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“Doc, what do you think caused my cancer?”

It is among the most common questions I am asked when a patient has a new diagnosis of cancer.

Despite the frequency I get asked this question, I still rarely have a satisfying answer for patients.

The causes of cancer are myriad and the truth of the matter is that humans are bombarded by carcinogens on a non-stop basis. Our cells are developing mutations all the time, and under healthy conditions our bodies have intricate and miraculous ways of dealing with pre-cancerous cells. While we may recognize certain features about your cancer that allow us to make well-educated guesses, medical research simply lacks the scientific and technological information to answer the question “what caused my cancer.”

There are a host of genetic mutations which we understand to be cancerous. These tend to sound like reading from an eye chart: “BCR/ABL,” “EGFR,” “KRAS,” TP53.” These seemingly random acronyms do convey meaningful information that can allow us to begin to understand your cancer, but what caused the mutation itself frequently remains a mystery.

Most of the cancers I treat typically develop from a “multi-hit hypothesis,” which means that there are multiple steps in the development of most cancers. Much of that is influenced by risks factors like medical, family and social history. If your parents had cancer, you are likely at an increased risk . There are many recognized genetic conditions which can increase cancer risk. BRCA gene mutation and Lynch syndrome are among the most common. These “cancer mutations” are insufficient to cause cancer by themselves, and so even in such instances, it isn’t possible to know the cause of cancer with any real certainty. Doctors merely speculate, based upon the best evidence.

While we cannot really recognize any one event to have caused cancer, we do know that lifestyle—the habits you keep, from diet, exercise and alcohol consumption—influence cancer risk significantly. We certainly know by now that cigarette smoking is among the most cancer-causing habits that we encounter.

Cancer is not one singular disease. It’s a multitude. The National Comprehensive Cancer Network (NCCN) publishes guidelines for more than 50 cancers that arise with the greatest frequency, and the guidelines for each cancer are unique. Each has its own recognized risk factors, and there remain some cancers that we know frustratingly little about their causes.

The majority of cancers treated nowadays are not the death sentence that people had once dreaded them to be. Newer treatments have turned many cancers (frequently, but certainly not always) into a chronic disease. People are living quality years of life with cancers that used to be considered fatal in months or less. As treatments improve, more and more, people are “living with cancer.”

Dr. Thomas Atkinson received his medical degree from the University of Arkansas for Medical Sciences in Little Rock. He earned a bachelor’s degree in chemistry from the University of Arkansas. He completed an internal medicine internship at Tulane University. Dr. Atkinson went on to complete a hematology and oncology fellowship at Tulane, where he was elected chief fellow in his final year. He is a fellow of the American College of Physicians, and his clinical interests include integrative oncology, palliative oncology and geriatric oncology. Dr. Atkinson practices hematology/oncology and sees patients at Ochsner Health Center – Kenner. To schedule an appointment with Dr. Atkinson at Ochsner Health Center – Kenner (200 W. Esplanade Ave., Kenner), visit www.ochsner.org or please call 504-464-8506.