Chronicle of Ideas: A Guide for Superheroines (and Superheroes): Asymptoting Logarithmic Response Curve, Logarithmic Curve, DNA Replication Errors, Drug Cocktail, Cancer Stem Cell, Orthogonal Approaches, Reproductive Enzymes, Anaerobic Conditions, Chemotherapy Drugs, Eukaryotic Cancer Cells, Food and Drug Administration, Mayo Clinic.