Mechanisms of Oncogenesis Flashcards

1
Q

List some cancer statistics.

A

INCIDENCE:

  • every two minutes someone in the UK is diagnosed with cancer
  • 359,960 new cases of cancer in the UK in 2015, that’s 990 cases diagnosed every day

MORTALITY:
- every four minutes someone in the UK dies from cancer

RISK:
- 1 in 2 people in the UK born after 1960 will be diagnosed with some form of cancer during their lifetime

SURVIVAL:

  • half (50%) of people diagnosed with cancer in England and Wales survive their disease for ten years or more (2010-11)
  • cancer survival is improving and has doubled in the last 40 years in the UK

PREVENTION:

  • 4 in 10 (42%) of cancer cases in the UK each year are linked to lifestyle
  • these are cases that can be prevented largely through lifestyle changes
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2
Q

What are some factors that can be targeted to prevent and reduce the risk of cancer?

A
  • smoking: smoking is the most important preventable cause of cancer in the world
  • obesity and weight: small changes you can stick with help keep weight off for good
  • hormones: changes in our hormone levels can affect the risk for cancer
  • alcohol: the less you drink, the lower the risk of cancer
  • workplace causes of cancer: some jobs can affect people’s risk of cancer or may have done in the past
  • sun and UV: overexposure to UV light from the sun or sunbeds is the main cause of skin cancer
  • physical activity: around 3400 cases of cancer in the UK each year could be prevented by keeping active
  • infections and HPV: you can’t catch cancer, but some infections such as human papilloma virus can increase the risk
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3
Q

What is cancer?

A

Cancer is the name for a group of diseases characterised by:

  • abnormal cell proliferation
  • tumour formation
  • invasion of neighbouring normal tissue
  • metastasis to form new tumours at distant sites

Over 200 different types of cancer have been classified, often according to their origin:

  • approximately 85% of cancer occur in epithelial cells - CARCINOMAS
  • cancers derived from mesoderm cells (bone and muscle) are SARCOMAS
  • cancers found in glandular tissue are called ADENOCARCENOMAS
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4
Q

List the hallmarks of cancer.

A
  • evading growth suppressors
  • avoiding immune destruction
  • enabling replicative immortality
  • tumour-promoting inflammation
  • activating invasion and metastasis
  • inducing angiogenesis
  • genome instability and mutation
  • resisting cell death
  • deregulating cellular energetics
  • sustained proliferative signaling
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5
Q

Explain how evidence suggests that cancer is a disease of the genome at the cellular level.

A

Carcinogens cause alterations to the DNA - mutation.
DNA from tumours has been shown to contain many alterations from point mutations to deletions.

The accumulation of mutations over time represents the multi-step process that underlies carcinogenesis.
This accumulation occurs only after the cells defence mechanism of DNA repair have been evaded.

In cases of severe damage cell apoptosis is induced; however, many mechanisms exist for blocking carcinogenesis, but over-burdening the system increases the possibility that cells will escape surveillance.

The longer we live the more time there is for DNA to accumulate mutations that may lead to cancer.
That’s why cancer is more prevalent as lifespan has increased.

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6
Q

Describe tumour cells.

A

Somatic mutations constitute almost all mutations in tumour cells.

All cells in a primary tumour arise from a single cell: initiation of the
development of cancer is clonal .

Only one of the 10^14 cells in the body need to be transformed to create a tumour.
It is the continued accumulation of mutations.

Tumour cells can ‘evolve’- sub clonal selection allows a growth advantage and explains the heterogeneity of cells in a tumour.

It’s dependent on interaction with other tumour cells and the tumour microenvironment.

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7
Q

Describe oncogenes and tumour suppressor genes.

A

Normal genes regulate growth

Normal genes that can be activated to be oncogenic are called proto-oncogenes.

An oncogene is a proto-oncogene that has been mutated in a way that leads to signals that cause uncontrolled growth- i.e., cancer.
This is like pushing down on the gas pedal.

Tumour suppressor genes inhibit both growth and tumour formation.
They act as braking signals during phase G1 of the cell cycle, to stop or slow the cell cycle before S phase.

If tumour-suppressor genes are mutated, the normal brake mechanism will be disabled, resulting in uncontrolled growth, i.e. cancer.

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8
Q

With the scheme of multi-stage carcinogenesis, what are the three assumptions made?

A
  • malignant transformation of a single cell is sufficient to give rise to a tumour
  • any cell in a tissue is as likely to be transformed as any other of the same type
  • once a malignant cell is generated, the mean time to tumour detection is generally constant
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9
Q

What are the 5 models of cancer?

A

Model 1: mutational

Model 2: genome instability

Model 3: non-genotoxic

Model 4: Darwinian

Model 5: tissue organisation

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10
Q

Describe the first model of cancer.

A

CHEMICAL CARCINOGENS

Cancer is a multi step process that includes initiation, promotion and progression.
Chemical carcinogens can alter any of these process to induce their carcinogenic effects.

The presence of multiple mutations in critical genes is a distinctive feature of cancer cells and supports that cancer arises through the accumulation of irreversible DNA damage.
In the majority of instances, chemical carcinogens can induce this DNA damage and act in a genotoxic manner.

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11
Q

List the several classes of carcinogens.

A

CHEMICAL: 10 groups:

  • polycyclic aromatic hydrocarbons
  • aromatic amines
  • azo dyes
  • nitrosamines
  • carbamates
  • halogenated compounds
  • alkylating agents

PHYSICAL:

  • radiation (ionising and UV)
  • asbestos

HERITABLE: predisposition

VIRAL:
Hep B, Epstein Barr

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12
Q

How do some chemical carcinogens (such as aromatic hydrocarbons) exert their effects?

A

Four of the major groups polycyclic aromatic hydrocarbons, aromatic amines, nitrosamines and alkylating agents exert their effects by adding functional groups to DNA bases called DNA adducts.

One example is coal tar, which contains benzo[a]pyrene BP), a polycyclic hydrocarbon.
Benzo[a]pyrene is commonly found in cigarette smoke (together with 81 other carcinogens)!

BP ranks high in the measure of how easy it enters into cells.

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13
Q

What is the Ames test?

A

A test to determine the mutagenic activity of chemicals by observing whether they cause mutations in sample bacteria.

AMES TEST:
You take rat liver extract, you mush it up and you combine it with a Salmonella strain that will only grow in the presence of histidine.

If you plate on that onto an agar plate that lacks histidine, following overnight incubation, you should have very few colonies on that plate. If you get one or two, it’s due to natural reversion.

If you add the chemical in question to that, and then plate it, and then you get lots of colonies, it suggest that there is now a change in the bacteria, and it can now grow in the absence of histidine. This confirms that the compound you’re testing is in fact carcinogenic.

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14
Q

How do physical carcinogens act?

A

Unlike chemical carcinogens physical carcinogens act by imparting energy into the biological material.

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15
Q

List some syndrome predisposing to cancer.

A
DNA REPAIR DEFECTS:
- Ataxia Telangiectasia
- Bloom’s syndrome
- Fanconi’s anaemia
- Li-Fraumeni syndrome
- Lynch type II
xeroderma pigmentosum

CHROMOSOMAL ABNORMALITIES:

  • Down’s syndrome
  • Klinefelter’s syndrome
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16
Q

What are some properties required of tumourigenic viruses?

A

Stable association with cells:
- chromosomal integration
episome

Must not kill cells:

  • non-permissive host (virus cannot replicate)
  • suppression of viral lytic cycle
  • viral release by budding

Must evade immune surveillance of infected cells:

  • immune suppression
  • viral antigens not expressed at cell surface
17
Q

List some viruses that are associated with human cancer.

A

DNA VIRUSES:

  • Epstein-Barr virus (Burkitt’s lymphoma, nasopharyngeal carcinoma)
  • papilloma viruses (cervical carcinoma, warts)
  • hepatitis B and C (hepatoma)

RNA RETROVIRUSES:
- HTLV-I (Adult T-cell leukaemia, lymphoma)

18
Q

Describe the second model of cancer.

A

It’s Knudson’s Hypothesis for Hereditary Cancers.

It was first proposed by Carl Nordling in 1953 and then formulated by Knudson in 1971. It was developed by Knudson for retinoblastoma, which became the basis of the ‘two-hit’ hypothesis
and led to the formulation of the theory of ‘tumour suppressor genes’(TSGs) and then to the discovery of Rb1, the TSG that causes retinoblastoma when both copies are mutated.

Knudson performed statistical analysis on cases of retinoblastoma of which there are two types: the inherited type and the sporadic type.

Knudson suggested that multiple hits were required to cause cancer. So, for example, if the first mutated allele was inherited the second mutation would lead to cancer. In the sporadic forms of the tumour both mutations had to take place and hence this could explain the difference of age at diagnosis.

At least two events are necessary for carcinogenesis and that the cell with the first event must survive in the tissue long enough to sustain a second event.

19
Q

Describe the third model of cancer.

A

Non-genotoxic is characterized by an emphasis on non-genotoxic effects.

Several important modulators of cancer risk (diet, obesity, hormones and insulin resistance) do not seem to act through a structural change in DNA but rather through functional changes including epigenetic events.

There is, however, a group of carcinogens that induce cancer via non-genotoxic mechanisms. Non-genotoxic carcinogens have been shown to act as:

  • tumour promoters (1,4-dichlorobenzene),
  • endocrine-modifiers (17β-estradiol),
  • receptor-mediators (2,3,7,8-tetrachlorodibenzo-p-dioxin),
  • immunosuppressants (cyclosporine) or
  • inducers of tissue-specific toxicity and inflammatory responses (metals such as arsenic and beryllium)

Although little is known about this group of carcinogens it is known that in a high proportion of them, multiple pathways need to be altered for cancer induction.

20
Q

Describe the fourth model of cancer.

A

This is carcinogenesis by Mutation and Selection-Model of Clonal Expansion .

It is based on the role of the environment in selecting cells that have some acquired advantage.

There is the sequential accumulation of mutations due to exposure to carcinogens .
The tumour cells will be selected for ability to grow and invade
Selection will include resistance to therapy.
Some mutations may be deleterious for tumour.

21
Q

Describe the fifth model of cancer.

A

To understand the changes that occur during cancer it is important to understand the principles of cell and tissue organisation and mechanisms that control growth and structure.

TISSUES - groups of cells with similar function are known as tissues: epithelial, connective muscle and nervous.

22
Q

Two drastically different approaches to understanding the forces driving carcinogenesis have crystallized through years of research.

What are they?

A

These are the somatic mutation theory (SMT) and the tissue organization field theory (TOFT).

23
Q

Describe the somatic mutation theory (SMT).

A

Cancer is derived from a single somatic cell that has successively accumulated multiple DNA mutations.
Those mutations damage the genes which control cell proliferation and the cell cycle.
Thus, according to SMT, neoplastic lesions are the results of DNA-level events.

Here, a single catastrophic event triggers carcinogenesis.

24
Q

Describe the tissue organization field theory (TOFT).

A

Carcinogenesis is primarily a problem of tissue organization.
Carcinogenic agents destroy the normal tissue architecture, thus disrupting cell-to-cell signalling and compromising genomic integrity.
The DNA mutations are random and the effect, not the cause, of the tissue-level events.

Here, carcinogenesis is viewed as general deterioration of the tissue microenvironment due to extracellular causes.

25
Q

What is the immune system’s response to cancer?

A

The immune system will:

  • protect from virus-induced tumours
  • eliminate pathogens
  • identify and eliminate tumour cells

This leads to immune surveillance. However, despite this, tumours can still arise.
This is the concept of cancer immunoediting.

26
Q

What is cancer immunoediting?

A

It’s easier to remember with the three E’s:

ELIMINATION:
The immune system is able to eradicate developing tumours.

EQUILIBRIUM:
When incomplete removal is present, tumour cells remain dormant and enter equilibrium. The immune system exerts a potent and relentless pressure that contains the tumour. During this phase, some of the tumour may mutate or give rise to genetic variants that survive, grow and enter the next phase (longest of the phases, around 20 years).

ESCAPE:
The expanding tumour populations becomes clinically detectable.