Cancer (genome) Flashcards
one reason why developed countries might have higher prevalence of cancer?
better technology for early detection
name one secondary cancer that might occur in women that have breast cancer?
lung
true or false: cancer is most common in older people and majority of cases occurs in people that are aged 60 or over?
true
What cells do cancers arise from?
normal ones
What are the 3 categories of cancers based on the type of cell they develop from?
- carcinoma
- sarcoma
- haematological malignancies
carcinomas are the most common tye of cancer and developed from what cell types and where would you find them?
epithelial cells in lung, colon and prostate etc
sarcomas are derived from what type of non epithelial cells? (1% of all cancer but more aggressive)
mesenchymal
What are examples of haematological malignancies and what percentage of cancers do they make up?
lymphoma and leukemia, 17%
What are the types of cancers based on their pattern of growth?
- benign
- malignant
name given to cancers or tumours whose growth is local and do not invade the surrounding organs and tissue?
benign
What is a malignant tumor?
invasion of neighbouring tissue w potential to metastasise
What is meant by metastasis?
development of secondary malignant growths at a distance from a primary site of cancer.
one site which is common for benign tumours?
brain
what might be the consequence of a brain tumour close to the optic nerve?
loss of sight
example of a benign tumour that can become malignant?
breast
are in situ carcinomas malignant or benign?
benign
90% of cancer deaths are caused by metastasis. where does colon cancer metastasize and where might melanoma metastisize?
colon cancer in liver and melanoma in lung
What are characteristics of a cancer cell?
- immortal
- loss of contact inhibition
- high saturation density
- reduced requirement for mitogenic growth factors
- inability to halt proliferation in response to deprivation of growth factors
- altered morphology
- anchorage independent
- tumorigenicity
What is meant by loss of contact inhibition?
cancer cells do not stop growing when they contact other cells, like healthy ones do
What is meant by cancer cells being anchorage independent?
they can adapt to different environments
What is meant by tumorigenicity?
when injecting cancer cells into mice, a tumour will form and able to live longer
What is an oncogene?
a mutated gene with the potential to cause cancer
What is a proto-oncogene?
normal gene that can become oncogene due to mutations or increased expression
whats the product of an oncogene?
tumour inducing agent
what types of proteins are usually proto oncogenes?
proteins involved in:
- promoting entry into cell cycle e.g. receptor-tyrosine kinases, Ras
- protection from apoptosis e.g. Bcl2
What are tumour suppressor genes and what is their status in cancer cells?
- anti-growth genes
- inactivated in cancer cells, both copies require inactivation of growth control to be lost
What are examples of tumour suppressor genes?
RB
p53
= examples that are proteins controlling cell cycle, particularly entry into G1
Where within the cell cycle do tumour suppressor genes fit?
between G0 and S, before apoptosis
what do protooncogenes enable, and suppress around G phase of cell cycle?
promote cell prolif, but if it mutates… can turn into oncogene -> uncontnrolled cell death. apoptosis
during cell prolif, cell undergoes DNA replication and this can -> mistakes due to elaborate process. what do DNA repair genes do?
can help fix this/ result in apoptsis
but these mutations can also present in these genes = mistakes dont get fixed
eventually -> metastasis + secondary tumours
how can familial adenomatous polyposis lead to cancer?
people inherit mutant form of tumour suppressor gene APC, prone to thousands of polyps, which can progress to become cancerous
different tumours have different combinations of mutations, what is usually the first tumour suppressor to be lost?
APC
whats the start of screening to monitor tumour progression?
hyperplastic epithelium point
(after loss of APC)
hallmarks of cancer outlines the different characteristics of cancer cells. what are they?
sustaining proliferative signalling,
evading growth suppressors,
activating invasion and metastasis,
enabling replicative immortality,
induce angiogenesis
resist cell death
What are the emerging hallmarks of cancer? 2
deregulating cellular energetics
avoiding immune destruction
What are the enabling characteristics of cancer? 2
genome instability and mutation
tumout promoting inflammation
what are 4 general areas/ broad causes of cancer?
- genetic predisposition
- lifestyle
- environmental causes
- micro-organisms
what are some environmental causes of cancer?
high radioactive environment
exposure to sun
how many cancers occur due to inheritence of faulty genes
relatively small num
5-10%
most cancers due to XX genes rather than oncogenes
tumour suppressor genes
tumours promote inflammation hence using what type of drug can reduce some of these in combination with other drugs?
anti inflammatories
name 3 types of cancer that can be hereditary?
breast, colon and thyroid
3 tumour suppressor genes involved in breast cancer?
BRCA1,2, p53
tumout suppressor gene in colon cancer?
APC
what are the lifestyle risk factors for cancer?
diet, excercise, alcohol, smoking, obesity
name one infective agent and the cancer that it can cause?
HPV and cervical cancer
what can micro-organism epstein barr virus associated w glandular fever, cause?
some lymphomas - cancer of lymph gland
what can micro organism HIV cause? cancers
kaposi sarcoma
if infection w H. Pylori is left untreated, may lead to what cancer?
stomach
what is key in successful treatment?
early diagnosis
name some environmental or occupational substances that can cause cancer?
asbestos
some cancers are difficult to detect early and thus more difficult to treat., what screening programmes exist in the UK for early detection?
mammograms for breast cancer women above 50, cervical smear tests and bowel cancer screen for men and women above 74
what are the 3 broad areas of cancer treatment?
surgery, chemo and radiotherapy
why may chemo drugs (drugs that target rapidly dividing) be given before surgery?
if tumour too big to remove
or sometimes its attached to diff cells= harder to remove
reason for so many SEs seen with chemo? hair loss, nausea, loss of appetite, weight loss, anaemia
suppressing immunity of whole body
how radiotherapy works
cause DNA damage and cell death
can be directed at tumour so reduce damage to other tissues and organs
what are some of the new treatments that are being developed? what do they target?
- target oncoproteins with specific drugs,
- angiogenesis inhibitors
- immune therapy
what do angiogenesis inhibitors do?
inhibit the formation of vessels that feed the tumour
tumour deprived of nutrients, cant grow
immune therapy drugs use body immune system to fight cancer, a drawback is…
they have bad SEs
5 cancer treatment drug types?
alkylating agents
antimetabolites
anti-microtubule agents
topoisomerase inhibs
cytotoxic antibiotics
what is the moa of alkalating agents?
eg nitrogen mustards
tetrazines
cisplatins
alkalation and damage of DNA
what is the moa of antimetabolites?
eg antifolates eg MTX
molecules impede DNA and RNA synthesis
similar struc to building blocks of both
what is the moa of anti microtubule agents?
vinca alkaloids eg vincristine
taxanes eg paclitaxel
prevent assembly of microtubules disrupts mitotic spindle and mitosis
or
prevent disassembly of microtubules disrupts mitotic spindle and mitosis
what is the moa of topoisomerase inhibitors?
eg irinotecan, topotecan
target topoisomerase enzymes,
disrupt dna replication and rna synthesis
what is the moa of cytotoxic antibiotics?
anthracyclines eg doxorubicin
intercalates with dna and generates free radicals
what are cons of IV infusion chemo?
long, uncomfortable and infusion reactions
GI ses
why are women encouraged to take right contraceptives during cancer treatment drug therapy?
they may cause infertility
what is use of neoadjuvant therapy before surgery?
reduce tumour size
adjuvant therapy may-may not be given after surgery. use of it?
to reduce chance of recurrence of metastases
drug class of nitrogen mustards, tetrazines and cisplatins?
alkalating agents
methotrexate is an anti folate drug belonging to what drug class?
antimetabolite
vincristine is a vinca alkaloid belonging to what drug class?
anti microtubule agent
paclitaxel is a taxane, what is its drug class?
anti microtubule agent
name two topoisomerase inhibitors?
ironotecan and topotecan
name one anthracycline cytotoxic antibiotic?
doxorubicin
DNA damage and repair…….
genome instability is a hallmark of tumour cells/ cancer that tumors have to develop. what does this mean?
= increased propensity to develop genomic alterations
true or false: mutations in genes involved in suppressing genome stability are a major cause of hereditary and sporadic cancer ?
true
cells maintain their genome through DNA repair after a variety of insult due to normal function. What 2 types of damage might occur?
intrinsic and exogenous
example of exogenous damage?
chemical mutagens
give 3 examples of intrinsic damage?
normal dna replication
spontaneous base damage
VDJ recombination
types of radiation that might cause dna damage?
UV or ionising
what might the inability to resolve dna lesions lead to?
genome instability
true or false: inherited mutations in DNA repair are closely linked to genome instability cancer?
true
affect of intrinsic DNA damage to DNA lesion?
base damage
base mismatches
insertions
deletions
DNA strand breaks
affect of chemical agent damage to DNA lesion? (bad)
base modifications
abasic sites
dna strand breakas, adducts, cross links
I
I
V
genome instability
affect of radiation DNA damage to DNA lesion?
pyrimidine dimers
base modifications
abasic sites
dna strand breaks
what prevents dna damage leading togenome instability?
dna damage response
outline the mutator hypothesis?
(what mutations in dna repair genes lead to)
- genome instability in people in precancerous lesions
- drives tumourigenesis by increasing spontaneous mutation rate
–> mutations in oncogenes/ tumour suppressors
how may base alkylation occur?
happens spontaneously or through exposure to chemical mutagens (eg benzoate pyrene)
what type of dna repair pathway repairs base alkylation due to instrinsic or chemical agent damage?
single strand break repair
what is meant by direct repair in the context of single strand break repair?
MGMT or ALKBH work directly on the base to reverse alkylation
what detects double strand break or abnormal DNA replication?
sensor molecules MRN complex or RPA molecule
MRN/ RPA pass signal of damage to transducers (ATM OR ATR/ATRIP), what does this allow the activation of?
recruitment of multifunctional mediator proteins
what is the term given to the molecules that carry out the checkpoint arrest or DNA repair, when there is a double strand break or abnormal DNA replication?
effectors:
Chk2/p53
chk1
DNA is very prevalent and dangerous thus cells must respond very quickly and effectively with good accuracy to prevent genome instability. What does the DNA repair pathway include to spread the repair signal across mega bases of DNA surrounding the break?
extra amplification, phosphorylation of histone variant that surround the break
H2AX
what type of repair removes simple alkylation and oxidative damage?
BER
what type of repair removes bulky helix distorting lesions (UV-C)?
NER
what does MMR remove?
mismatched bases
give 3 pathways that repair the majority of single strand breaks ?
NER, BER and MMR
are single or double strand breaks more dangerous?
double
double strand breaks in both backbones of DNA molecule is sufficient to kill a cell, true or false?
true
what type of damage might cause double strand breaks?
hard to replicate areas, immune system recombination events, chemo and radiation
what 2 main pathways repair double stranded breaks?
HRR and NHEJ
in what way does NHEJ repair double strand breaks?
broken ends are directly ligated together
what repair pathway performs the majority of DNA DSB repair?
NHEJ
what does HRR require for DSB repair?
homologous template of sister chromatids
why does HER pathway only occur in the S or G2 phases of the cell cycle?
after replication
requires a sister chromatid
is HRR or NEHJ faster?
NHEJ
HRR perhaps more accurate but more time consuming
genome instability drives the loss of tumour suppressor genes and the gain of oncogenes which leads to carcinoma. What is the reason behind this?
inherited MMR defects
or gene inactivation/ promoter hypermethylation
give 3 ways in which tumoural cells are more susceptible to therapies?
loss of DDR pathway/s,
increased levels of replication
increased levels of endogenous DNA damage
the 3 ways/ characteristics that make tumoural cells susceptible to therapies include:
loss of DDR pathway/s,
increased levels of replication
increased levels of endogenous DNA damage
give 2 examples of when these can be exploited to kill cancer cells?
- loss of BRCA1 (HR pathway), use PARPi Olaparib to induce legions requiring HR for repair -> cell death
- use ATRi to sensitise cells to replic problems -> cell death
Synthetic lethality and treatment……
what is meant by synthetic lethality?
exploiting mutations in cancer cells… using inhibitor against a complementary pathway to exploit a pre-existing genetic defect
explain the concept of synthetic lethality and the differences in normal and cancer cells?
- normal cells have both repair pathways A and B
- cancer cells have a functional pathway B but weakened pathway A
- introducing a pathway B inhibitor means both pathways are compromised for cancer cells but normal cells can rely on pathway A (compensates)
- normal cells survive and cancer cells die
mutations in dna repair factors BRCA1/BRCA2 increase the risk of developing what 2 types of cancer?
breast and ovarian
mutations in BRCA1/BRCA2 mean that cancers are susceptible to targeted therapies eg?
PARP inhibitors
give two tumour areas/ cancers that PARPi can be used to target aside from breast and ovarian?
tumours w similar mutations eg prostate, leukemia
PARP acts to repair many different types of DNA damage. if inhibited the damage that is created relies on BRCA1/2 on repair. What effect will PARPi have on cells that are normal vs cancer cells (that are BRCA1/2 deficient)?
normal cells survive and cancer cells die
BRCA 1 and 2 are key factors in which DSB repair pathway?
HRR
PARP inhibitors are lethal for cells that lack BRCA1/2 and fine for those that have it, true or false?
true
PARPis inhibit PARP thus leading to what damage?
DNA damage and cell death
2 most likely pathways that PARPi work?
PARP functions in BER
PARP trapping in DNA damage
what PARPi would you give for genomic BRCA mutation treated with chemo for ovarian cancer?
Olaparib
what PARPi would be appropriate for metastatic breast cancer with genomic BRCA mutations?
Olaparib
what 2 PARPi have been approved for clinical use?
olaparib and niraparib
what PARPi would be appropriate for HR defective tumours in advanced ovarian/fallopian & primary peritoneal cancer?
niraparib
what PARPi would be appropriate for maintenance treatment for genomic BRCA-mutated cancers such as pancreatic?
olaparib
BRCA1/2 mutations give HRR defiency and sensitivity to platinum, why is this?
bc platinum damage requires HRR to repair
why are platinum sensitive tumours more responsive to PARPi?
platinum sensitivity correlates to HRR function
PARPi are a potential treatment for radio and immune therapy such as PDL1 inhibition, true or false?
true
many tumours have ATM mutations which regulates the entire response to DNA damage. these mutations lead to loss of function of pathway thus the cells become reliant on ATR (sister kinase to ATM) which acts on different types of damage. Would would happen to these cells if given ATRi?
cell death as dont have functional ATM
need ATM + ATR. like BRCA1,2
activated oncogenes via mutation or over expression drives dys regulated replication and thus replication stress. ATR prevents replication stress. If ATR is inhibited what effect will this have on activated oncogenes?
anything with activated oncogene susceptible to cell death via ATRi
there are currently no ATRi validated for clinical use, true or false?
true
why is effective DNA repair a 2 sided coin essentially?
can promote tumourgenesis + gives cells intrinsic weaknesses we can exploit using targeted therapies to kill cancer cells
Cell proliferation & oncogenes…..
cancer results from defects in the what?
regulatory pathways that allow escape from normal controls of cell prolif, diff, death
there are 3 points in the regulation pathway which may defect and result in cancer what are they?
driving proliferation
blocking quiescence/ differentiation
inducing apoptosis
what are the steps in controll of cell survival and proliferation that -> can have a knock on effect on DNA replication,cell cycle, mitosis etc.
growth factors in ECM bind to their receptors on cell memb
activate intracellular signalling
can cause change in transcription in nucleus->.
when growth factors in the extracellular space such as EGF and PDGF bind to their receptors embedded in cell membranes (eg cytokine receptor) , what is activated?
intracellular signalling pathways
what is the end result of activating any of the intracellular signalling pathways?
cause a change in gene transcription in nucleus
name some processes that a change in gene transcription can have an effect on?
DNA replication, cell cycle, mitosis
how can control of cell survival and proliferation be changed during cancer?
can be deregulated -> drives tumourgenesis
name of normal genes that control proliferation/ growth that become X due to mutations or increased expression/ translocation of gene to an area of the genome where it shouldnt be?
protooncogene
to oncogene
do oncogenes induce tumour genesis directly?
yes
gene amplification is one process by which protocogenes can become oncogenic. How are these amplified in tumours?
duplicated, more gene copies so higher level of expression
give an example cancer where protooncogenes become oncogenic by gene amplification?
HER2 in breast cancer
give 2 examples other than gene amplification/overexpression that drive proto-oncogenes -> oncogenes and example cancers
translocations -> hybrid oncogenes (BCR-ABL in leukemia)
missense mutations -> consecutively sctive protein (EGFR in lung cancer, B-RAF in melanoma)
what type of receptors (the mols that transmit extracellular signals into cell) due growth factors usually bind to?
receptor tyrosine kinases