The topic is heavy with biochemistry, and made even more obscure to the lay person with jargon describing pathways, DNA, mutation, repair, pharmacokinetics and such. I'm going to make it simple without simplifying.
A mutation occurs. This means that somewhere along that billion base-pair strand we call DNA, there's a mistake...one of those rungs along the spiral staircase has been modified, and the result is magnified by enzymes whose job it is to make proteins from the code in that DNA. So the protein that's made is imperfect, and as a result it doesn't do the job Nature designed it for. An imbalance occurs and the cell grows out of control. This wouldn't be a big deal normally, but the cell divides and when it does, it carries that same mutation over to the newly formed cell....and so it goes. Now you have a tumor which could spread and interfere with the workings of the entire organism.
This sort of thing, ie, the mutation, occurs quite often. We have repair enzymes that locate such errors and fix the DNA. They're not perfect, and a mutation can slip through the cracks. So, what to do?
For many years we've focused on what we can do, and that is kill cells that grow more rapidly than normal cells. This we have done quite well. The trouble is, we've got a lot of normal cells that grow fast, and when we kill these (like in the gut, inside your mouth, in your bone marrow) we get a horrible array of side effects. In recent years we've gotten more clever, and fished out slight differences between normal cells and cancer cells, and these efforts have yielded some improved drugs. But all these approaches amount to using a sledgehammer to thread a needle. Besides, rapidly growing tumor cells make even more mutations, so a tumor eventually consists of a bunch of slightly different cells, each with a different sensitivity to our drugs.
The advent of DNA technology, a better understanding of DNA repair and biochemistry, has opened up some very exciting possibilities. We've actually been able to tailor cancer therapy to the individual's biochemistry based on what we see in that person's DNA. This has led to better outcomes with less side effects...but the cure continues to elude.
We are at the doorstep. What we need is a repair system designed at the molecular level to locate that mutation (or mutations) in an individual's DNA, excise it, and replace it with the correct chunk. We know how these repair enzymes work. What we face now is a technological barrier that is twofold: design a repair system based on the person's normal DNA sequence, and get that system into cancer cells. Both these steps are immensely difficult. But the good news is that we can actually envision what needs to be done ... something mankind was never able to do until recently. Such an approach would be free of side effects and guaranteed to rid the body of all cancer cells, regardless of their level of mutation.
Now we await the workings of a creative mind unfettered by traditional boundaries. At the pace of scientific discovery, it may take a generation or two, but I'm very optimistic. Who knows ... someone may already be smiling at the words in this blog.