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The Pace of Cancer

Why some cancers accelerate and others crawl

Usually we want things fast: Internet connections, food delivery, commute times. But not cancer. You hope tumors grow at a snail's pace and survival is measured in years or decades.

Some types of cancer, such as prostate cancer and chronic lymphocytic leukemia (CLL), do tend to progress slowly. But others — including melanoma, brain, pancreatic, esophageal and lung — are often very aggressive and usually more difficult to treat successfully.

It's in the genes

What determines the speed of cancer? According to Nick Pfanzelter, MD, a medical oncologist at Rush University Medical Center, it's genetic changes in the tumor.

"Cancers develop because cells lose genes that prevent growth, they gain genes that cause uncontrollable growth, or both," he says. "The specific combination of genes affected determines a tumor's growth pattern."

Some of these genetic changes are inherited. Others are caused by lifestyle factors, such as smoking.

Predicting tumor growth

Although most cancers tend to follow a specific pace, there are no rules for how a tumor will behave. Not only does the growth rate vary by cancer type, but one small genetic difference can cause variations in two patients with the same type of cancer.

For instance, hormone receptor-positive breast cancers can be slow-growing, while hormone receptor-negative breast cancers grow quickly. Similarly, normally slow-growing cancers like CLL can grow rapidly if there is a mutation in specific tumor suppressor genes.

This unpredictability can make treatment challenging. For slower-growing cancers, like prostate cancer, whether to treat or simply monitor (called active surveillance) depends on factors like the tumor's location and the patient's age and health. 

"For the most aggressive cancers, however, we would never just watch and wait," Pfanzelter says. "The faster we're able to start treatment, the better the chance we can slow the cancer down."

Fast or slow tumor growth: What can you do?

Early diagnosis can mean more options, more effective treatment and a better outlook for most cancers. And of course, prevention is the best way to stop cancer in its tracks.

Pfanzelter recommends making screening tests — such as mammograms, colonoscopies and PAP tests — part of your health routine. And getting your children — girls and boys — vaccinated for human papillomavirus (HPV) to help protect against cervical cancer and head and neck cancer, both of which are linked to HPV infection.

In fact, recent studies show that about 72 percent of cancers of the oropharynx (back of the throat, including the base of the tongue and tonsils) — which are usually caused by tobacco and alcohol use — are now caused by HPV. These cancers develop slowly, from an HPV infection that was likely acquired years earlier during oral sex with a female partner who was infected with HPV.

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