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Cancer in biology
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Cancer in Biology
Cancer is among the hot topics and concerns worldwide. The initial asymptomatic stages
further increase the concerns. Being a medical student, knowledge about cancer is of utmost
importance. Cancer, in simple words, is an exponential and uncontrolled growth of various cells
in the human body. Under normal circumstances, a human body possesses several defenders and
regulators, that monitor the normal growth of every cell in the body. an optimal level of growth
is desirable for normal development, growth, and survival.

Changes called mutations lead to impaired regulation of growth factors and lead to the
enhanced and accelerated proliferation of cells in the body. cancer can occur almost anywhere in
the human body.

Genetic Basis of Cancer

The complex interplay of genes plays the most important role in cancer formation.
Without genetic involvement, cancer is unlikely. Genes are the smallest structures that are
responsible for the formation of any structure of the body and defining their roles. Any serious,
noticeable alteration in genetic makeup can lead to cancer. Cancer may be congenital or
acquired. This alteration leads to the formation of oncogenes, which in turn define the phenotype
of the affected population.

The oncogenes are responsible for generating a positive feedback cycle that causes rapid
and continuous proliferation of the cells. The resultant overgrowth of a certain type of cells leads
to the development of a mass called a tumor. Mutations may be of specific types. Some major
types mentioned in books are listed ahead. in one of the studies, it was seen that retroviral
insertional mutation occurred in BXH2 and AKXD genes in the mice. This mutagenesis was
seen to be responsible for causing B- and T- cell lymphoma. BXH2 was linked with myeloid
leukemia. The RIS of the involved genes has referred to as the genetic tags, which help in the
identification of genes. These genetic tags ease the analysis of genetic makeup and the
consequent mutations.

For knowing the genetic involvement of cancer in detail, it is wise, to begin with, the cell
cycle. Normally, a cell cycle consists of five phases, named Go, G1, S, G2, and M phases. The
first phase, Go is quiescent, which means there is no replication but the cells prepare for the
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division here. G1 phase is the growth phase of the cell cycle, where the organelles duplication
occurs. In this phase, the duplicated mitochondria can be observed.

The next phase is the S-phase, commonly referred to as the synthesis phase. This is the
point where DNA replication takes place in the cells. following the S-phase, is the G2 phase. In
this phase, the cell grows again and prepares itself for the M-phase. The M-phase is the mitotic
phase, where the cells are destined to be divided into two identical cells called daughter cells.
The fate of the daughter cells is either to re-enter in the growth phase pr go back to the quiescent
phase (Israels, 2000).

As the cycle progresses, the cyclins vary with each phase. Throughout the cell cycles,
some checkpoints assure that no deviations from normal are present. The first checkpoint is at
the end of the G1 phase. This checkpoint makes sure that there are no impairments in the DNA
or the cell itself as it enters the growth phase.

(Israels, 2000)
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The second checkpoint is located at the G2 phase to make sure that a cell is normal
before entering the mitotic phase. Because mitosis allows the exact duplication of the parent
cells, therefore the second checkpoint is essential to avoid any disease. Another checkpoint is
located at the M-phase.

The cell cycle appears to be continuously progressing between these phases. But several
regulators are needed for the smooth and safe progression. These regulators are the proteins
known as cyclins and cyclin-dependent kinases (CDK). When a cell is ready to enter the cell
cycle, proteins called CDK 4/6 are produced in the early g1 phase. When cyclin D binds to it, it
gives rise to the reaction inside the cells causing the production of E2F to detach from the
retinoblastoma protein. When it occurs, detached E2F act as a transcription factor. This reaction
allows the smooth progression of the cell cycle from g1 to S-phase. However, at the end of the
g1 phase, another CDK and cyclin CDK 2 and cyclin E are produced (Mathews et al 2022).

Once at the S-phase, cyclin A and CDK 1 and 2 are produced. Again, at the g2 phase,
CDK 1 and cyclin B are produced. These are necessary for the safe and error-free progression of
the cell cycle. Thus, we conclude that CDK and cyclins are the drivers of the cell cycle. If the
amount of either CDK or cyclins is too low, the cell will not be able to progress through the cell
cycle. On the contrary, if an excess of any of these proteins is produced, cells will continuously
and rapidly continue to recirculate through the cell cycle, causing exponential proliferation of the
cells. The consequence will be the formation of tumorous masses. The uncontrolled growth and
proliferation of cells is by far the most common mechanism of cancer. Responsible for this
uncontrolled proliferation are the genetic mutations mentioned in the next text.

Point Mutations

Point mutation is the alteration of only one or a few nucleotides from the genetic
framework. The best and most discussed example of point mutation is the case of sickle cell
anemia. In the condition, the codon of only one amino acid called glutamic acid is replaced by
valine. The resultant condition is not mild and can affect almost every part of the body leading to
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drastic impairments (Ballas, 2012).

Frameshift Mutation

In this type of mutation, the base pair of nucleotides are either deleted or added to the
genetic framework. It causes the shifting of the whole frame from the point of mutation to the
onwards till the end of the frame. It means that unlikely of the point mutation, the whole
sequence after the mutation is altered in the case of a frameshift mutation.

The frameshift mutation can be identified by extraction of DNA from the normal as well
as affected cells and then comparing both using various techniques. Amplification of genetic
sequence followed by a polymerase chain reaction and final analysis help.

DNA Amplification
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The mutation when a certain gene is repeated several times, amplifying the sequence of
that particular gene.

Chromosomal Rearrangement

In this type of mutation, the chromosome is attached to the other at points where it should
not have been.

Germline vs. Somatic Mutations

Germline mutations occur in the sex cells/gametes. Therefore, any mutation in the
germline cells is transmitted from mother to offspring. These mutations are significant because
every cell in the daughter cells is likely to get the mutation. for determining the likelihood and
incidence of human diseases and evolution, it is essential to know the extent and type of
mutation. These mutations are common with advancing paternal age. According to different
studies, it has been concluded that the majority of germline mutations occur in the LFS and LFL
family of the TP53 gene. It, however, is rare (Campbell & Eichler, 2013).

On the contrary, somatic mutations are the mutations that occur in the body cells
other than germline cells or gametes. It means now the mutations are occurring in the diploid
(2n) cells. Because the somatic cells are not transmitted in the next generation, the chances for an
inheritance to the next generation are zero. Because of the continuous replication of most of the
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somatic cells via mitosis, the mutated strain will be present in every daughter cell. It means that
every daughter cell will join the cascade of uncontrolled replication and the process will continue
till the tumorous mass is formed. In rare cases, the reversion of the mutation occurs. But in most
cases, the mutation stays and causes the disease (Campbell & Eichler, 2013).

Types of Cancer Cells

The cancer cells may be malignant or benign. Being benign suggests that the cancer cells
are localized and do not have the potential to invade other sites or organs in the body. However,
these cells may not be completely silent in certain cases. Cancer cells, like giant cells, may be
aggressive and can have the potential to recur without metastasizing.

The second type of cancer cell is metastatic. As the name suggests, the fate of metastatic
cancer cells is the invasion of other organs of the body. In many circumstances, the initial stages
may not be severely symptomatic. Mild flu-like symptoms are some features but, in most cases,
these are overlooked in any clinical setting. In the later stages, when severe symptoms arise,
cancer has exceeded the stage of being cured. Some features are not easily diagnosed but a
detailed investigation is a prerequisite, for instance, an important feature is the night pain. if the
pain is in the chest or epigastric area, it may be of gastrointestinal origin of cancer. If due to
some ulcer (duodenal or gastric), the symptoms are altered by intake of food. If the symptoms
are from cancer, having or delaying food does not affect the symptoms. History is another step to
ruling out cancer.

Factors responsible for Causing Cancer

Though mutation is genetic and can occur in any cell at any time, certain environmental
and lifestyle factors contribute to the development of cancer. In any organism, including humans,
the genetic alterations are somehow linked to the organism’s lifestyle and the environment.
Therefore, certain extrinsic and intrinsic factors contribute to the modification of cancer (Stein
and Colditz, 2004).

Among the modifiable risk factors are a sedentary lifestyle, tobacco smoke,
hypertriglyceridemia, hypercholesterolemia, alcoholism, and unsafe sexual practice. The
incidence of cancer is also linked with the type of workplace. For instance, lung cancer is highly
associated with asbestosis and silicosis. Coal mining and asbestos usage in industries and
manufacturing are linked with a high risk of lung cancers. Therefore, for these individuals,
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cancer screening must be mandatory at regular intervals. It allows early detection and even
prevention of cancer. Asbestos usage is more in the electrical and construction industries as well
as shipyards. Brakes and textile industries are also linked with a higher risk of cancer
development.

Different cancers have different risk factors. For instance, in women, breast cancer is
among the most common cancers. The risk factors include any family history. it doubles if the
mother or sister of a woman has been the suspect of breast cancer. Personal history of breast or
ovarian cancer is also among the risk factors. Also, having a first-degree relative having breast
cancer further amplifies the risk. The risk of testis cancer in males increases with impairments in
prenatal life. Advancing age and comorbidities including diabetes, pancreatitis, and obesity also
increase the risk of cancer (Midha, 2016).

Incidence and Prevalence of Cancer

The cancer statistics have been varying over time worldwide. With better screening and
investigation techniques, cancer progression and metastasis have been improved. In 2020,
approximately 19 million new cases of cancer were reported. Around 10 million deaths were also
recorded from cancer. Among the most common cancers are breast cancer in women, lung
cancer, prostate cancer, and liver cancer. Stomach cancers are also included in the list (Ferlay et
al, 2021).

In another study, liver cancer has been the fifth most common cancer worldwide. This
statistic was between the time duration of 2000 and 2004. The incidence of liver cancer was
564,000 per year. The male proportion was more than the female proportion of newly diagnosed
cases each year. In high-risk geographical areas, cancer began even before the age of 20 years.
This trend in liver cancer was measured by the cohort studies (Bosch et al, 2004).

The global burden of cancer, in general, is huge. Studies have been done to study and
evaluate the global burden of each cancer separately. In this article, I will be mentioning the
global burden of some common cancers worldwide. In 2004, the total deaths reported due to
breast cancer were 5,884,000 (Azubuike et al, 2018). These statistics were reported by World
Health Organization (WHO).
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In Middle Africa, mortality of breast cancer was higher between 2008 and 2012 than in
the west. Reduction in HIV/AIDS showed drastic improvements in the mortality caused by
breast cancer. It shows that improving the lifestyle can reduce mortality and prevent or at least
delay the deaths. In the case of lung cancer, the mortality was relatively high among smokers and
alcoholics. In 2016, 4.8 percent of the global expenses were spent on the treatment of lung
cancer (Rumgay et al, 2021).

Ways to Prevent Cancer

Because treatment of cancer is difficult and, in most instances, the suspect die, therefore
there must be some ways to reduce and prevent the incidence. Improvements in the lifestyle and
environment are important and when implemented, have shown to drastically improve the
general health conditions. irrespective of the age of the individual, a sedentary lifestyle must be
prohibited. Physical activity detoxifies the toxins and kills the unwanted agents accumulating in
the body, that may otherwise lead to cancer development.

Physical activity is an underrated drug that can allow people to live healthily. The
potential benefits of physical activity are seen before, during, and after the diagnosis of cancer. it
increases the overall fitness, decreases complications, reduces the fat mass, increases the lean
muscle mass, increases or regulates the bone mineral density, reduces and controls cancer-related
fatigue, improves mood, decreases the chance of cancer recurrence, and much more. Thus,
physical activity must be incorporated into a daily routine even if the person is undergoing
surgery or chemotherapy.

Apart from physical activity, a reduction in reliance on tobacco smoke or alcohol also
increases alertness. It also reduces the chances of cancer development. Furthermore, alleviation
of the risk factors is more important than directly heading to the treatment.

Early Detection of Cancer

Mortality caused by cancer is two-fold. One is the late detection of cancer, and the other
is that the current drugs are not good enough to fight against cancer. however, tides are turning
and scientific technologies have revolutionized to the point when humankind can finally think of
defeating cancer. one of the exciting revolutions is precision medicine, also known as
personalized medicine. Scientists have succeeded in formulating targeted drugs, meaning drugs
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having a direct action on the targeted cells. It has been made possible by years of deeply studying
the unique genetic profile of the targeted cells.

The other revolution is immunotherapy, which is using the host’s immune system to fight
cancer. cancer usually invades the body whose immune system is weak. The drugs are injected
which turn on the immune cells, which in turn are directed to fight cancer. there are also ways by
which scientists extract the immune cells from the host’s body, engineer them, and reinject them
into the body. The reinjected cells are now capable of fighting against cancer (Stein & Colditz,
2004).

Early detection of cancer has now been made possible by the introduction of many cancer
screening tools and tests. Screening is not for the patients but for the healthy males and females
to identify any hidden mutations in the body. For breast cancer, self-examination and annual
mammography have proven to be useful in women after 50 years of age. For cervical cancer, pap
smear tests have been introduced and advised after 21 years of age. For prostate cancer, serum
PSA and internal examination is advised every year after the age of 50 (Stein and Colditz, 2004).

Conclusion
It was a brief description and discussion of cancer. Cancer is a serious topic worldwide.
Science has been revolving around the pathology, prevention, and cure of cancer. Further studies
are being carried out to improve the morbidity and mortality caused by cancer.
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References
Azubuike, S. O., Muirhead, C., Hayes, L., & McNally, R. (2018). Rising global burden of breast
cancer: the case of sub-Saharan Africa (with emphasis on Nigeria) and implications for
regional development: a review. World journal of surgical oncology, 16(1), 1-13.
https://doi.org/10.1186/s12957-018-1345-2

Ballas, S. K., Kesen, M. R., Goldberg, M. F., Lutty, G. A., Dampier, C., Osunkwo, I., ... &
Malik, P. (2012). Beyond the definitions of the phenotypic complications of sickle cell
disease: an update on management. The Scientific World Journal, 2012.
https://doi.org/10.1100/2012/949535

Bosch, F. X., Ribes, J., Díaz, M., & Cléries, R. (2004). Primary liver cancer: worldwide
incidence and trends. Gastroenterology, 127(5), S5-S16.
https://doi.org/10.1053/j.gastro.2004.09.011

Campbell, C. D., & Eichler, E. E. (2013). Properties and rates of germline mutations in
humans. Trends in Genetics, 29(10), 575-584. https://doi.org/10.1016/j.tig.2013.04.005

Ferlay, J., Colombet, M., Soerjomataram, I., Parkin, D. M., Piñeros, M., Znaor, A., & Bray, F.
(2021). Cancer statistics for the year 2020: An overview. International Journal of
Cancer, 149(4), 778-789. https://doi.org/10.1002/ijc.33588

Matthews, H. K., Bertoli, C., & de Bruin, R. A. (2022). Cell cycle control in cancer. Nature
Reviews Molecular Cell Biology, 23(1), 74-88. https://doi.org/10.1038/s41580-021-
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Midha, S., Chawla, S., & Garg, P. K. (2016). Modifiable and non-modifiable risk factors for
pancreatic cancer: A review. Cancer letters, 381(1), 269-277.
https://doi.org/10.1016/j.canlet.2016.07.022

Israels, E. D., & Israels, L. G. (2000). The cell cycle. The oncologist, 5(6), 510-513.
https://doi.org/10.1634/theoncologist.5-6-510

Rumgay, H., Shield, K., Charvat, H., Ferrari, P., Sornpaisarn, B., Obot, I., ... & Soerjomataram,
I. (2021). Global burden of cancer in 2020 attributable to alcohol consumption: a
population-based study. The Lancet Oncology, 22(8), 1071-1080.
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Stein, C. J., & Colditz, G. A. (2004). Modifiable risk factors for cancer. British journal of
cancer, 90(2), 299-303. https://doi.org/10.1038/sj.bjc.6601509

Viegi, G., Maio, S., Fasola, S., & Baldacci, S. (2020). Global burden of chronic respiratory
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