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Understanding Cancer Tutorial Information for Teachers Understanding Cancer Tutorial • This tutorial was adapted from the Understanding Cancer: Cancer Tutorial available at http://www.cancer.gov/cancertopics/ understandingcancer/cancer • There are two forms for this PPT: – Teacher Presentation version (with a script) – Student Handout version (if printing, specify black/ white on print menu) R Understanding Cancer Tutorial Information for Teachers • The National Cancer Institute has produced a series of cancer related PowerPoint tutorials. These are available as downloadable format at http://www.cancer.gov/cancertopics/ understandingcancer. • Each PowerPoint in this series includes a teacher script. Once these have been downloaded, you may modify the slide show and print student handouts. R Understanding Cancer Teacher Information Developed by: Lewis J. Kleinsmith, Ph.D. Donna Kerrigan, M.S. Jeanne Kelly Brian Hollen Discusses and illustrates what cancer is, explains the link between genes and cancer, and discusses what is known about the causes, detection, and diagnosis of the disease. These PowerPoint slides are not locked files. You can mix and match slides from different tutorials as you prepare your own lectures. In the Notes section, you will find explanations of the graphics. The art in this tutorial is copyrighted and may not be reused for commercial gain. Please do not remove the NCI logo or the copyright mark from any slide. These tutorials may be copied only if they are distributed free of charge for educational purposes. R Cancer R Understanding Cancer Developed by: Lewis J. Kleinsmith, Ph.D. Donna Kerrigan, M.S. Jeanne Kelly Brian Hollen Discusses and illustrates what cancer is, explains the link between genes and cancer, and discusses what is known about the causes, detection, and diagnosis of the disease. R What are some different kinds of cancer? Bloodstream Lung Breast (women) Colon Bladder Prostate (men) Lymph nodes Fat Bone Muscle R What are some different kinds of cancer? Carcinomas: Lung Breast (women) Colon Bladder Prostate (men) Leukemias: Bloodstream Lymphomas: Lymph nodes Sarcomas: Fat Bone Muscle R What are some different kinds of cancer? 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 R How are Normal and Cancer Cell Division Different? Normal cell division Cancer cell division R How are Normal and Cancer Cell Division Different? Normal cell division Cell Suicide or Apoptosis Cell damage— no repair Cancer cell division First mutation Second mutation Third Fourth or mutation later mutation R Uncontrolled growth How are normal and cancer growth different? R How are normal and cancer growth different? Normal Growth Dead cells shed from outer surface Epidermis Dividing cells in basal layer Cell migration Dermis R How are normal and cancer growth different? The Beginning of Cancerous Growth Underlying tissue R How are normal and cancer growth different? Tumors (Neoplasms) Underlying tissue R How are normal and cancer growth different? Invasion Cancer cells grow into surrounding tissues and blood vessels Metastasis Cancer cells are transported by the circulatory system to distant sites Cancer cells reinvade and grow at new location R What is the difference between a benign tumor and a malignant tumor? Benign Malignant Time R What is the difference between a benign tumor and a malignant tumor? Benign (not cancer) tumor cells grow only locally and cannot spread by invasion or metastasis Malignant (cancer) cells invade neighboring tissues, enter blood vessels, and metastasize to different sites Time R Why are malignant tumors dangerous? R Why are malignant tumors dangerous? Brain Melanoma cells travel through bloodstream Liver Melanoma (initial tumor) R What is cancer screening? R Why is cancer screening important? R Why is cancer screening important? Early Cancer May Not Have Any Symptoms R What are some types of cancer screening? R What are some types of cancer screening? Cervical Cancer Screening (Pap Smear) Normal Pap smear Abnormal Pap smear R What are some types of cancer screening? Breast Cancer Screening (Mammogram) R What are some types of cancer screening? Prostate and Ovarian Cancer Screening (Blood Tests) R What are some types of cancer screening? Colon Cancer Screening Fecal Occult Blood Test and Colonoscopy R How is cancer diagnosed? R What is a biopsy? How is the biopsy analyzed? R What is a biopsy? How is the biopsy analyzed? Pathology Proteomic profile Patient’s tissue sample or blood sample Genomic profile R What does a pathologist look for examining biopsy tissue? R What does a pathologist look for examining biopsy tissue? R What does a pathologist look for when he examines biopsy tissue with a microscope? Hyperplasia Mild dysplasia Carcinoma in situ (severe dysplasia) Cancer (invasive) Normal R What does a pathologist look for when he/she examines biopsy tissue with a microscope? Normal Hyperplasia Mild dysplasia Carcinoma in situ (severe dysplasia) Cancer (invasive) R What is the relationship between tumor grade and patient survival? 100% General Relationship Between Tumor Grade and Prognosis Low grade I or II Patient Survival Rate High grade III or IV 1 2 3 4 5 Years R What is the relationship between tumor grade and patient prognosis? Low grade I or II Patient Survival Rate High grade III or IV Years R What does Stage III cancer mean? 100% Five-Year Survival Rates for Patients with Melanoma (by stage) 50% I II III Stage at Time of Initial Diagnosis R What does Stage III cancer mean? Five-Year Survival Rates for Patients with Melanoma (by stage) Stage III Cancer 100% 50% I II III Stage at Time of Initial Diagnosis R What Causes Cancer? R What Causes Cancer? Some viruses or bacteria Some chemicals Radiation Heredity Diet Hormones R How could you explain the differences in the cancer incidence in different countries? R Population-Based Studies Regions of Highest Incidence U.K.: Lung cancer JAPAN: Stomach cancer CHINA: Liver cancer AUSTRALIA: Skin cancer CANADA: Leukemia U.S.: Colon cancer BRAZIL: Cervical cancer R Is the incidence of these cancers due to genes, behavior, or environmental risk? 100 Colon Cancer 100 Stomach Cancer 70 50 5 0 Japan Japanese families in U.S. U.S. 7 0 Japan Japanese families in U.S. U.S. R Is the incidence of these cancers due to genes behavior, or environmental risk? Colon Cancer 100 (Number of new cases per 100,000 people) Stomach Cancer 100 (Number of new cases per 100,000 people) 70 50 5 0 Japan Japanese families in U.S. U.S. 7 0 Japan Japanese families in U.S. U.S. R What increases peoples’ risk of cancer? Sunshine X-ray R What increases peoples’ risk of cancer? Some Carcinogenic Chemicals in Tobacco Smoke R What increases peoples’ risk of cancer? 20-Year Lag Time Between Smoking and Lung Cancer Cigarettes Smoked per Person per Year 4000 3000 2000 Cigarette consumption (men) Lung cancer (men) 150 Lung Cancer 100 Deaths (per 100,000 people) 50 1000 1900 1920 1940 1960 1980 Year R What increases peoples’ risk of cancer? Low Strength (Ultraviolet) Radiation High Dallas Skin Cancer Incidence Pittsburgh Detroit Low Least Most Annual Sunshine (UV radiation) R What increases peoples’ risk of cancer? High-Strength (Atomic) Radiation High Leukemia Incidence Low Least Most X-ray Dose (atomic radiation) R What increases peoples’ risk of cancer? Viruses Virus inserts and changes genes for cell growth Cancer-linked virus R What increases peoples’ risk of cancer? Some Viruses Associated with Human Cancers R What increases peoples’ risk of cancer? Without disease HIV infection Depressed immune system KSHV infection Kaposi’s sarcoma R What increases peoples’ risk of cancer? Bacteria and Stomach Cancer Patient’s tissue sample H. pylori R What increases peoples’ risk of cancer? All Breast Cancer Patients Inherited factor(s) Other factor(s) R What increases peoples’ risk of cancer? Inherited Conditions That Increase Risk for Cancer R How do you know if you have genes that make getting cancer more likely? Genetic Testing R How do you know if you have genes that make getting cancer more likely? Genetic Testing R What happens to genes to cause cancer? R What happens to genes to cause cancer? Viruses Chemicals Radiation Heredity Chromosomes are DNA molecules R What happens to genes to cause cancer? Chemical bases A C T G DNA molecule R What happens to genes to cause cancer? DNA DNA Mutations CA AG C T A A C T Normal gene CA AG C G A A C T Single base change CA A G G CG C T A A C T Additions C T CA A G A A C T Deletions R How do mutations in oncogenes lead to cancer? Growth factor Receptor Signaling enzymes Transcription factors Cell nucleus DNA Cell proliferation R How do mutations in oncogenes lead to cancer? Normal cell Cancer cell Mutated/damaged oncogene Normal genes regulate cell growth Oncogenes accelerate cell growth and division R How do mutations in oncogenes lead to cancer? Normal Growth-Control Pathway Growth factor Receptor Signaling enzymes Transcription factors Cell nucleus DNA Cell proliferation R How do mutations in oncogenes lead to cancer? Inactive growth factor receptor Inactive intracellular signaling protein Signaling protein from active oncogene Activated gene regulatory protein Transcription Cell proliferation driven by internal oncogene signaling R How do mutations in tumor suppressor genes lead to cancer? Tumor Suppressor Gene Proteins Signaling enzymes Transcription factors DNA Cell proliferation R How do mutations in tumor suppressor genes lead to cancer? Normal genes prevent cancer Normal cell Remove or inactivate tumor suppressor genes Cancer cell Damage to both genes leads to cancer Mutated/inactivated tumor suppressor genes R How do mutations in tumor suppressor genes lead to cancer? Tumor Suppressor Gene Proteins Growth factor Receptor Signaling enzymes Cell nucleus Transcription factors DNA Cell proliferation R How do mutations in the p53 gene lead to cancer? R How do mutations in the p53 gene lead to cancer? p53 Tumor Suppressor Protein Triggers Cell Suicide p53 protein Normal cell Excessive DNA damage Cell suicide (Apoptosis) R How do mutations in DNA Repair Genes cause cancer? R How do mutations in DNA Repair Genes cause cancer? Normal DNA repair T C GA C Base pair mismatch No cancer TC T AC AG C T G TC TAC TCT AC AG C T G Cancer AG TG AG A T G No DNA repair R What other kinds of mutations can lead to cancer? Genes Implicated in Cancer R What other kinds of mutations can lead to cancer? Genes Implicated in Cancer R Why does cancer risk increase with age? Colon Breast Risk Age R Why does cancer risk increase with age? Cancer Risk and Aging 400 Colon 300 Breast Number of Cancer Cases 200 (per 100,000 people) 100 0 40 60 80 20 Age of Person (in years) R Cancer Tends to Involve Multiple Mutations Benign tumor cells grow only locally and cannot spread by invasion or metastasis Malignant cells invade neighboring tissues, enter blood vessels, and metastasize to different sites Time Mutation Cells inactivates proliferate suppressor gene Mutations inactivate DNA repair genes Proto-oncogenes mutate to oncogenes More mutations, more genetic instability, metastatic disease R Cancer Tends to Corrupt Surrounding Environment Growth factors = proliferation Invasive Matrix Proteases Fibroblasts, adipocytes Blood vessel Cytokines, proteases = migration & invasion Cytokines R What can people do to prevent cancer? R What can people do to prevent cancer? Carcinogenic chemicals Carcinogenic radiation Cancer viruses or bacteria R What can people do to prevent cancer? Lung Cancer Risk Increases with Cigarette Consumption 15x 10x Lung Cancer Risk 5x 0 Non-smoker 15 Cigarettes Smoked per Day 30 R What can people do to prevent cancer? R What can people do to prevent cancer? Combination of Alcohol and Cigarettes Increases Risk for Cancer of the Esophagus 40x Risk Increase 30x 20x 10x Alcoholic Drinks Consumed per Day AND Packs of Cigarettes Consumed per Day R What can people do to prevent cancer? Correlation Between Meat Consumption and Colon Cancer Rates in Different Countries 40 Number of Cases (per 100,000 people) 30 20 10 0 80 100 200 300 Grams (per person per day) R What can people do to prevent cancer? R What can people do to prevent cancer? High HPV Infection Increases Risk for Cervical Cancer Cervical Cancer Risk Low Noninfected women Women infected with HPV R What can people do to prevent cancer? Some Carcinogens in the Home and Workplace R Does industrial pollution cause cancer? R Does industrial pollution cause cancer? Incidence of Most Cancers 1930 1950 1970 1990 Year R Is There a Cancer "Epidemic"? R Is There a Cancer "Epidemic"? R Write a paragraph to answer each of these questions. R