Neoplasia II

Double hit hypothesis

  • One working gene is enough
  • One faulty gene puts person at increased risk
  • Two faulty mutated genes will result in a functional problem

Chemical carcinogens

  • Initiators: long lasting genetic damage, not sufficient to cause cancer – must be followed by a promoter
  • Promoters: require initiators to have caused damage, time period can vary after initiation

Smoking

  • > 40 carcinogens, e.g. polycyclic aromatic hydrocarbons –
  • Can also be present in animal fat (meat), smoked meat and fish
  • Lung cancer, head and neck cancers, cervical cancer (with HPV)

Aflatoxin (fungus on peanuts)

  • Liver cancer
  • Associated with p53 mutations
  • Common in China
  • Most liver cancers in the west don’t have p53 abnormality until the later stages

Beta-naphthylamine (chemical dyes)

  • Bladder cancers
  • Conjugated in the liver with glucuronic acid – not toxic for too long

Nitrosamines

  • Food preservatives

Arsenic

  • Skin cancer

Other carcinogens

Radiation

  • Causes formation of pyrimidine dimers in DNA
  • Nucleotide excision repair is eventually overwhelmed
  • Xeroderma pigmentosa: genetic defect in NER, suffer from numerous skin cancers
  • CT scanners → leukaemias and thyroid cancers
    • New scanners use lower dose of radiation

Viruses

  • HPV: produces E6 and E7
    • E6 increases destruction of p53
    • E7 prevents Rb protein from acting - E2F can promote transcription
  • EBV (glandular fever): responsible for a subset of malignancies including Burkitt lymphoma, B-cell lymphoma, Hodgkin lymphoma and nasopharyngeal carcinoma

Chronic inflammation

  • Constant lymphocyte reproduction may lead to errors in production → lymphomas
  • Tissue replicating so often will cause it to become unstable → tumours
  • Schistosomiasis - squamous cell tumours caused by chronic inflammatory response to parasite

Obesity

  • Hyperplastic tissue
  • Cholesterol is analogous to oestrogen → renal cell carcinoma

Weinberg's Hallmarks of Cancer

  • Resisting apoptosis
  • Sustained proliferative signaling
  • Evading growth suppressors
  • Activating invasion and metastasis
  • Inducing angiogenesis