I stumbled on this fascinating link, and I could draw parallels immediately.
In his seminal book Seeing Like a State, James Scott describes what he calls “high modernists:” lovers of orders who mistake complexity for chaos, and rush to rearrange it from the ground up in a more centralized, orderly fashion. Scott argues that high modernists end up optimizing for a system’s legibility from their perspective, at the expense of its performance from that of the user.
Indeed, that love of order is above all else about appearances. Streets arranged in grids, people waiting in clean lines, cars running at the same speed… But everything that looks good doesn’t necessarily work well. In fact, those two traits are opposed more often than not: efficiency tends to look messy, and good looks tend to be inefficient.
Cancer is anything but orderly. It rests within an isolated state called “microenvironment”. One of the primary reasons why we aren’t able to crack the cancer code is because we have not been able to focus on the microenvironment. Radiation Therapy destroys it (or makes many subtle alterations) that it requires a whole sub-specialisation on exploiting it.
This is because complex systems — like laws, cities, or corporate processes — are the products of a thousand factors, each pulling in a different direction. And even if each factor is tidy taken separately, things quickly get messy when they all merge together.
The chaotic look of structural orderliness shouldn’t be so surprising. Intellectually, we do understand that appearances are misleading — things don’t have to look as they are, nor be as they look. But intuitively, we all remain hopeless slaves of appearances, no matter how often we were misled by them.
The effect of surgery is to disrupt the microenvironment (for good or bad, I don’t know). Although resulting in a lower number of sub-clinical population of cancer cells, it doesn’t completely eliminate the risk (a fact well known to the Radiation Oncologists who have to take extensive margins around the tumours). For those dabbling in chemotherapy, it appears like a single “target”, but the truth is that those targets multiply manifold without respite. Cancer exists in perfect equilibrium, and I marvel at its self-growth and the way it survives the onslaught. Radiation Therapy has grown empirically to counter this with millions of showering photons that eliminates this, but the real trick is in altered fractionation and dose escalation.
One way out to treat cancer effectively is to utilise radiation more effectively. Other therapies are purely adjunct.