The hallways on the fourth floor of the Research Center at the Medical College of Wisconsin are lined with freezers and refrigerators and big tanks of liquid nitrogen.
The laboratories have spilled over with culture samples and specimens, and you go through gaps in the appliances to find the offices of lead researchers.
Those offices, not really spacious to begin with, are made less so by the piles of data printouts and stacks of draft studies being conducted at a near-frenetic pace.
This is the Cancer Center. It fairly hums, and not just with the white noise of lab equipment but also with the pink noise of conversation, of researchers talking to one another, constantly, excitedly, if in low tones, about discovery — talking about the advances they are making daily in the battle against cancer.
As National Breast Cancer Awareness Month comes to a close, this is a look at where we are going from here, where hope lies, and how much of that hope is being birthed right here in Southeast Wisconsin, at the Medical College of Wisconsin — a Wauwatosa institution that is now among the top 10 in the country in funding from the National Institutes of Health.
Getting deep inside the cancer cell's workings
It's hard to imagine anyone more excited about her work than Carol Williams, professor of pharmacology and toxicology at the college. It's Friday afternoon, and she's picking through a 4-inch-thick stack of papers that she's planning on reading over the weekend, looking for one specific sheet.
"I just can't wait to read all this," Williams said. "I really can't. I'm going to settle down on the couch with this Saturday morning and just enjoy it. I love my job, I really do."
Williams is co-director, along with Dr. Balaraman Kalyanaraman, of the Cancer Cell Signaling and Metabolism program at the Medical College. She and her colleagues work with all cancers, but they do focus on certain cancers because of their prevalence. Among those are lung and prostate cancers — and breast cancer.
"The Cancer Center has been growing by leaps and bounds," Williams said. "We have come together to understand what makes a cancer cell be a cancer cell. We are really focusing on what are the biochemical pathways that are abnormally altered in cancer cells compared to normal cells, because if we can identify those abnormalities, then we can identify ways to change them and stop the cancer cells from being malignant.
"Signaling is where all those biochemical pathways interact with each other, and in which one cancer cell talks to another, or to many."
"The metabolism part, it's been discovered that the requirements of cancer cells for nutrients are different than normal cells," Williams said. "You think of a cancer cell dividing over and over again, growing very quickly. Cancer cells require lots of nutrients and lots of energy. They have a very different use of the energy program compared to normal cells.
"By understanding those nutrient and energy requirements we can target those in new approachs to therapy — new approaches to stop those abnormalities."
So, at the core of all cancer research is that burning question of why a particular cell becomes cancerous to begin with, and can then multiply and spread with impunity in the body. While we know that genetic mutation is at the heart of the matter, we still don't know all the triggers that might make that happen. And continuing research does show that there are likely many such possible triggers, and no one golden nugget that would explain all.
Williams and her cohort, while always on the lookout for that nugget, are seeking and finding steps a bit farther down the path. They believe they can find ways, if not to make a cancer disappear all together, to stop it in its tracks.
Outlaw genes producing outlaw proteins
If you already think of cancer as insidious — your own cells mutating, multiplying and overwhelming healthy tissues — the actual science underlines and highlights that notion.
Williams describes, for instance, exactly how rogue cancerous cells, like outlaws, ignore direct signals from the body to stop, and instead send their own signals to produce new proteins that allow them to spread rapidly.
"It isn't just the cells themselves," Williams said. "The genes in every cell produce proteins. And these proteins also signal and communicate with one another.
"Among the proteins that cancer cells produce are certain ones that make them very mobile. They aren't just breaking loose and drifting through the body — they actually move on their own. And it is this, metastasis, the spread of the cancer throughout the body, that makes it so damaging."
It would seem fairly simple to find the one magic bullet to stop that spread if it were a matter of one known protein to target. But it's never so simple. There are many, many forms of cancer and an indefinite number of proteins that genes can arrange from the building blocks of amino acids. And in the case of cancers, those proteins are abnormal, too, and have to be identified individually.
"Breast cancer, for instance, is not one cancer," Williams said. "It is multiple cancers, and an approach to one might not be effective for another."
Individualized care to the ultimate degree
If that sounds like bad news, it really isn't. It means, Williams says, that we can get away from untargeted chemotherapies and radiation that, beginning 50 years ago, sometimes stopped some cancers but always debilitated healthy body tissues as well.
"We have amazing technology at our disposal," Williams said. "Thanks to the Human Genome Project and the many other advances in genetic science, we no longer biopsy just to determine malignancy. We biopsy and do a genetic scan.
"I can get on the computer and in five minutes identify a suspect gene."
The same goes for the proteins that do the dirty work of cancer.
"If we identify a protein we think is involved with, say, cancer mobility," Williams said, "I can go to my computer and access a program that will model that protein, then access a database of more than 100,000 compounds to see which ones might bind to that protein.
"Potentially, we would be able to produce a drug that, while perhaps not killing the cancer cells, could stop them from communicating with one another or take away their ability to spread."
Williams said that such technologies raise the real possibility of individualized treatment, even specified to a patient's unique genetic code, and thus much less invasive and damaging and much more potentially helpful.
"We haven't cured any cancers yet," Williams said, "but we are making great strides, I can say that."