10/24 - Hereditary Cancer Syndromes (Darcy) Flashcards
The Human Genome and Cancer
- All cancer arises form genetic alterations
- Tumorgenesis is a multistep process
- Most cancer is NOT inherited
- About 5-10% of cancer is due to an inherited predisposition
List of common Dominantly Inherited Cancer Syndromes
- Von Hippel Lindau: VHL
- Familial Adenomatous polyposis: APC
- Hereditary nonpolyposis colorectal cancer (Lynch): MLH1, MSH2, MSH6, PMS2
- Multiple Endocrine Neoplasia Type 2: RET
- Cowden: PTEN
- Li-Fraumeni: TP53
Most cancer susceptibility genes are dominant with incomplete penetrance
- Penetrance is often incomplete
- May appear to “skip” generations
- Individuals inherit altered cancer susceptibility gene, not cancer
Genes Associated with Cancer Predisposition
- Tumor Suppressor Genes
- Oncogenes
- DNA-Damage Response Genes (e.g. Mismatch Repair)
Tumor Suppressor Genes
- The cell’s brakes for tumor growth
- Cancer arises when both copies of the gene are mutated
- Control cell growth
- Loss of function can result in uncontrolled or abnormal cell growth or faulty apoptosis.
- Recessive at the cellular level
Oncogenes
- Accelerates cell division or apoptosis fails
- Tumors arise when the gene is stuck in the “on” mode
- A single gene mutation is sufficient to cause tumorgenesis
DNA-Damage Response Genes (e.g. Mismatch Repair)
- Repair DNA
- Cancer arises when both genes fail due to accumulation of mutations in other important genes
The Cell cycle and cancer predisposition genes
- Oncogenes (between G1, cell growth, and G1, resting or S, synthesis)
- Tumor Suppressor genes; step before Synthesis
- DNA repair genes: between synthesis and G2
Proto-oncogenes
- highly conserved and tightly regulated genes that function to regulate the cell cycle progression, cell division and differentation
Oncogenes are activated ______________
- are activated proto-oncogenes which act through signal transduction or blunted apoptosis. Dominant at the cellular level
Mechanisms for Proto-Oncogene Activation
- Regulatory mutation
- Mutation
- Chromosome translocation, retroviral insertion or gene amplification
Examples of Chromosome translocation, retroviral insertion or gene amplification
- Chimeric protein (CML) t(9;22)
- Downstream of a strong promoter (Burkitt Lymphoma) t(8;14)
Genetics of MEN2 Syndromes
- RET proto-oncogene on chromosome 10
- Autosomal dominant transmission
- Mutated RET gene remains activated (stuck in the “on” position), leading to tumorgenesis
RET proto-oncogene on chromosome 10
- 21-exon gene codes for membrane-associated tyrosine kinase receptor
- Protein spans the cell membrane allowing it to interact with specific factors outside the cell and to receive signals that help the cell respond to its environment
Features of Multiple Endocrine Neoplasia Type 2A (MEN2A)
- Lifetime risks in patients who manifest clinical disease: Medullary thyroid carcinoma (95%), pheochromocytoma (~50%), hyperparathyroidism (20-30%)
- Skin lesions in some families
Features of MEN2B
- Early onset and aggressive MTC
- Pheochromocytoma
- Developmental abnormalities (mucosal neuormas, ganglioneuromatosis, marfanoid phenotype, megacolon)
Clinical Presentation of MTC
- Sporadic: unilateral MTC, no familial pattern, no associated abnormalities
- MEN2A: Bilateral MTC, familial pattern present, pheo & HPT are associated abnormalities
- MEN2B: Bilateral MTC, can have familial pattern or not, and associated abnormalities are mucosal neuormas, ganglioneuromatosis, marfanoid phenotype, megacolon)
- FMTC: Bilateral MTC, familial pattern present, no associated abnormalities
Hirschsprung Disease
- Autosomal dominant, recessive or sporadic
- 1 in 5000 live births
- Congenital lack of enteric innervation resulting in blocked intestines
- 30% penetrance
- 10-40% of patients have RET mutations
- Mutations cause inactivation or loss of RET function
Features of Familial Medullary Thyroid Carcinoma (FMTC)
- 4 or more family members with MTC
- No pheochromocytoma or parathyroid disease
- Later age at onset and indolent course
- Associated with specific mutations in RET gene
MEN2 Syndromes: key points
- MEN2 is a well-defined hereditary syndrome associated with RET gene mutations
- Benefit of testing: Prophylactic thyroidectomy in RET mutation carriers is thought to substantially reduce morbidity and mortality and identifies non-carriers in affected family
- Limitations: no detectable mutation in some families