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CANCER
PATHOPHYSIOLOGY
Radhika D Prabhu
MS124129
0UTLINE- Pathophysiology
Genetics-
Cancer genes
Environmental
 Carcinogenesis:
Chemical
Physical
Viral
Dietary
What is Cancer?
• Neoplasia means ‘new growth’
• Neoplasm means ‘tumour/ cancer’
• A neoplasm is : Abnormal mass of tissue which grows in an
uncoordinated manner even after cessation of the stimuli which
evoked the change.
• Cancer results from a series of molecular events that fundamentally alter
the normal properties of cells.
• As long as these cells remain in their original location, they are considered
benign and if they become invasive, they are considered malignant.
TYPES
COMMON CANCERS : GLOBAL
* Related to Infection
All the three common cancers above ( both developed & Developing) are also leading
causes of cancer death.
15 % of all cancers – infection related ( 3 times more in developing countries)
All tumors, benign and malignant, have two
basic components
 clonal neoplastic cells that constitute their
parenchyma
 reactive stroma made up of connective
tissue, blood vessels, and variable numbers of
macrophages and lymphocytes
An important hallmark of many cancers is
resistance to apoptosis, which
contributes to the ability of the cells to
divide uncontrollably
When normal cells become old/damaged,
they go through apoptosis (programmed
cell death)
Normal cell
division
Cell damage –
no repair
Apoptosis
Cancer cell
division
Uncontrolled
growth
Fourth or
later
mutation
Third
mutation
Second
mutation
First
mutation
• Tumors are clonal (one parent)
• But have different mutations  different shapes &
features.
• Each new mutation adds a new feature.
How apoptosis happens…….
Genetics of Cancer
Four kinds of normal genes:
• Genes that promote growth (proto-oncogenes)
• Genes that inhibit growth (tumor-suppressor genes)
• Genes that regulate apoptosis (apoptotic genes)
• Genes involved in DNA repair (DNA repair genes)
ONCOGENES
Normal
Cancer
Proto-oncogenes Cell growth
and
proliferationTumor suppressor genes
+
-
Mutated or “activated”
oncogenes Malignant
transformation
Loss or mutation of
Tumor suppressor genes
What are the genes responsible for cancer
cell growth?
++
“Cancer genes” contribute:
1. Autonomous growth
2. Insensitivity to growth-inhibitory signals
3. Evasion of apoptosis
4. Defects in DNA repair
5. Limitless replication
6. Sustained angiogenesis
7. Invasion and metastasis
• Heredity - 5%
AUTONOMOUS GROWTH
• Growth factors may be made by cell itself!
• Receptors may be over expressed or always on
• Signal-transducing proteins may always be on
• Nuclear transcription factors may always be expressed
• Cyclins may be overactive
In cancer cells…
Cell divides on its own!!!
INSENSITIVITY TO GROWTH-INHIBITORY SIGNALS
Tumor-suppressor genes/ anti-oncogenes : normal
genes whose products act as “brakes” on the cell
cycle.
Mutation cause loss of these brakes!
EVASION OF APOPTOSIS
DEFECTS IN DNA REPAIR
• Normal cells have ability to
repair DNA damage
• Thus, prevent mutations in
genes
• But if mutations are not
repaired, results in cancer.
LIMITLESS REPLICATION
 Normal human cells:
 Telomeres keep getting shorter…leading to
cell cycle arrest
 In cancer cells:
 Length of telomeres – regulated by enzyme
TELOMERASE
 Stem cells and cancer cells use telomerase to
maintain telomere length and keep
replicating!
SUSTAINED ANGIOGENESIS
• Tumor cells need blood too!
• Can’t grow >1-2 mm without
new vessels
• Tumor cells eventually
stimulate angiogenesis
• Tumor vessels are abnormal
INVASION AND METASTASIS
• Abnormal cells proliferate and spread
(metastasize) to other parts of the body
• Invasion - direct migration and
penetration into neighboring tissues
• Metastasis - cancer cells penetrate into
lymphatic system and blood vessels
CARCINOGENESIS
• Carcinogens: Substances known to cause cancer
or produce an increase in incidence of cancer.
• Unidentified ‘environmental’ agents play a role in
95% of cancers
o PHYSICAL CARCINOGENESIS
o CHEMICAL CARCINOGENESIS
o MICROBIAL CARCINOGENESIS
Physical Carcinogenesis-Radiation
Properties of radiation carcinogens:
Result in mutations following a long period of latency after the initial
exposure (10-20 yrs)
May enhance the effect of other carcinogens
2 types:
• Ionizing radiation
• Ultraviolet rays
Ionizing radiation
• Ex- X-rays, alpha, beta & gamma rays, radioactive isotopes
• Mechanism of action:
1. Directly alter cellular DNA
2. Dislodge ions from water & other molecules  free radicals  damage
• Causes chromosome breakage, translocations
• Occasionally, point mutations
genetic damage and carcinogenesis.
Examples:
o Unprotected miners: lung cancer
o Atomic bomb survivors: leukemia, other cancers
o Therapeutic head/neck radiation: thyroid cancer
UV Rays
• UV rays derived from the sun cause an increased incidence of
squamous cell carcinoma, basal cell carcinoma, and possibly
melanoma of the skin.
• The degree of risk depends on the type of UV rays, the intensity
of exposure, and the quantity of the light-absorbing “protective
mantle” of melanin in the skin.
Chemical Carcinogenesis
• 2 Types:
• Proximate/direct acting: act
locally without metabolic
change.
• Indirect acting: carcinogenic
only after being metabolised
into active compounds
• ( procarcinogen ultimate
carcinogen)
Some Chemical Carcinogens
DIRECT-ACTING
CARCINOGENS
PROCARCINOGENS THAT
REQUIRE METABOLIC
ACTIVATION
1- Alkylating Agents:
β-Propiolactone,
Dimethyl sulfate,
Diepoxybutane,
Anticancer drugs
(cyclophosphamide,
chlorambucil, nitrosoureas
1-Polycyclic and Heterocyclic
Aromatic Hydrocarbons:
Benz[a]anthracene,
Benzo[a]pyrene,
Dibenz[a,h]anthracene,
3-Methylcholanthrene,
7,12-Dimethylbenz[a]anthracene.
3- Natural Plant and Microbial
Products:
Aflatoxin B1:
Griseofulvin,
Cycasin,
Safrole,
Betel nuts.
2- Acylating Agents:
1-Acetyl-imidazole,
Dimethylcarbamyl chloride
2-Aromatic Amines, Amides,
Azo Dyes:
2-Naphthylamine (β-
naphthylamine),
Benzidine,
2-Acetylaminofluorene,
Dimethylaminoazobenzene
(butter yellow)
4- Others:
Nitrosamine and amides,
Vinyl chloride, nickel, chromium,
Insecticides, fungicides,
Polychlorinated biphenyls.
MICROBIAL CARCINOGENESIS
 Oncogenic DNA viruses:
1. Human Papilloma Virus
2. Epstein-Barr Virus
3. Hepatitis B Virus
 Oncogenic RNA virus:
1. Human T-cell Leukemia virus Type 1
 Bacteria:
1. Helicobacter pylori
ONCOGENIC DNA VIRUSES- PATHOGENESIS
• Genomes of oncogenic DNA viruses integrate & form stable
associations with host genome.
The virus is unable to complete its replicative cycle because viral
genes essential for completion of replication are interrupted
during integration of viral DNA.
Thus, the virus can remain in a latent state for years.
HUMAN PAPILLOMA VIRUS
• 70 genetically distinct types identified
• Low risk types- HPV 6, 11 genital warts
• High risk types- 16,18, 31,33,35,51 Ca cervix, severe dysplasia
and CIS
Cervical cancer
Anogenital cancer
Oral cancer
Laryngeal cancer
Infection with high-risk HPV types simulates :
• loss of tumor suppressor genes
• activates cyclins
• inhibits apoptosis
• combats cellular senescence
EPSTEIN-BARR VIRUS
• Burkitt lymphoma
• Post-transplant lymphoproliferative disease
• Primary CNS lymphoma in AIDS patient
• Subsets of Hodgkin lymphoma
• Nasopharyngeal carcinoma
Hepatitis B and Hepatitis C Viruses
70-85% of hepatocellular carcinomas :
due to infection with HBV or HCV
HELICOBACTER PYLORI
• Gastric lymphoma
• Gastric carcinoma
• Mucosal Associated Lymphoid Tumor (MALT)
Oncogenic RNA Virus
• HTLV-1 causes a T-cell leukemia
Dietary Causes
• Energy Balance: Cancers of breast ,endometrium, gall bladder and
kidney
• Meat: Digestive tract cancers
• Sugars: Simple sugars,colorectal cancer
• Fat: Breast cancer, prostate cancer
• Vitamins and minerals: Lung cancer: oro-pharyngeal, oesophageal
cancers
• Alcohol,tobacco: Mouth,throat,pharynx and oesophagus
• Nitrates: stomach, colorectal
• Aflatoxins: liver cancer
Other Causes
• Stress
• Hormones: Estrogens
• Age
• Physical Activity
• Immune Factors
Cancer pathophysiology dietetics-1
Cancer pathophysiology dietetics-1

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Cancer pathophysiology dietetics-1

  • 2. 0UTLINE- Pathophysiology Genetics- Cancer genes Environmental  Carcinogenesis: Chemical Physical Viral Dietary
  • 3. What is Cancer? • Neoplasia means ‘new growth’ • Neoplasm means ‘tumour/ cancer’ • A neoplasm is : Abnormal mass of tissue which grows in an uncoordinated manner even after cessation of the stimuli which evoked the change. • Cancer results from a series of molecular events that fundamentally alter the normal properties of cells. • As long as these cells remain in their original location, they are considered benign and if they become invasive, they are considered malignant.
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  • 6. COMMON CANCERS : GLOBAL * Related to Infection All the three common cancers above ( both developed & Developing) are also leading causes of cancer death. 15 % of all cancers – infection related ( 3 times more in developing countries)
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  • 9. All tumors, benign and malignant, have two basic components  clonal neoplastic cells that constitute their parenchyma  reactive stroma made up of connective tissue, blood vessels, and variable numbers of macrophages and lymphocytes
  • 10. An important hallmark of many cancers is resistance to apoptosis, which contributes to the ability of the cells to divide uncontrollably When normal cells become old/damaged, they go through apoptosis (programmed cell death) Normal cell division Cell damage – no repair Apoptosis Cancer cell division Uncontrolled growth Fourth or later mutation Third mutation Second mutation First mutation • Tumors are clonal (one parent) • But have different mutations  different shapes & features. • Each new mutation adds a new feature.
  • 12. Genetics of Cancer Four kinds of normal genes: • Genes that promote growth (proto-oncogenes) • Genes that inhibit growth (tumor-suppressor genes) • Genes that regulate apoptosis (apoptotic genes) • Genes involved in DNA repair (DNA repair genes)
  • 14. Normal Cancer Proto-oncogenes Cell growth and proliferationTumor suppressor genes + - Mutated or “activated” oncogenes Malignant transformation Loss or mutation of Tumor suppressor genes What are the genes responsible for cancer cell growth? ++
  • 15. “Cancer genes” contribute: 1. Autonomous growth 2. Insensitivity to growth-inhibitory signals 3. Evasion of apoptosis 4. Defects in DNA repair 5. Limitless replication 6. Sustained angiogenesis 7. Invasion and metastasis • Heredity - 5%
  • 16. AUTONOMOUS GROWTH • Growth factors may be made by cell itself! • Receptors may be over expressed or always on • Signal-transducing proteins may always be on • Nuclear transcription factors may always be expressed • Cyclins may be overactive In cancer cells… Cell divides on its own!!!
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  • 18. INSENSITIVITY TO GROWTH-INHIBITORY SIGNALS Tumor-suppressor genes/ anti-oncogenes : normal genes whose products act as “brakes” on the cell cycle. Mutation cause loss of these brakes!
  • 20. DEFECTS IN DNA REPAIR • Normal cells have ability to repair DNA damage • Thus, prevent mutations in genes • But if mutations are not repaired, results in cancer.
  • 21. LIMITLESS REPLICATION  Normal human cells:  Telomeres keep getting shorter…leading to cell cycle arrest  In cancer cells:  Length of telomeres – regulated by enzyme TELOMERASE  Stem cells and cancer cells use telomerase to maintain telomere length and keep replicating!
  • 22. SUSTAINED ANGIOGENESIS • Tumor cells need blood too! • Can’t grow >1-2 mm without new vessels • Tumor cells eventually stimulate angiogenesis • Tumor vessels are abnormal
  • 23. INVASION AND METASTASIS • Abnormal cells proliferate and spread (metastasize) to other parts of the body • Invasion - direct migration and penetration into neighboring tissues • Metastasis - cancer cells penetrate into lymphatic system and blood vessels
  • 24. CARCINOGENESIS • Carcinogens: Substances known to cause cancer or produce an increase in incidence of cancer. • Unidentified ‘environmental’ agents play a role in 95% of cancers
  • 25. o PHYSICAL CARCINOGENESIS o CHEMICAL CARCINOGENESIS o MICROBIAL CARCINOGENESIS
  • 26. Physical Carcinogenesis-Radiation Properties of radiation carcinogens: Result in mutations following a long period of latency after the initial exposure (10-20 yrs) May enhance the effect of other carcinogens 2 types: • Ionizing radiation • Ultraviolet rays
  • 27. Ionizing radiation • Ex- X-rays, alpha, beta & gamma rays, radioactive isotopes • Mechanism of action: 1. Directly alter cellular DNA 2. Dislodge ions from water & other molecules  free radicals  damage • Causes chromosome breakage, translocations • Occasionally, point mutations genetic damage and carcinogenesis. Examples: o Unprotected miners: lung cancer o Atomic bomb survivors: leukemia, other cancers o Therapeutic head/neck radiation: thyroid cancer
  • 28. UV Rays • UV rays derived from the sun cause an increased incidence of squamous cell carcinoma, basal cell carcinoma, and possibly melanoma of the skin. • The degree of risk depends on the type of UV rays, the intensity of exposure, and the quantity of the light-absorbing “protective mantle” of melanin in the skin.
  • 29. Chemical Carcinogenesis • 2 Types: • Proximate/direct acting: act locally without metabolic change. • Indirect acting: carcinogenic only after being metabolised into active compounds • ( procarcinogen ultimate carcinogen)
  • 30. Some Chemical Carcinogens DIRECT-ACTING CARCINOGENS PROCARCINOGENS THAT REQUIRE METABOLIC ACTIVATION 1- Alkylating Agents: β-Propiolactone, Dimethyl sulfate, Diepoxybutane, Anticancer drugs (cyclophosphamide, chlorambucil, nitrosoureas 1-Polycyclic and Heterocyclic Aromatic Hydrocarbons: Benz[a]anthracene, Benzo[a]pyrene, Dibenz[a,h]anthracene, 3-Methylcholanthrene, 7,12-Dimethylbenz[a]anthracene. 3- Natural Plant and Microbial Products: Aflatoxin B1: Griseofulvin, Cycasin, Safrole, Betel nuts. 2- Acylating Agents: 1-Acetyl-imidazole, Dimethylcarbamyl chloride 2-Aromatic Amines, Amides, Azo Dyes: 2-Naphthylamine (β- naphthylamine), Benzidine, 2-Acetylaminofluorene, Dimethylaminoazobenzene (butter yellow) 4- Others: Nitrosamine and amides, Vinyl chloride, nickel, chromium, Insecticides, fungicides, Polychlorinated biphenyls.
  • 31. MICROBIAL CARCINOGENESIS  Oncogenic DNA viruses: 1. Human Papilloma Virus 2. Epstein-Barr Virus 3. Hepatitis B Virus  Oncogenic RNA virus: 1. Human T-cell Leukemia virus Type 1  Bacteria: 1. Helicobacter pylori
  • 32. ONCOGENIC DNA VIRUSES- PATHOGENESIS • Genomes of oncogenic DNA viruses integrate & form stable associations with host genome. The virus is unable to complete its replicative cycle because viral genes essential for completion of replication are interrupted during integration of viral DNA. Thus, the virus can remain in a latent state for years.
  • 33. HUMAN PAPILLOMA VIRUS • 70 genetically distinct types identified • Low risk types- HPV 6, 11 genital warts • High risk types- 16,18, 31,33,35,51 Ca cervix, severe dysplasia and CIS Cervical cancer Anogenital cancer Oral cancer Laryngeal cancer
  • 34. Infection with high-risk HPV types simulates : • loss of tumor suppressor genes • activates cyclins • inhibits apoptosis • combats cellular senescence
  • 35. EPSTEIN-BARR VIRUS • Burkitt lymphoma • Post-transplant lymphoproliferative disease • Primary CNS lymphoma in AIDS patient • Subsets of Hodgkin lymphoma • Nasopharyngeal carcinoma
  • 36. Hepatitis B and Hepatitis C Viruses 70-85% of hepatocellular carcinomas : due to infection with HBV or HCV
  • 37. HELICOBACTER PYLORI • Gastric lymphoma • Gastric carcinoma • Mucosal Associated Lymphoid Tumor (MALT)
  • 38. Oncogenic RNA Virus • HTLV-1 causes a T-cell leukemia
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  • 40. Dietary Causes • Energy Balance: Cancers of breast ,endometrium, gall bladder and kidney • Meat: Digestive tract cancers • Sugars: Simple sugars,colorectal cancer • Fat: Breast cancer, prostate cancer • Vitamins and minerals: Lung cancer: oro-pharyngeal, oesophageal cancers • Alcohol,tobacco: Mouth,throat,pharynx and oesophagus • Nitrates: stomach, colorectal • Aflatoxins: liver cancer
  • 41. Other Causes • Stress • Hormones: Estrogens • Age • Physical Activity • Immune Factors