SBL100-Lecture

Introduction to Cancer
What Is Cancer?
Cancer
— Cancer is one of the most common diseases in the world after heart disease.
— 1 in 4 deaths are due to cancer

— Lung cancer is the most common cancer in men

— Lung and Breast cancer is common in women

— There are over 100 different forms of cancer

— Every year 18 million people are diagnosed.

— More than 22 million peoples are living with cancer

— An estimated 9.6 million deaths in 2018.

— The most common cancers are:

— Lung (2.09 million cases)

— Breast (2.09 million cases)

— Colorectal (1.80 million cases)

— Prostate (1.28 million cases)

— Skin cancer (non-melanoma) (1.04 million cases)

— Stomach (1.03 million cases)

— $200 billion: The overall costs of cancer, according to the National

http://www.who.int/mediacentre/factsheets/fs297/en/
Institutes of Health (NIH).
WHO-2018

file:///Users/ashokkumarpatel/Downloads/9789240001299-eng.pdf
 Cancer scenario in India
•Estimated number of people living with the disease: around 2.25 million
•Every year, new cancer patients registered: Over 11,57,294 lakh
•Cancer-related deaths: 7,84,821
Risk of developing cancer before the age of 75 years
Male: 9.81%
Female: 9.42%
Total deaths due to cancer in 2018
•Total: 7,84,821
•Men: 4,13,519
Women: 3,71,302
Risk of dying from cancer is 7.34% in males and 6.28% in females.

MEN WOMEN
1 ORAL BREAST
2 LUNG ORAL
3 STOMACH CERVIX
4 COLORECTAL LUNG
5 ESOPHAGUS GASTRIC
The top five cancers in men and women account for 47.2% of all cancers; these cancers
can be prevented, screened for and/or detected early and treated at an early stage.
ICMR-2018
 What is Cancer?
Cancer is a disease that begins when a single cell escapes from the
regulation of its own division.
Cell division is the process a cell undergoes in order to make copies
of itself. This division is normally regulated so that a cell divides
only when more cells are required, and when conditions are
favorable for division.
A cancerous cell is a rebellious cell that divides without instructions
from the body.
Cancer is a group of diseases characterized by the uncontrolled
growth and spread of abnormal cells. it can result in death.

• As genes switch on and off, they determine when and how fast the
cell will grow and divide, when it will stop dividing, and even when
it will die. Cancer can result when controls over cell division are
lost…
 WHY IS CRAB ( )THE SYMBOL OF
CANCER?

u “Cancer” is the Latin word for crab.

u Similarly cancer spreads from the
u In its natural habitat, a crab is a fast, place at which it first arose as a
resilient decapod crustacean that primary tumor to distant
springs to action and moves in
locations in the body.
multiple directions.
Background / Rationale

u Cancer is uncontrolled cell growth.

u Cancer progression is a multistep process that
begins with abnormal cells with malignant
potential or neoplastic characteristics and
proceeds with tumor growth, stromal invasion,
and metastasis.
u However, despite of numerous efforts, effective
therapeutic inventions against many cancer types
have not been achieved.
u Our goal should be to develop early diagnosis for
cancer and assess drugs for effective & affordable
candidate against cancer.
 Loss of Normal Growth Control
Normal
cell division

Cell Suicide or Apoptosis

Cell damage—
no repair

Cancer
cell division

First Second Third Fourth or

mutation mutation mutation later mutation
Uncontrolled growth
 Naming Cancers

Cancer Prefixes Point to Location

Prefix Meaning
adeno- gland
chondro- cartilage
erythro- red blood cell
hemangio- blood vessels
hepato- liver
lipo- fat
lympho- lymphocyte
melano- pigment cell
myelo- bone marrow
myo- muscle
osteo- bone
 Different Kinds of Cancer

Leukemias:
Some common
carcinomas: Bloodstream
Lung Lymphomas:
Lymph nodes
Breast (women)

Colon
Some common
Bladder sarcomas:
Prostate (men) Fat
Bone

Muscle
More than 80% of human cancers are carcinomas, because Most cell
proliferation in the body occurs in epithelia. Epithelial tissues are
most frequently exposed to the various forms of physical and
chemical damage that favor the development of cancer.
Cancer and metastasis
Tumor: Unregulated cell division that leads to a pile of cells that form
a lump.
A tumor is a mass of tissue that has no apparent function in the
body.
Tumors that stay in one place and do not affect surrounding tissues
are said to be benign
Cells from the original tumor can break away and start new cancers
at distant locations, this process is called metastasis
Cancer cells differ from normal cells in three ways:

(1)they divide when they should not;

(2)they invade surrounding tissues; and
(3)they move to other locations in the body.
ØThe purpose of cell division is to heal wounds, replace damaged
cells, and help tissues and organs grow.
Ø Normal cells are programmed to divide a certain number of
times— usually 60– 70— and then they die.
ØCancer cells do not obey these life-span limits, instead they are
immortal .
ØThis is because cancer cells can activate a gene that is usually
turned off after early development.
ØThis gene produces an enzyme called telomerase . This enzyme,
only active early in development and in cancer cells, allows cells to
divide without limit. Cells with active telomerase enzyme are
immortal.
Cancer Cells Versus Normal Cells
Invasion and Metastasis

1
Cancer cells invade
surrounding tissues
and blood vessels

2
Cancer cells are
transported by the
circulatory system
to distant sites

3
Cancer cells
reinvade and grow
at new location
 Malignant versus Benign Tumors
Benign (not cancer) Malignant (cancer)
tumor cells grow cells invade
only locally and cannot neighboring tissues,
spread by invasion or enter blood vessels,
metastasis and metastasize to
different sites

Time
What is Angiogenesis? It is growth of new capillary blood vessels in the body. It is an
important natural process used for healing and reproduction. The body controls angiogenesis
by producing a precise balance of growth and inhibitory factors in healthy tissues.
Abnormal blood vessel growth leads to cancer

http://bcove.me/erpvo6ia http://www.med.unibs.it/~airc/angiogen.html
What is Metastasis? It is process by which a tumor cell leaves the primary tumor, travels to a
distant site via the circulatory system, and establishes a secondary tumor.

Metastatic tumors

Malignant tumors typically give rise to

metastases, making the cancer hard to
eradicate. bone marrow for metastases
from carcinoma of the prostate gland.

(From Union Internationale Contre le Cancer, TNM Atlas:

Illustrated Guide to the Classification of Malignant Tumors,
2nd ed. Berlin: Springer- Verlag, 1986.)
 Apoptosis is needed to destroy cells
Examples: Cells infected with viruses
Cells of the immune system
Cells with DNA damage
Cancer cells

• Apoptosis is called programmed cell death,

which means coordinated collapse of cell,
protein degradation , DNA fragmentation
followed by rapid engulfment of corpses by
neighbouring cells.
• Apoptosis is needed for proper
development Examples:
• The resorption of the tadpole tail
• The formation of the fingers and toes of the
fetus
• The formation of the proper connections
between neurons in the brain.
Stages of Cancer Spread
•Stage 1: Confined to organ of origin
•Stage 2: Locally invasive
•Stage 3: Spread to lymph nodes
•Stage 4: Spread to distant sites

WHICH PARTS OF THE BODY ARE AFFECTED BY CANCER?

u Almost all the major parts of our body may be affected by cancer.
u Size of cancer cells:
u One million cancer cells = head of a pin
u One billion cancer cells = a small grape
 CAUSES OF CANCER

The Etiology of Cancer

Ø Viruses (papilloma, Epstein-Barr, hepatitis B, retrovirus)
Ø Radiation exposure
Ø Environmental/ industrial carcinogens
* Asbestos
* Aromatic amines
* Bischloromethyl ethers
* Beta-naphthalene and benzedrine
* Polycyclic hydrocarbons
* Drug-induced cancers (alkylators such as melphalan and
cyclophosphamide)
* Nickel
* Vinyl chloride
* Isopropyl alcohol
Ø Diet and nutrition
Ø Tobacco and alcohol consumption
Ø Immunodeficiency syndromes: HIV is associated with Kaposi's sarcoma,
Ø Genetic susceptibility

Cancer is caused by external factors, such as tobacco, infectious organisms, and an unhealthy diet, and
internal factors, such as inherited genetic mutations, hormones, and immune conditions etc..
Chemicals
u Alcohol
u Asbestos
u Wood dust
u Rubber, plastics,
dyes
u Tobacco
Smoking
u Single biggest cause of
cancer

u 25-40% smokers die in

middle age

u 9 in 10 lung cancers
Smoking and alcohol
Life style

Highly caloric diet

Rich in fat
Low physical activity
Smoking /drinking
Tobacco
Carcinogens
Any agent that provoke the development of cancer is called carcinogenic
Carcinogenesis is linked to the Mutagenesis(i.e. cause mutations)
Carcinogens are classified into 2 classes
1) Chemical carcinogen: Typically cause simple local changes in nucleotide sequence and
2) Radiations such as x- Rays: Typically cause chromosomal breakage and Translocation &
UV Rays: Cause specific DNA base alteration i.e. Point mutation
Oncogene : genes whose products play important roles in the regulation of biochemical
activities within cells, including those activities related to cell division

2-Naphthylamine is used to make azo dyes (R-N=N-R‘).

It is found in cigarette smoke and suspected to be contributory to the development of bladder

cancer. It is activated in the liver but quickly deactivated by conjugation to glucuronic acid.

In the bladder, glucuronidase re-activates it by deconjugation, which leads to the

development of bladder cancer.

[On average, each cigarette smoked shortens lifespan by 11 minutes and smokers who die of
tobacco-related disease lose, on average, 14 years of life.]
Cancer diagnosis and treatment
➠ The earlier cancer diagnosis, the better the chance of its being cured.

➠ Some cancer – such as skin, breast, mouth, testicles, prostate, and rectum -- may be
detected by routine self-exam or other screening measures.

➠ Cancer diagnosis begins with a thorough physical exam and a complete medical history.

➠ Followed by Laboratory studies of blood, urine, and stool can detect abnormalities that
may indicate cancer.

➠ When a tumor is suspected, imaging tests such as X-rays, computed tomography (CT),
magnetic resonance imaging (MRI), ultrasound, and fiber-optic endoscopy examinations
help doctors determine the cancer's location and size.

➠ To confirm the diagnosis of most cancers , a biopsy needs to be performed in which a

tissue sample is removed from the suspected tumor and studied under a microscope to
check for cancer cells.
Physical Diagnosis - Melanoma
The Gold Standard of Diagnosis - Biopsy
² A biopsy is the surgical removal of a small piece of tissue for microscopic
examination, which will tell whether a tumor is actually present and if so,
whether is malignant or benign.
² There are three ways tissue can be removed for biopsy:
• Endoscopy
• Needle biopsy
• Or surgical biopsy
Endoscopy
By using a thin lighted tube, doctor is able to look at areas inside the
body, see what’s going on, take pictures, and remove tissue or cells for
examination, if necessary.
Needle Biopsy
The doctor takes a small tissue sample by inserting a needle into the
abnormal area
Surgical Biopsy: excisional biopsy when the doctor removes the entire
tumor, often with some surrounding normal tissue. While An incisional
biopsy when the doctor removes just a portion of the tumor. If cancer is
found to be present, the entire tumor may be removed immediately or
during operation.
Next step is to determine the “aggressiveness”of the cancer
or how fast the cancer is growing
after the diagnosis of cancer the doctor want to learn the
stage, or extent, of the disease. This process is referred to
as “ staging” and tells the doctor how far the cancer has
spread in body. Treatment based on the results of staging.
The four common stage of cancer are:
Stage1: In situ : Early cancer that has not spread to neighboring tissue.
Stage 2: Local: Cancer is found only in the organ where it started to
grow
Stage 3: Regional: Cancer has spread to the surrounding tissues or lymph
nodes.
Stage 4: Distant: Cancer has spread to other organs and systems of the
body.

Staging determines the extent of the disease.

Staging is performed using a number of methods such as Imaging studies
(ultrasound, magnetic resonance imaging (MRI), and computed
tomography (CT scan), x- rays, various blood tests, bone marrow biopsy,
and surgery.
 Imaging
u CT computed tomography
scan
u PET positron emission
tomography
u SPECT (single photon
emission computed
tomography)

u Patients are injected with a

small amount of
radioactive material and
then have to lie in a
machine that captures the
Modern diagnostic imaging
gamma ray emissions from
technologies provide the ability
the material. The images
to discriminate tissues down to
that are created represent
a millimetre, using magnetic
thin 'slices' through the
resonance imaging (MRI) and X-
body. Computer software
ray computed tomography (CT),
is then used to combine the
while the range of positron
slices to make a virtual
emission tomography (PET) and
three dimensional model
single photon emission
that can be viewed from
tomography (SPECT) are a few
any angle
millimetres.
u MRI magnetic resonance
imaging
 Clinical Manifestations of Cancer
u Anemia
u A decrease of hemoglobin in the blood
u Mechanisms
u Chronic bleeding resulting in iron deficiency, severe malnutrition, medical therapies, or
malignancy in blood-forming organs

• Leukopenia and thrombocytopenia

– Direct tumor invasion to the bone marrow causes leukopenia
and thrombocytopenia
• Infection
– Risk increases when the absolute neutrophil and lymphocyte
counts fall
What Are the Treatments for Cancer?
Depending on the type and stage of cancer, treatments to eradicate
the tumor or slow its growth may include some combination of
surgery, radiation therapy, chemotherapy, hormone therapy or
immunotherapy
Cancer therapy
u Surgery
u Radiation
u Chemotherapy
u Antibodies
u Small molecules
u Adjunctive
 Cancer Treatment
u Chemotherapy
u Use of nonselective cytotoxic drugs that target vital
cellular machinery or metabolic pathways critical to both
malignant and normal cell growth and replication
u Goal
u Eliminate enough tumor cells so body’s defense can eradicate any remaining cells

• Other forms of immunotherapy

– Interferon administration
– Antigens
– Effector cell lymphokines
– Monoclonal antibodies
 Chemotherapy
u Chemotherapy
u Compartments
1: cells undergoing mitosis and
cytokinesis
2: cells capable of entering the
cell cycle in G1 phase
3: cells not dividing or have
irreversibly left cell cycle

u Cells will die a

natural death
 Cancer Treatment
u Ionizing radiation
u Eradicate cancer without excessive toxicity
u Avoid damage to normal structures
u Ionizing radiation damages the cancer cell’s DNA
u Surgery
u Biopsy and lymph node sampling
u Sentinel nodes
u Debulking surgery –remove most of tumor
u Palliative surgery – relief of symptoms
u Palliative care is a multidisciplinary approach to specialized
medical and nursing care for people with life-limiting illnesses. It
focuses on providing people with relief from the symptoms, pain,
physical stress, and mental stress of the terminal diagnosis
u Hormone therapy
u Receptor activation or blockage
u Interferes with cellular growth and signaling
Side Effects of Cancer
Treatment
u Gastrointestinal tract
u Bone marrow
u Hair and skin
u Reproductive tract
Antibodies
u Target specific antigen
u Specificity is relative
u Various mechanisms of action
u Complement activation
u antibody-dependent cell-mediated cytotoxicity ADCC
u Calcium entry
u May synergize with chemotherapy
u Expected or unexpected toxicities
Small molecules u Target oncogene product
u Inhibit signaling at key steps
u Safer than chemotherapy
u Specific side effects
u Specificity is often relative
Laser capture microdissection
An example for Innovation

MIT “Russian Doll” teams were awarded a total of $23 Million to fight brain tumors
Researchers from MIT's Koch Institute will work with teams in the UK and Europe to use
nanoparticles to carry multiple drug therapies to treat glioblastoma. The team will use tiny
“Russian doll-like” particles — a technology developed at MIT — to deliver drug
combinations to brain tumors

Temozolomide, which is usually the first chemotherapy

drug given to glioblastoma patients.

Bromodomain inhibitors JQ-1 are believed to interfere

with cells’ ability to repair DNA damage

they coated the liposomes with a protein called

transferrin, the particles could pass through the blood-
brain barrier with little difficulty. Furthermore,
transferrin also binds to proteins found on the surface
of tumor cells, allowing the particles to accumulate
directly at the tumor site while avoiding healthy brain
cells
Pharmacogenomics: drug
therapies tailored to individuals
u Design therapies based on the individual’s genome

u Subtle, but important, differences in genomes

- Linked to differences in how one responds to drugs

u Identify those who will suffer harmful side effects from

particular drugs and who will respond best

u Customized therapy or personalized medicine

Pharmacogenomics
Pharmacogenomics

Remove
Pharmacogenomics
Summary
➟ Cancer cells proliferate defying normal controls; invades and colonize surrounding tissues
(malignant); gives rise to secondary tumors, or metastases; harder to eradicate surgically.

➟ mutations have important role in cancer.

➟ phenomenon of tumor progression, takes many years

➟ It is mainly disturbance of balance between cell division (mitosis) and cell death (apoptosis)

➟ Thus many factors contribute to the development of cancer, and since some factors are
avoidable features of environment, a large proportion of cancers are in principle preventable.

➟ To cure the disease requires an understanding of the special properties of cancer cells that
enable them to evolve, multiply, and spread.

➟ Drugs for differentiation/ program cell death are good approaches.

➟ To become malignant, tumor cells must cross basal laminae; antibodies can be designed that
interfere with this ability. Drugs can be designed to maintain function of suppressor genes.

➟ Cancer cells develop resistance to anticancer drugs. Suitably designed therapeutic attack
required. Combinatorial treatment.
 Textbook & Readings:
Alberts B. et al., The Molecular Biology of the Cell 4th Edition (2002) Garland Science Press, ISBN 0-
8153-3218-1

Robert A. Weinberg, The Biology of Cancer Garland Science Press, ISBN 0-8153-4078-8 (2007).

Lauren Pecorino, Molecular Biology of Cancer, Oxford University Press. ISBN

978-0-19-921148-7 (2008).

M. Molls, P. Vaupel, C. Nieder, M.S. Anscher. The impact of tumor biology on cancer treatment and
multidisciplinary strategies, Springer. ISBN 978-3-540-74385-9 (2009).

Yi Lu, R. I. Mahato, Pharmaceutical perspectives of cancer therapeutics, Springer. ISBN 978-1-4419-

0130-9 (2009).
•Acknowledgement:
•Slides help from Prof C.S.Dey previous year slides
•Internet sources, teaching slides on slideshare, scitable , MIT videos and others ppts
•Students: Nitika, Praveen and Kirtika
Today: We learnt basic introduction about Cancer and some therapy

Assignment: what are the measures can be taken to prevent cancer

Next class: Stem cells