Cells without a purpose

Given the many unknowns about cancer, Gerard understands why these battle metaphors have emerged and become embedded into our language. But he thinks that terminology can detract from our understanding of what cancer actually is. “When we use emotive language like this, it implies that the cancer, or tumour, is actively competing with us. This suggests that it has a purpose, a thought process, what we would call ‘agency’,” he says.

“I think this misconception is rooted in the pervasive notion that evolution is heading in a particular direction. The giraffe didn’t grow its neck to be able to eat the fronds and leaves at the top of the tree. Giraffes weren’t aiming to make that change. It happened because of natural selection. Natural variation in neck length gave some giraffes a food advantage and this was passed on through their offspring. Evolution looks like it’s heading in a particular direction because we only see the winners. We don’t see the many losers that died out.

“And the same goes for cancer. We know that cancers are caused by changes in the genes that control whether and when a cell divides and spreads or not. Such changes are happening all the time in your body, but in most cases the errors in the DNA are so catastrophic that these would-be cancer cells simply can’t survive. They die off, or are dealt with by our immune system, and don’t go on to form a tumour. So we only see the genetic changes that are the so-called ‘winners’ – the cancer cells that survive, which unfortunately are not good news for the patient.”

This is a topic that has interested the Crick’s resident philosopher too. James DiFrisco is a group leader who works on theoretical and philosophical issues in biology. He says: “Systems like cancer can appear goal-oriented. For example, the cancer ‘wants’ to spread. But this doesn’t mean that the tumour has true agency, or that it’s ‘aiming’ to act in a specific way.”

James has recently published a discussion on the topic of agency in biology and how natural selection shapes complex systems, making it appear as though a biological process is acting with purpose. “Humans are predisposed to attribute agency, or purpose, when dealing with complex or poorly understood phenomena,” he says. “And in the context of a cancer diagnosis, people have a strong need to make sense of their condition, so may naturally see purpose and intention where it doesn’t exist. Our consideration of the language that we use needs to balance clarity, scientific accuracy and sensitivity to the psychological needs of people with cancer.”

The pursuit of meaning

The pull of the “villainous cancer” narrative is strong, as stories provide comfort. They can help us to explain the inexplicable, soften the blow of randomness and give purpose to suffering. For some people, the metaphor of battle might feel empowering – it’s easier to rally against an enemy than accept a glitch in the system. Yet as cancer research advances, the gap between myth and reality widens. The war metaphor may have served its purpose in an era when cancer was mysterious and untreatable. But today, when targeted therapies offer new hope, our language should evolve alongside our understanding.

Kaleb Ells was diagnosed with a brain tumour at the age of 14 and underwent surgeries and treatments in the years after. Now an Oxford English graduate, he has studied the language of illness, cancer and trauma. He reflects on how battle language is applied to cancer: “It evokes the physical and mental bombardment of cancer – the fight for survival – but, so often, it’s used to imply that cancer is also a test of your spiritual and moral fortitude. I prefer language that acknowledges the sheer arbitrary chance of it all. I find it unsettling but also freeing to recognise that it’s no one’s fault. What truly matters is an individual’s unique emotional and physical experience.”

If the way we talk about cancer has an impact on the people it affects, how should we be talking about it? Gerard sees demystification as an important step, not only for people with cancer, but for everyone.

Instead of framing cancer as a battle, we could describe it as a technical problem – something complex but solvable. “If a fuse blows in your house, you don’t think the fuse box is out to get you. We should take the same approach with cancer,” he says. “If we can strip away the mythology, we might reduce the stigma around cancer and foster a more accurate and reassuring understanding of the disease.”

Although cancer is still a worrying diagnosis, there’s a lot to be hopeful about. Treatments are improving every year and some cancers can now be cured or managed successfully for decades. Gerard believes that in the future, a cancer diagnosis will no longer feel like a death sentence. “I dream of the day when more people might say of their diagnosis, ‘I’ve got cancer, but thank goodness they can fix it’.”

Our aim should be to reduce the emotional burden for people with cancer and focus on understanding the disease for what it is: a malfunction in the body’s machinery that we’re getting better at fixing. Cancer isn’t an enemy. It’s not a punishment. It’s biology; messy and indifferent. By embracing this reality, we can shift the focus from fear and guilt to knowledge and hope. And that’s a narrative worth telling.

Watch a recording of Gerard’s talk on why we get cancer and how science is unravelling this complex disease.

By Dani Diaper, Crick Science Writer