Bio Factsneu

Basisof Cancer Biological
characteristics, diagnosisand treatment of cancer. This Factsheetdescribesthe causes,
There are over 200 different forms of cancer,All have a similar origin: the uncontrolled replication of cells, resulting in the formation of fumours' Cancers account for about 25oh of all deaths in the UK, and are the secondbiggest killer aftet cardiovasculardisease.In males, lung cancer is the most comlnon, whereasin femalesit is breastcancer. Remember - epidemiologt is the study of the patterns of disease and the variousfactors that affect the spreadof diseasewithin populations Exam Hint: Learn the detailsof celt division because this will help you to answer longer essaYquesfions. Tumour DeveloPment The tumours aise from prob)ems wttlt tbe mechan)sms responsible for the control of cell division' The problems may be due to: . mutations: . abnormal activation of the genesinvolved (if this occurs the genesare referred to as oncogenes).The genesmay be activatedby carcinogens" A carcinogen is any agentthat can causethe developmentof cancer. If these abnormal cells are not recognised by the immune system and they will multiply uncontrollably, resulting in the formation suppressed, ola bundle of identical cells, called the primary tumour' Tumour cells can break away and spread to other parts of the body by two methods: . the tumoul cells become mobile by amoeboid action (then called 'tadpole cells') and can migrate into nearby areas' . the tumour cells can be ffansported in the bloodsffeam and the lymphatic sYstem. The process of invasion of other body tissues by cells from the prirnary tumour is called metastasis. This gives rise to secondary tumours or metastasesin organs such as the liver, adrenal glands and the brain' If the tumour cells are transportedin the blood the secondarytumour is likely to be distant from the primary tumour, however if the transport system is the lymph, it is most likely to occur in a lymph node closeto the original tumour' Some tumours that form do not spread and are referred to as benign, and are usually harmless.Tumours that spread,thus causingthe development of secondarytumours, (which can also spread),are classedas malignant and can result in seriousillness or death. Exam Hint: A common (and simpte)mistakels fo confusebenign and malignanttumours.

Fig 1. Cervical smears,showing normal cellsand malignant cells'
(a) Normal cervical cells Normal cells have clear cYtoPlasm and nuclei

,is\dp v\Yc b?

r)

^v\r\

fi^

Fig 2. Diagram of development and spread of secondarytumours.

whose,:;;;3;1.' cers Normar areactivatedbycarctnosens &p
W,
Tumour supplied bY blood/lYmPh' Tumour cells becomemobile, some enter vesselsand are ffansported to other organs

_

o C/T

r*"\cm
v \

bv removed not ffffi:xlce's
*_

he
Via blood

vfl,

Tumour gets larger, cells may become mobile (tadpole cells)

Tumour (tadpole) cells squeeze through wall of caPillary and invade surrounding tissue 'Tadpole cell

Secondary tumour tbrms tn lymph node

lymph node

splitting water into reactive ionised fragmentswhich damageDNA indirectly.niy-.. that in light repairs the DNA. It is likely that the formation of a malignant cancer cell is caused by severalfactors operatingover a number of years. such as breast cancer and ovarian cancer' The genes involved may be oncogenes. F.000 1.000 0 t991 10.papilloma viruses).3.000 (. HIV-1.500 a L 30.500 t0-) tr Women 30. cancers.500 1. Most people have a gene mutation which un .000 () >. causingthe which when insertedinto the host's Epstein-Barr virus contain their own oncogenes.Biologicalbasisof cancer Table I Carcinogenic agents.beta-rays electrons Cancers.causingthe DNA to develop abnormalbulges. Lung Cancer The link between lung cancer and smoking was first identified by epidemiological studies. Smoking and lung cancer tr 4.t CD (D E r.e can then be filled by anotherbase.000 o l< C) 4.. 4. Relevant information Ultraviolet light (non-ionising radiation). (ionising radiations) .000 25.500 4. .u. These couple across the DNA instead of thymine (Xeroderma formation of people have pigmentosum). to cell it rr.000 a c) d 15.soo . UV-light cannot penetratefurther than the epidermis. Other hydrocarbons).DNA viruses such as the and switching them on.aromatic amines' base Environmentally Mustard gas adds a methyl or similar alkyl group to guaninealtering its ability to cancers.lf you are askedto compare the data for malesand femalesyou must refer to both for each comparison you make' Fig 2.ooo -8 5oo z 0 1931 1951 Year t97 | Z l91l 193 I l99l Key: Deaths Cigarettessmoked per personper year .000 l-1 CD 8. cosmic raYs. T .but do not try to explain the data. Alpha-raysareheliumnuclei. breast. since ozone has become dePletedin the upper atmosPhere. carcinogens(seeTable 1) can increasethe chanceof tumour formation. 000 . Polycyclic hydrocarbonsare found in soot and tobacco smoke' the host cells DNA become Cervical cancer Some viruses can contain genesthat when inserted into Viruses an (linked to papilloma For EPstein-oncogenes. It.such pair. *r 1. example.000 - o0 O (r t< q) ..rather than being caused by a single factor alone. caffeine. coupling to adenine.500 a 2. for example. This causesthe releaseof guanine from DNA so that the position occupied by caused other chemicals are base analogues as lung cancer guani. and this allows the development of skin causesthe repair . maIToW act and gamma-rays by: X-rays radiation. Mutagenic chemicals Polycyclic hydrocarbons nitrosamines.nry-. u k Bio Factsbeet Associatedcancers in the Skin cancer uv-light energy is absorbed by the niffogenous bases in DNA and results thymine dimers. invades viruses.when a retrovirus such as HIV-I. 2) sirowing the number of cigarettessmokedand the number of deathsfrom lung cancer it was possibleto seethe first evidenceof an association' Practice exam technique: study the graphsand practisesummansng the trends shown.e transcriptase convert the viral RNA into copy DNA' The animal Barrvirus.. genes cDNA can then be insertedinto the host's genomealtering the host's cell division cell to become malignant.000 3 3. skin and urinary tract. *.500 2.w tt. (an RNA virus).Many (linked to polycyclic to which have similar structures the normal basesand so can becomeincorporatedinto in place of them during replication.tf a questioniusfasks you to describe the data.or genes that stop the immune systemfrom recognisingand attacking cancercells thereforeallowing the developmentof tumours.c u r ri c ul u m Dre ss'c o. the DNA mutagenic chemicals include dioxin. DNA causeuncontrolled cell division' Causes of cancer with age. Some to be damaged. because markswitt not be availablefor an explanation. Some cancelshave been shown to have a strong genetic predisposition.500 c) b 3. between250 to 270 nrn Wavelengths the most dangerous and are are particularly found in bright sunshine.000 L C) 25..000 500 1951 Year 15.gamma-rays electomagnetic Lung.rays.000 CD C! 0 JZ (t a 0) C) l' 2.cancerof The incidenceof some cancersincreases the gut. directly breaking DNA and RNA into short lengths' .30 10. By studying and comparing graphs (Fig. then referto the trendsshown and include values.000 20.) C) E 2.000 3. An example is 5-bromouracil.They all come from radioactivesources.000 5. are orpositrons. some pesticidesand several tobaccoproducts.Also. colchicine.bone are X-raysr cr.

which often forms secondarytumours in the brain. Treatment once cancer is diagnosed. This technique is called ADEPT (Antibody Direct Enzyme Prodrug Therapy). not just of developing lung cancer. Smokes cigarettes without filters o If smoking is stopped the risk decreases. and testing them biochemically for abnormal products of cancer cells or histologically for abnormal leucocytesin leukaemias.without taking samplesof body fluids. The monoclonal antibodiesare taggedwith harmlessradioactive tracers (radionuclides) which emit gamma-rays.for example. radiotherapy can only be used for cancersthat are in discretetumour form and cannot be used asainst dispersed cancercells. For thyroid studies. As a result there are a range of techniquesavailable. Chemotherapy of the whole body using chemicals which kill dividing cells. Skin Cancers/Melanoma Similar to lung cancer. The use of monoclonal antibodies in diagnosis has already been discussed.ranging from X-raying the possibleaffected areasuch as the breast(mammography)or assessing the area using imaging techniques such as ultrasound scanning.also the withholding of certain treatments. therefore a lot of researchhas focusedon this aspectof cancer. resulting in calls to prioritise treatment.(such as heart bypasssurgery).with smokersbeing treatedafter non-smokers. but also of developing coronary heart disease. The advantage of using monoclonal antibodies is their specific binding to antigenson the cancercells in question. three-dimensional A image of the tumour and its position can be built up and this enables radiotherapy treatment to be accurately directed. and research is being directed towards finding ways to stimulate immune reactions. they also have a potential role in the treatmentof cancers.uk computerised tomography (CT) and magnetic resonance imaging (MRI).such as atmosphericpollution. Exam Hint: The topic of UV-radiation and skin cancer often appears in guesfbns relating to pollution. so the number of deathsfrom lung cancerincreased.thus killing them. Smoking and Lung Cancer o The risk of developinglung cancerwill be higher if the smoker: . such as blood.and of the increasedrisk of strokes. .such as benzyprene and co-carcinogens. which reduces the risk of developing of breasttumours by reducing oestrogenlevels as high oestrogenlevels can stimulate the growth of breasttumours.aerosolpropellants and foam expanders. A natural means of defence against cancer is the immune system. while not having any effect on non-cancerouscells. More recently there have been advancesusing monoclonal antibodies. while thesesfudiesweren't conclusive. . The main treatmentsare: . theseare the so-calledmagic bullets.'I) are used.there has been a link observedbetweenincreasing levels of UV-radiation in sunlight and skin cancer. Becauseradiation has to be precisely directed to the cancer. but it takes over ten years for the risk to return to the samelevel as a non-smoker o a o One-third of all cancer-related deaths are a direct result of cigarettesmoking Lung cancer is responsiblefor 25o/o all deathsof smokers of Smokers are nearly 20 times more likely to develop lung cancer than non-smokers . others techniques involve taking samples of body fluids. Diagnostic techniqueslike this should enableearly diagnosisof common cancers.co. . The increase UV-light intensity is linked directly to an in increasedincidence of skin cancer. Diagnosis of cancer The sooner cancer is diagnosedthe better the prognosis (likelihood of a cure).As the tracer collects at clumps of cancer cells it can be visualised by gamma scanning(not all types of gamma-ray are dangerous). Smokes for a long period of time . The successof these techniquesrelies on the presenceof a tumour that is large enough to be detected. which allow the diagnosis of cancers much earlier than the other techniques.cu rriculum Bio tactsbeet ss. the number of people smoking is still very high. The prodrug is then administeredin high doses.particularlyin synoptic guesflbnsand essays.such as breastand colon cancer. A radionuclide in common use is technetium (*Tc).Biologicalbasisof cancer There is a clear correlation showing that as smoking became more prevalent.although this trend is being reversed to some extent by increased public awareness about pollution and use of sun lotions which 'filter out'the UV-light. Radiotherapyand chemotherapy unfortunately kill some norrnal dividing body cells as well as cancercells and so treatmentwith thesemethods has unpleasantside effects. Smokes a large number of cigarettesa day . due to changing fashions.This has lead to a huge strain on the health service. including normal and tumour cells.the choice of treatment depends on the site. Melanoma is a highly malignant tumour.rttut. if the patient is still smoking. resulting in death. Fortunately the cancer cells are much more sensitive to the treatmentsthan normal cells and so treatmentis still possible. Another technique is to tag monoclonal antibodies with an enzyme that convertsthe inactive form (prodrug) of an anti-cancerdrug into an active form. The skin pigment melanin provides some protection by absorbing the radiation. Surgery to remove the fumour Radiotherapy of the affected area using X-rays or y-rays to kill tumour cells. A co-carcinogenis a substance that increases the chancethat a carcinogen will causechangesin DNA Throughout both the developed and developing world. Some tumours respondpoorly to this type of treatment if they have low intemal oxygen levels.The use of monoclonal antibodiesallows the recognition of the different antigenson these cells. no such correlationswere found. experimentalevidencehas shown a direct causative link befweenthe chemicalscontainedin cigarettesmoke and lung cancer.For example. by using interferons and interleukins produced by genetically modified bacteria.when they were repeatedfor other possiblecauses. Since these studies. Starts smoking from a young age . both financially and physically. hair loss and damage to the gut lining. nature and extent of the tumours. due to the depletion of the ozone layer causedby polluting CFCs used in refrigerators.but will only be activatedat cancercells by the presenceof the enzyme. It has been shown that the tar present in cigarettes contains polycyclic hydrocarbon carcinogens. leukaemiasand lymphomas are both cancersof white blood cells. Chemotherapy using drugs such as Tamoxifen. Over the years UV levels have been increasing. radionuclides iodine (r25I of and '. despite the evidence of the risk to health. rt. for example. but Anti-cancer drugs can be attachedto the antibody and thus delivered to the desiredsite. which are hard to distinguishbetween. Inhales . Smokes high tar cigarettes .

[g cancer/melanomaixerodermapigmentosum. lulg ultra-violetlight.Birmingham BI8 6NF Bio Press.c u rricu I u m P re ss. tumour supplied with blood and lymph vessels. (a) (i) A carcinogenis an agentwhich can causethe development 1 of cancer.4 0. max l0 3.0 0.Biologicalbasisof cancer Practice Questions from of rateper thousand the population the l.4 t.The table below betweendevelopedand developingcounffies: shows somedifferences Developed countries Developing countries Number of new cancercasesper year Number of deaths due to cancerper year 2. Outline the sequence eventsin the formation of a secondarytumour' Total 10 3.6 a - ex-smokers named deposit take time to remove (ii) carcinogens/deposits/ from lungs.2 deathsper thousand. rapid mitosis occurs. mitosis occurs. and tumour gets bigger. in anv other form or bv any other means. L q) 5 1 0 1 5 2 0 smoking/years time sincestopping (ii) (a) (i) Describethe pattern of the curve for ex-smokers. emit harmless/softgammarays which can be imaged by a camera. max 2 (b) non-smokers (i) 0. No part of these Factsheets mav be reproduced. hydrocarbons. to cancer cells more susceptible radiation damagethan normal cells. J 1. benzyprene/polycyclic cancer. The graphshows death and of luns cancer non-smokers ex-smokers. Name a non-ionising radiation and say which cancerit is 2 implicated to. TheBig Peg.ra. invade other tissues.copied free of charge bv teaching staJf or students. 2 There are approximately 5. Acknowledgements This Factsheet was researched and written bv Fiona MacBain' Street. w u. Explain this statement' Total 10 . cancerouscells are not removed by the immune system.8 0. cancerouscell does not respondto signals from other cells. ref to migratory cells/tadpolecells. Answers 1. u k Bio Factsbeet rapid fall of deathsper thousandfrom1. or transmitted. (a) (i ) co. in fewer contols on industrialemissions developingcounffies. developedcountriespeople live longer so more likely to die ofcancer.9 million new cancer casesin the world each year and I in 10 deaths is causedby cancer. cancersalready presentdue to exposureto carclnogens before stopping smoking. more slowly in next 10 years from 0'6 to 0'2. harmful. 120 Vvse their be Bio Factsheetsma.2 0 more people smoke in developing countries. tumour cells spreadin thesevesselsto other parts of the body. gf./hard X-rays or gamma-rays. (ii) Suggesttwo reasonswhy it takes so many years for the number of deaths to decrease to the lowest point' a L 2 .v.0 million lin16 Age range with highest incidenceof cancer (ii) 2 (b) Suggestan explanation for the difference between developed (industrialised)countriesand developing countriesin: (i) the age range with the gteatestincidence of cancer' 2 (b) (ii) the deathsper year due to cancer' 2 Total 9 (iii) of 2.6 t. in developed countries better diagnosis of cancer as max 2 causeof death. prior retrieval system.4 to 0. 3 in developing counffies people more likely to die of communicablediseases.6inumber of deaths(more than) halve in first five years.9 million 3. lung damagedue to smoking takeslong time to rePair.unit 3058. max ) Name a chemical carcinogenand say which cancer it is 2 implicated to. (a) (i) (ii) Define the term 'carcinogen'. oncogenesare activatedby carcinogens. 1 I t31I' ref to radionuclides/technetium/eeTc'/iodine lt2sl to taken up preferentially by cancercells/attached monoclonal antibodieswhich attachto cancercells. ref to metastasis/cells secondarycancersform throughoutthe body.2 1. without the permissionofthe publisher ISSN I35l-5136 (iii) (b) 'Ionising radiationscan be used for diagnosisand for treatment 5 of cancer'. cells changetheir appearance can be detected under a microscoPe.provided that stored in a school is a registered subscriber. decreases levels off at around 0. gaffIma scanner/gamma tumours can be directly inadiated with damaging radiation.