인터넷서점 인터파크도서

암은 성장함에 따라서 유전자의 변이가 지속되고, 대사작용이 정상세포와 달라져 지속적인 성장을 한다. 암세포들이 모여서 형성된 미세환경은 그 구조나 환경이 암에 유리하게 변하여 환자의 면역작용을 피해서 생존하게 된다. 이러한 변화는 환자가 섭취하는 식이와 음식물, 환자의 심적인 상태와 육체적인 운동, 그리고 공생하는 미생물 등의 영향을 받는데 암의 성장과 전이 뿐 아니라 치료의 결과와 예후에 영향을 미친다. 지난 40여 년 동안 암 환자를 진료하고 수술하며, 암에 대한 기초 및 임상연구를 하였다. 아직도 나에게 해결되지 않는 의문은 ‘왜 암세포는 자신도 죽게 되는데 자신의 숙주인 환자를 죽도록 만들까?’ 하는 것이다. 나는 그동안 시행하고 암 환자들에게 권유했던 수술, 항암화학요법, 방사선요법 등의 표준치료에 더해서 최근에 새로이 암의 표준요법으로 각광을 받는 면역요법을 알아보고자 하였다. 특히 암과 환자의 면역상태와 그것을 검사하고, 치료하는 다양한 방법들을 공부하였다. 그리고 암의 미세환경과 면역요법에 영향을 주는 약물과 물질들에 대해서 그 작용기전과 임상적인 결과들을 공부하고 종합적으로 정리하여 그 지식을 나누고자 하였다. 이 책이 암을 연구하는 연구자, 그리고 암을 치료하는 암 전문가뿐만 아니라 암에 대해 관심을 갖고 있는 많은 사람들에게 암의 면역학적인 치료방법을 이해하고, 암환자를 치료하는데 자그마한 도움과 참고가 되었으면 한다.

1 암 면역시스템(Cancer Immune System)·································· 1 1-1 암 면역계··········································· 1 1-2 종양항원과 면역인지······································ 3 1-3 수지상세포(Dendritic cell)의 세포독성 T세포와 교차감작· ····················· 6 1-4 암 면역세포의 종양 내로의 이동································· 10 1-5 암 면역과 염증반응······································ 12 1-6 암 면역에서 호중구의 역할· ·································· 14 1-7 암 면역에서 NK세포의 역할··································· 15 1-8 암 면역에서 B세포의 역할· ·································· 17 1-9 암 면역에서 대식세포의 역할· ································· 20 1-10 면역내성(Immune Tolerance)· ·································· 23 2 암 면역시스템 검사(Test for Cancer Immune System)···························· 27 2-1 암조직에서 면역상태(Cancer Immunogram)의 검사· ························ 27 2-1-1 선천성면역(Innate Immune)의 검사···························· 28 2-1-2 ...획득면역(Adaptive Immune)검사······························ 29 2-1-3 선천성과 획득면역검사· ································ 30 2-2 암 미세환경(TME)의 면역상태(Immunity)에 대한 검사· ······················ 31 2-2-1 면역점수(Immunoscore) 검사· ······························ 31 2-2-2 암 미세환경의 면역검사 방법······························· 33 2-2-3 종양의 침윤림프구와 암의 예후······························ 40 2-2-4 면역관련 유전자의 특징에 따른 암의 예후························· 41 2-2-5 면역검사에서 유전체검사· ······························· 42 2-2-6 암조직의 계통면역학적(Cancer System Immunology) 검사방법················· 42 2-2-7 종양 미세환경의 면역상태에 의한 암의 분류························ 45 2-2-8 종양 미세환경에서 면역관문(Check point)검사· ······················ 47 2-2-9 종양 미세환경에서의 면역억제검사· ··························· 51 2-2-10 종양 미세환경에서의 암 줄기세포화(Stemness) 검사· ··················· 52 2-2-11 암의 미세환경에서의 전이관련 검사· ·························· 52 2-3 말초혈액에서 면역검사····································· 53 2-3-1 호중구와 림프구· ··································· 53 2-3-2 말초혈액에서 면역검사· ································ 53 2-3-3 말초혈액소견과 면역치료 효과· ····························· 54 2-3-4 액체생검(Liquid Biopsy)의 소견과 면역치료 효과· ····················· 54 2-3-5 종양항원 특이 항체와 항원반응성 T세포·························· 55 2-3-6 기타 말초혈액소견· ·································· 55 2-4 면역세포 세포살해력 검사(Immune Cell Killing Assay)· ······················· 55 2-5 암의 면역학적인 분류와 검사 결과에 따른 암의 치료 방침····················· 56 3 암의 면역요법············································· 63 3-1 암의 면역요법(Cancer Immunotherapy)······························· 63 3-1-1 면역요법의 목표· ··································· 63 3-1-2 암 면역요법의 역사· ·································· 65 3-1-3 암의 예방과 면역· ··································· 65 3-1-4 암 면역요법의 방법(Methods of Cancer Immunotherapy)· ··················· 66 3-1-5 암 면역치료에 대한 내성과 이의 극복방법························· 77 3-1-6 GM-CSF, G-CSF, M-CSF 기반 면역요법·························· 83 3-1-7 면역치료의 효과 예측· ································· 84 3-1-8 현재까지의 면역치료의 방향· ······························ 85 3-1-9 개인 맞춤형 및 복합적인 암 면역요법의 원칙······················· 86 3-1-10 면역요법의 임상적인 효과· ······························ 89 3-1-11 암의 면역요법에 대한 내성의 기전(Mechanisms of Resistance to Immunotherapy)········· 95 3-1-12 암 면역요법의 부작용· ································ 96 3-1-13 암 면역요법의 미래· ································· 98 3-2 사이토카인을 이용한 면역보강요법······························· 101 3-2-1 사이토카인 강화요법· ································· 101 3-2-2 사이토카인 차단요법· ································· 104 3-2-3 사이토카인 치료의 미래· ································ 108 3-3 면역관문(Immune Checkpoint)억제제· ······························ 113 3-3-1 면역관문(Immune Checkpoint)······························· 113 ` 3-3-2 면역관문억제제(Immune Check point inhibitor)························ 117 3-3-3 면역관문억제 치료의 생물학적인 예측표지자(Biomarkers of Checkpoint Inhibitor therapy)····· 118 3-3-4 면역관문억제제 요법(Checkpoint Inhibitor therapy)· ····················· 121 3-4 암의 입양 T세포치료(Adoptive T Cell Therapy for Cancer)······················· 142 3-4-1 사이토카인 유도 살해세포(Cytokine Induced Killer Cell Therapy: CIK, CD3+CD50+) 치료· ··· 143 3-4-2 자연살해T(NKT: Natural Killer T)세포치료· ························ 144 3-4-3 종양침윤림프구(TIL) 치료· ······························· 148 3-4-4 T세포수용체(T cell receptor: TCR) 유전자 조작 T세포 치료·················· 152 3-4-5 T세포 탈진(exhaustion) 방지 치료· ···························· 153 3-4-6 키메라항원 수용체(Chimeric Antigen Receptor)-T(CAR-T)세포 치료··············· 153 3-4-7 바이러스특이 T세포 치료(Virus Specific T cell therapy; VST)·················· 158 3-4-8 T세포의 활성도 증가 방법· ······························· 160 3-4-9 기억T(TRM)세포를 표적으로 하는 치료··························· 160 3-5 암의 NK세포 기반 치료(NK based Immunotherapy for Cancer)····················· 162 3-5-1 NK세포의 성장과 분화································· 162 3-5-2 NK세포의 기능····································· 163 3-5-3 NK세포의 항암작용 기전································ 163 3-5-4 암의 NK세포치료···································· 165 3-5-5 Allogenic(동종) NK세포 치료······························· 168 3-5-6 면역관문의 차단 및 NK세포 항종양력 상승을 위한 물질의 사용· ·············· 170 3-5-7 CAR-NK세포 치료··································· 174 3-6 면역억제세포를 표적으로 한 암의 면역치료(Cancer Immunotherapy Targeting Immunosuppressive Cell)··· 177 3-6-1 골수유래억제세포(MDSCs)를 표적으로 한 암의 치료(MDSC targeted therapy for Cancer)······ 177 3-6-2 조절T(Treg)세포를 표적으로 하는 치료· ························· 184 3-6-3 종양연관대식세포(TAMs)를 표적으로 하는 치료· ····················· 187 3-6-4 호중구의 역할과 이를 이용한 암의 면역요법························ 191 3-7 암의 백신요법········································· 191 3-7-1 암 백신의 제조· ···································· 192 3-7-2 수지상세포백신요법(Dendritic Cell Vaccine)· ························ 200 3-7-3 펩타이드/단백 백신(Peptide/Protein Vaccine)························ 204 3-7-4 핵산(DNA)/mRNA 기반 백신······························· 205 3-7-5 바이러스 백터를 이용한 백신······························· 209 3-7-6 종양용해 바이러스(Oncolytic Virus)· ··························· 209 3-7-7 암의 나노백신요법(Nanovaccine for Cancer Immunotherapy)· ················· 210 3-7-8 개인 맞춤형백신(Personalized vaccine)· ·························· 212 3-7-9 암백신의 미래 전망· ·································· 214 4 종양의 미세환경과 이를 표적으로한 암의 치료(Cancer Therapy targeting TME)· ··············· 233 4-1 종양의 미세환경(tumor microenvironment: TME)· ························· 233 4-2 종양미세환경(TME)과 암 면역계································ 235 4-3 암의 미세환경에서의 저산소증의 영향· ····························· 236 4-4 암의 기계적인 미세환경(Mechanical Microenvironment)· ······················ 237 4-5 암 면역과 염증반응······································ 239 4-6 암의 미세환경(TME)을 표적으로 하는 치료···························· 240 4-6-1 직접적인 방법(Direct Methods)· ····························· 242 4-6-2 간접적인 방법(Indirect Methods)······························ 243 4-6-3 암의 미세환경에 대한 복합적인 면역요법· ························ 253 5 암의 표준치료와 면역요법의 관계와 복합치료 전략· ···························· 259 5-1 수술과 면역요법········································ 259 5-2 항암화학요법과 면역요법···································· 265 5-3 방사선요법과 면역요법····································· 271 6 암과 대사작용(Cancer and Metabolism)································· 279 6-1 정상세포에서 암세포로 이행하는 과정· ····························· 280 6-2 암과 대사작용의 재프로그래밍(Cancer and metabolic reprogramming)·················· 282 6-2-1 암과 비만과의 관계· ·································· 284 6-2-2 암과 동물성 단백과의 관계································ 284 6-2-3 암과 면역대사(Cancer and Immunometaboloism)· ······················ 284 6-3 암의 대사작용을 표적으로 한 치료(Cancer Therapy Targeting Metabolism)················ 291 6-3-1 당대사(Glucose Metabolism)에 관계되는 대사치료· ····················· 291 6-3-1-가 메트포민(Metformin)· ······························ 294 6-3-1-나 시타글립틴(Sitagliptin; DPP4억제제)· ······················· 298 6-3-1-다 인슐린 강화요법(Insulin Potentiation Therapy)····················· 300 6-3-2 지질대사(Lipid Metabolism)에 관계되는 대사치료· ····················· 300 6-3-3 콜레스테롤 대사(Cholesterol metabolism)와 암························ 305 6-3-4 아미노산 대사와 암의 치료제······························· 310 6-3-5 핵산대사 물질을 표적으로 한 치료· ··························· 310 6-3-6 세포 증식관련 물질의 대사································ 310 6-3-7 암의 전이관련 물질의 대사를 표적으로 한 치료······················ 312 6-3-8 활성산소(ROS)와 암치료································· 313 7 암의 명상과 이완요법에 대해서······································ 329 7-1 암에 대한 스트레스의 반응과 심리요법의 효과에 대한 기전····················· 330 7-2 암 치료에 심리적인 접근· ··································· 336 7-2-1 마음신체요법(mind body technique)···························· 336 7-2-2 암 환자에 대한 심리적인 치료의 지침··························· 339 7-2-3 암종별 심리적 치료의 효과································ 340 7-2-4 정신신경면역치료의 미래· ······························· 340 8 미생물과 암·············································· 343 8-1 인체의 미생물········································· 343 8-2 미생물의 종류와 동정(Identification of Microbiome)· ························ 347 8-3 유산균(Lactic Acid Bacteria)· ·································· 347 8-4 장내미생물에 영향을 미치는 인자· ······························· 349 8-5 운동의 장내미생물에 대한 영향과 면역······························ 352 8-6 장내미생물과 암········································ 354 8-7 장내미생물과 질병의 치료··································· 360 8-8 장내미생물과 항암요법의 효과································· 360 8-9 장내미생물과 암의 면역요법의 효과· ······························ 360 8-10 장내미생물을 이용한 암 면역요법· ······························· 363 8-11 호흡기 미생물과 암의 관계· ·································· 365 9 암의 온열요법············································· 371 9-1 온열요법의 역사········································ 371 9-2 온열치료의 기전········································ 371 9-3 온열치료의 면역학적인 효과·································· 372 9-4 온열치료의 방법········································ 378 9-5 온열요법의 임상효과······································ 381 9-6 온열요법의 통합의학적인 복합치료 상승효과· ·························· 383 9-7 온열요법의 부작용과 금기증·································· 384 9-8 온열요법의 미래········································ 385 10 운동과 암 면역(Exercise and Cancer Immunology)····························· 389 10-1 운동면역학(Exercise Immunology)································· 389 10-2 운동의 호르몬에 대한 영향· ·································· 389 10-3 노화에 의한 변화와 면역기능· ································· 392 10-4 운동과 면역기능········································ 393 10-5 운동의 암에 대한 효과의 기전·································· 396 10-5-1 암의 발생과 운동· ·································· 398 10-5-2 암의 치료와 운동의 효과· ······························· 399 10-5-3 암의 예후와 운동· ·································· 401 10-5-4 암의 증상과 치료와 연관된 부작용에 대한 운동 효과···················· 401 10-6 암 환자의 운동방법······································ 403 10-6-1 운동을 정지해야 할 경우· ······························· 404 10-6-2 암의 종류와 암 환자의 개별 맞춤형 운동요법· ······················ 405 10-6-3 암 환자에 대한 운동치료의 미래····························· 406 10-6-4 암 환자에 대한 개인 맞춤형 운동치료 처방· ······················· 406 11 암의 통합의학적인 치료에 대한 이해· ·································· 411 11-1 암의 발생과 치료의 통합의학적 개념······························· 412 11-2 암의 진행과 치료의 통합의학적 개념······························· 413 11-3 통합암의학(Integrative Oncology)· ································ 414 11-3-1 암치료에서 통합의학은 무엇인가?···························· 414 11-3-2 통합암 치료의 목표·································· 415 11-3-3 보완의학적이고 생물학적인 암 치료 방법························· 416 11-3-4 영양요법· ······································ 417 11-3-5 분자교정요법(Orthomolecular Therapy)··························· 418 11-3-6 물리적인 자극에 의한 암의 치료····························· 422 11-3-7 정화 및 해독요법··································· 422 11-3-8 면역강화요법· ···································· 423 11-3-9 메트로놈 화학요법(Metronomic Chemotherapy)· ······················ 426 11-3-10 통합의학적 암치료의 안전성에 대한 고려· ······················· 426 11-4 통합의학적 암 치료방법의 실제· ································ 427 11-4-1 미국과 유럽에서의 통합의학적인 암치료의 실제······················ 427 11-4-2 닥터 Williams의 암 면역요법 전략· ··························· 427 11-4-3 암종별 통합의학적인 치료방법과 결과· ························· 430 11-5 통합의학적인 암치료의 현재와 미래······························· 430 11-6 통합의학적인 암치료의 결론· ································· 431 12 암 환자의 식이(Diet of Cancer Patients)·································· 435 12-1 암의 예방과 식이요법····································· 435 12-2 암의 예방식품, 암과 싸우는 음식(Food that fight cancer)· ······················ 436 12-2-1 지방산(Fatty acid)··································· 438 12-2-2 폴리페놀(Polyphenols)································· 439 12-2-3 미세영양소(Micronutrients)······························· 444 12-3 장기별 암에 따른 발암식품과 항암식품······························ 446 12-3-1 암의 발생에 관여하는 식품· ······························ 447 12-3-2 암의 치료에 해가 되는 식품······························· 449 12-4 암과 비타민요법········································ 450 12-4-1 비타민 A· ······································ 450 12-4-2 비타민 B12······································ 450 12-4-3 비타민 D· ······································ 451 12-4-4 비타민 E· ······································ 454 12-5 암 환자에서 식이 원칙· ···································· 456 12-5-1 암의 치료와 식이요법(Diet for Cancer)·························· 457 12-5-2 암의 치료에 도움이 되는 식품······························ 457 12-5-3 암의 면역반응에 영향을 주는 식이···························· 458 12-5-4 콩과류의 이소플라본(Isoflavone)과 유방암과의 관계· ··················· 459 12-5-5 지중해식 식이(Mediterranean diet)···························· 460 12-5-6 채식주의자 식이(Vegetarian diet)· ···························· 461 12-5-7 일본식 식이(Japanese diet)································ 461 12-5-8 케톤체 생성식이(Ketogenic diet), 극저탄수화물 케톤체 생성식이(very low carbohydrate ketogenic diet: VLCKD)·········· 461 12-5-9 영양결핍 없는 칼로리 제한· ······························ 464 12-6 영양요법에 대한 결론····································· 464 13 암의 치료와 식물화학물질(Phytochemicals)································ 471 13-1 암에 현재 사용되고 있는 식물화학물질(Phytochemical)· ······················ 473 13-1-1 강황(Turmeric, Curcumin)· ······························· 473 13-1-2 미슬토(Abnoba- viscum, Mistletoe extract, 겨우살이 추출물, 렉탄올, 유릭소)·········· 476 13-1-3 레스베라트롤(Resveratrol), 레스베라겐(Resveragen: 마디풀속 Polygonum cuspidatum)······ 478 13-1-4 이뮤노쎄라(Immunothera), 프로텍타겐(Protectagen)····················· 480 13-1-5 소태나무(Picrasia quass)································· 480 13-1-6 트리고넬린(Trigonellin)· ································ 481 13-1-7 베타글루칸· ····································· 481 13-1-8 녹차추출물· ····································· 482 13-1-9 Triptolide(뇌공등, 미역줄나무, Tripterygium wilfordii Hook F: TWHF)· ············ 482 13-1-10 옻나무(Rhus verniciflua stoke)· ····························· 483 13-1-11 크레스틴(PSK: protein bound polysaccharide K)······················ 483 13-1-12 식물 아로마타제 억제물질(Aromatase inhibitors)······················ 484 13-1-13 기타 식물화학물질· ································· 484 13-2 식물화학물질의 암의 치료에 대한 결론······························ 485 14 염증억제에 의한 항암효과· ······································· 489 14-1 COX-2 억제제········································· 489 14-2 파이로토시스(Pyroptosis)와 염증조절을 통한 암의 치료······················· 490 14-3 멜라토닌(Melatonin)· ····································· 494 14-4 시메티딘(양성자 교환 억제제)·································· 495 14-5 밀크씨슬(Milk thistle: 엉겅퀴)· ································· 495 14-6 디클로로아세테이트(Dichloroacetate: DCA)· ··························· 496 14-7 면역치료와 염증반응······································ 497 15 기존 개발된 약물의 항암효과와 암 치료에서의 응용 가능성· ························ 499 15-1 TGFβ 억제제: 기관지천식 약(Tranilast)· ····························· 499 15-2 발기부전 치료제: 실데나필(sildenafil, tadalafil)··························· 501 15-3 CD73억제제········································· 502 15-3-1 펜톡시필린(pentoxifylline: PTX)· ···························· 502 15-3-2 항생제 티아무린(Tiamulin)······························· 502 15-4 항기생충재제· ········································ 502 15-4-1 펜벤다졸(Fenbendazole) 및 메벤다졸(Mebendazole)· ···················· 502 15-4-2 이버맥틴(Ivermectin)· ································· 506 15-5 항곰팡이재제(Antifungal agent)·································· 507 15-5-1 이트라코나졸(Itraconazole)······························· 507 15-6 면역억제제(Immunosuppressive Agents)· ····························· 509 15-6-1 라파마이신(Raphamycin; sirolimus)···························· 509 15-7 말라리아 치료제(Antimalarial Agent)······························· 511 15-7-1 아르테수네이트(Artesunate)· ······························ 511 15-8 항정신질환 약물········································ 512 15-8-1 MALT1억제제(Mepazine, Biperiden)··························· 512 15-9 결론· ············································ 513 16 암과의 전쟁·············································· 517 찾아보기 ················································· 521

저자 서문 나는 지난 40여 년 동안 암 환자를 수술하고 암에 대한 연구를 하며 지냈는데, 나에게 가장 큰 의문은 ‘왜 암세포는 자신도 죽게 되는데 자신의 숙주인 환자를 죽도록 만들까?’ 하는 것이었다. 물론 진화론적으로는 다세포 생물이 하나의 세포나 장기가 망가지면 전체를 죽이는 하나의 방법으로써 암을 활용한다는 진화론적인 이론이 있기는 하지만 아직도 잘 이해하기 힘든 부분이다. 후배인 외과의사로부터 섬진강 강변을 거닐면서 쓴 편지를 읽는다. 내가 직장암으로 수술하고 재발하여 방사선요법과 천추절제, 그리고 회장뇨루 등의 수술을 하고 결국은 재발하여 돌아가신 대학 선배 의사의 치료에 대한 자신의 소회와 다른 방법을 찾기 위해 독일, 인도 등에서 통합의학적인 암치료에 대해서 공부한 배경과 그리고 자신이 암에 대해서 갖게 된 생각들을 정리한 편지이다. 히포크라테스는 인간에게 생긴 질병을 치료하기보다 병에 걸린 인간을 치료하라고 하였다. 그리고 헬렌타우시그는 ‘전자 현미경에서 고개를 들어 환자의 간청하는 눈빛을 바라보라’하였다. 내가 근무하는 병원에는 ‘先愛治患’이라는 액자가 있다. 먼저 환자를 사랑하고 질병을 치료하라는 말이다. 근대의학은 기계론적인 세계관에 입각하여 인간의 생리적 법칙을 기계의 작동 원리로 치환시켰다. 인간의 병리적 상태는 곧잘 비정상적인 기계의 고장이나 오작동으로 묘사되었으며, 나아가 정상적인 구조와 기능을 되찾기 위해 수리가 필요한 대상으로 규정한다. 환자의 생활, 병의 배경, 영혼이 부서지는 듯한 고통, 가족들의 고뇌, 회복에 대한 희망, 이 모든 것이 혈액의 나트륨 수치에 대한 지식만큼 치료의 일부이다. 내가 그동안 시행하고 암 환자들에게 권유했던 수술, 항암화학요법, 방사선요법 등의 표준치료와 최근에 새로이 암의 요법으로 각광을 받는 면역요법에서 암의 다양한 입양세포치료 방법과 면역억제 세포에 대한 표적치료, 미국의 카터 전대통령의 악성흑색종의 뇌전이 치료에 사용된 면역관문억제제 치료에 대한 관심과 함께 암의 미세환경과 이에 대한 다양한 암의 치료 방법에 대해서 공부하고 그 지식을 나누고자 하였다. 30년전 뉴욕의 코넬대에서 수술장에서 전이된 대장암의 조직을 배양액에 담아 실험실로 보내서 면역세포치료를 시행하던 DeCosse교수가 생각난다. 특히 열심히 치료하고 노력하였음에도 점차 전이되고 진행되어 죽음에 이르는 환자들을 보면서 그들에게 무엇이 필요하고 무엇을 해 줄 수 있을지를 고민하였다. 그리고 통합의학적인 방법으로 광범위하게 시행하고 있는 많은 치료 방법들과 약제들 그리고 한동안 암 환자들에게 유행한 구충제 등 다양한 치료 방법들이 과연 무엇인가? 그리고 어떤 기전에 의해서 이들이 암치료에 사용되었고, 왜 환자들에게 어필하고 사용하는지도 의문이었다. 또 암의 교과서에서 다루어지고 있는 미국의 엠디 엔더슨 암센터에서 시행하고 있는 통합적인 암치료는 무엇인가?하는 의문들이 나에게 다양한 연구들에 대한 문헌을 찾아 공부하고 정리하는 동기가 되었다. 암은 우리가 임상적으로 발견 가능한 1gm의 종괴가 10억 개의 암세포로 이루어져 있다. 암의 미세환경을 보면 혹시나 이러한 수많은 세포들의 집단 지성이 이들을 공격하는 숙주와 의사들의 노력에 반해서 생존에 관여하고 있지는 않는지 우문을 해본다. 암은 성장함에 따라서 미세환경이 변하고, 암세포는 정상세포와 그 대사작용이 서로 다르며, 공생하고 있는 미생물, 암과 숙주인 환자의 면역환경과 면역세포가 변하게 된다. 그리고 이러한 변화와 함께 환자가 섭취하는 영양과 ...음식물, 환자의 심적인 상태와 환자의 정신적인 의지, 환자의 운동 등이 암의 발생, 성장과 전이 그리고 치료에 관여한다. 그래서 나는 암은 하나의 치료 방법이 나 한 가지 약 혹은 방법으로 치료될 수는 없다는 생각을 갖고 있다. 미래에는 이러한 세포와 세포 주위의 환경들에 대한 자세한 작용기전이나 이러한 지식을 이용한 치료에 대한 임상 결과가 밝혀지리라 생각되지만, 현재로서는 여러 가지 방법을 잘 알아서 이들에서 가장 좋은 조합을 찾아 병용하여 치료하는 것이 가장 좋은 방법이라 생각된다. 물론 이들 방법에 대한 객관적인 임상연구가 필요하고 그 결과에 의한 근거가 중심에 있어야 되겠다. 이 책은 정통적인 암치료법에서 표준요법으로 시행되고 있는 수술, 방사선요법이나 항암화학요법에 대해서는 생략하거나 간략하게 그 원칙만 기술하였으며, 각 장기에서 발생하는 암에 대해서도 잘 알려져 있고 또한 너무 방대하여 언급하지 않았다. 그리고 암의 면역요법이나 대사, 식이, 온열요법, 운동요법, 심신요법 등의 다른 치료에 대해서도 이 책의 부족한 점이 많아서 다른 견해와 방법이 있을 수 있다. 그러나 암의 표준치료를 시행하고 있는 암 전문가와 암에 관심이 있는 많은 사람들, 그리고 통합의학적 방법으로 암 환자들을 치료하고 있는 의사들에게 환자를 이해하고 치료하는데 도움이 되고 참고가 되었으면 한다. 그리고 암 환자들이나 그의 가족들에게 참고가 되었으면 하는 바램을 갖고 있다. 21세기에는 암이 정복되리라고 많은 과학자들은 생각하지만 암의 완치는 아직 갈 길이 멀다. 내가 2년 전 고창 석정웰파크병원에 근무하기 시작하면서 집사람과 밤에 산책을 나갔는데, 높은 곳에 밝은 빛이 보여서 나는 당연히 별인 줄 알았고 별이라고 우겼다. 나중에 방장산의 높은 곳에 미소사의 한 스님이 암자에 기거하고 거기에 켜놓은 전등불이라는 것을 알았지만 말이다. 여기 기술한 내용이나 치료 방법이 암치료의 극히 일부분이고, 또한 아직 과학적으로 증명되지 않은 치료 방법도 있다. 그리고 내가 치료에 경험하지 않은 방법도 참고로 기술하였으며 과학적인 논거를 찾기 위해서 노력하였다. 그러나 알고 선택하는 것과 전혀 모르면서 어떤 치료 방법을 선택하는 것은 다르다. 여기 기술한 기전이나 원리, 이러한 방법을 이용한 임상결과들이 암 환자 치료에 도움을 주고 여러분의 고민에 참고가 되기를 바란다. 그리고 후에 훌륭한 후학이 암의 치료 방법들을 종합해서 암을 완치할 수 있는 전략을 만드는데 조그마한 도움이라도 되었으면 한다. 이 책을 쓰면서 나의 암에 대한 근본적인 질문에 해답을 찾는데 동기를 부여하고 격려해 주신 송도병원의 이종균 이사장님께 감사를 드린다. 그리고 표준치료와 면역치료 등 다양한 치료를 하였음에도 폐암이 늑막에 전이되어 찾아온 환자, 담도암이 경부림프절까지 전이 된 환자와 그 밖의 수많은 암 환자들이 완치되는 기적이 일어나기를 빌어본다. 2023년 3월 김 영 진

김영진 [저]