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/understandin
gcancer/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/understandi
ngcancer
.
• Each PowerPoint in this series includes a
teacher script. Once these have been
downloaded, you may modify the slide show and
print student handouts.
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 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

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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.

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What are some different kinds of cancer?

Bloodstream

Lung
Lymph nodes
Breast (women)

Colon

Bladder
Prostate (men) Fat
Bone

Muscle R
What are some different kinds of cancer?

Leukemias:
Carcinomas:
Bloodstream
Lung Lymphomas:
Lymph nodes
Breast (women)

Colon

Bladder Sarcomas:
Prostate (men) 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

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How are Normal and Cancer Cell Division Different?

Normal
cell division

Cell Suicide or Apoptosis

Cell damage—
no repair

Cancer
cell division

First Second Third Fourth or

mutation mutation mutation later mutation R

Uncontrolled growth
How are normal and cancer growth different?

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How are normal and cancer growth different?
Normal Growth

Dead cells
shed from
outer surface

Epidermis Cell migration

Dividing cells
in basal layer
Dermis

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How are normal and cancer growth different?

The Beginning
of Cancerous
Growth

Underlying tissue
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How are normal and cancer growth different?

Tumors
(Neoplasms)

Underlying tissue
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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
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 What is the difference between a
benign tumor and a malignant tumor?
Benign Malignant

Time
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 What is the difference between a
benign tumor and a malignant tumor?
Benign (not cancer) Malignant (cancer)
tumor cells grow cells invade
only locally and cannot neighboring tissues,
spread by invasion or enter blood vessels,
metastasis and metastasize to
different sites

Time
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Why are malignant tumors dangerous?

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Why are malignant tumors dangerous?

Brain

Melanoma
cells travel
through
bloodstream

Liver

Melanoma
(initial tumor)

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What is cancer screening?

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Why is cancer screening important?

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Why is cancer screening important?

Early Cancer May Not

Have Any Symptoms

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What are some types of cancer screening?

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What are some types of cancer screening?

Cervical Cancer
Screening (Pap Smear)

Normal
Pap smear

Abnormal
Pap smear

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What are some types of cancer screening?

Breast Cancer
Screening
(Mammogram)

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What are some types of cancer screening?

Prostate and
Ovarian
Cancer
Screening
(Blood Tests)

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What are some types of cancer screening?

Colon Cancer Screening

Fecal Occult Blood Test and Colonoscopy

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How is cancer diagnosed?

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What is a biopsy?
How is the biopsy analyzed?

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What is a biopsy?
How is the biopsy analyzed?

Pathology

Proteomic profile

Patient’s
tissue sample or
blood sample Genomic profile
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What does a pathologist look for
examining biopsy tissue?

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What does a pathologist look for
examining biopsy tissue?

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 What does a pathologist look for when he
examines biopsy tissue with a microscope?
Carcinoma in
Mild situ (severe Cancer
Hyperplasia dysplasia dysplasia) (invasive)

Normal

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What does a pathologist look for when he/she
examines biopsy tissue with a microscope?

Normal Hyperplasia Mild Carcinoma in

dysplasia situ (severe
dysplasia) Cancer
(invasive)

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 What is the relationship between
tumor grade and patient survival?
General Relationship Between
Tumor Grade and Prognosis
100%

Low grade
I or II
Patient
Survival
Rate
High grade
III or IV

1 2 3 4 5
Years
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 What is the relationship between
tumor grade and patient prognosis?

Low grade
Patient I or II
Survival
Rate
High grade
III or IV

Years

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What does Stage III cancer mean?

Five-Year Survival Rates for

Patients with Melanoma (by stage)
100%

50%

I II III
Stage at Time of Initial Diagnosis
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What does Stage III cancer mean?
Five-Year Survival Rates for
Patients with Melanoma (by stage)

100% Stage III Cancer

50%

I II III
Stage at Time of Initial Diagnosis

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What Causes Cancer?

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 What Causes Cancer?
Some viruses or bacteria

Some chemicals Radiation

Heredity
Diet
Hormones

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How could you explain the differences in the
cancer incidence in different countries?

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 Population-Based Studies
Regions of Highest Incidence
U.K.:
Lung
cancer

JAPAN:
Stomach
cancer CANADA:
Leukemia

U.S.:
CHINA: Colon
Liver cancer
cancer
BRAZIL:
Cervical
AUSTRALIA: cancer
Skin
cancer R
Is the incidence of these cancers due to
genes, behavior, or environmental risk?
100 Colon Cancer 100 Stomach Cancer

70

50

5 7
0 0
Japan Japanese U.S. Japan Japanese U.S.
families families
in U.S. in U.S.

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Is the incidence of these cancers due to
genes behavior, or environmental risk?
Colon Cancer Stomach Cancer
(Number of new cases (Number of new cases
per 100,000 people) per 100,000 people)
100 100

70

50

5 7
0 0
Japan Japanese U.S. Japan Japanese U.S.
families families
in U.S. in U.S.

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What increases peoples’ risk of cancer?

Sunshine X-ray

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What increases peoples’ risk of cancer?

Some Carcinogenic Chemicals

in Tobacco Smoke
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What increases peoples’ risk of cancer?

20-Year Lag Time Between

Smoking and Lung Cancer

Cigarette
consumption
(men)
4000
Cigarettes
150
Smoked Lung
per Person 3000 cancer
(men) Lung Cancer
per Year 100 Deaths (per
2000 100,000 people)
50
1000

1900 1920 1940 1960 1980

Year
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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

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What increases peoples’ risk of cancer?

Without
disease

HIV infection
Depressed
immune
system

KSHV infection
Kaposi’s
sarcoma

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What increases peoples’ risk of cancer?
Bacteria and Stomach Cancer

Patient’s H. pylori
tissue sample

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What increases peoples’ risk of cancer?

All Breast Cancer Patients

Inherited factor(s)
Other factor(s)
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What increases peoples’ risk of cancer?

Inherited Conditions That Increase Risk for Cancer

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How do you know if you have genes that
make getting cancer more likely?
Genetic Testing

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How do you know if you have genes that
make getting cancer more likely?
Genetic Testing

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What happens to genes to cause cancer?

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 What happens to genes to cause cancer?
Viruses

Chemicals Radiation

Heredity

Chromosomes
are DNA R

molecules
What happens to genes to cause cancer?

Chemical
bases

A
T
C
G

DNA molecule

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 What happens to genes to cause cancer?

CA AG C T A A C T
DNA

Normal gene
DNA
Mutations 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
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How do mutations in oncogenes
lead to cancer?
Growth factor

Receptor

Signaling enzymes

Transcription
factors

Cell nucleus
DNA

Cell proliferation

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How do mutations in oncogenes
lead to cancer?

Normal cell Normal

genes
regulate
cell growth

Oncogenes
Cancer cell accelerate
cell growth
and division

Mutated/damaged oncogene R
How do mutations in oncogenes
lead to cancer?
Normal Growth-Control Pathway
Growth factor

Receptor

Signaling enzymes

Transcription
factors

DNA
Cell nucleus

Cell proliferation

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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 R

internal oncogene signaling

How do mutations in tumor suppressor
genes lead to cancer?
Tumor Suppressor
Gene Proteins

Signaling
enzymes Transcription
factors
DNA

Cell proliferation
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How do mutations in tumor suppressor genes
lead to cancer?

Normal
Normal cell genes
prevent
cancer

Remove or inactivate
tumor suppressor genes

Cancer cell Damage to

both genes
leads to
cancer

Mutated/inactivated
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tumor suppressor genes

How do mutations in tumor suppressor
genes lead to cancer?
Tumor Suppressor
Gene Proteins
Growth factor

Receptor

Signaling
enzymes Transcription
factors
Cell nucleus DNA

Cell proliferation
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How do mutations in the p53 gene lead to
cancer?

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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)

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How do mutations in DNA Repair Genes
cause cancer?

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How do mutations in DNA Repair Genes
cause cancer?

Normal DNA repair

T C GA C

Base pair
mismatch No cancer
TC TAC

AG C T G

TCTAC 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

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What other kinds of mutations can lead
to cancer?
Genes Implicated in Cancer

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 Why does cancer risk increase with age?
Colon

Breast
Risk

Age

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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 20 40 60 80
Age of Person (in years)
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Cancer Tends to Involve Multiple Mutations
Benign tumor cells Malignant cells invade
grow only locally and neighboring tissues, enter
cannot spread by blood vessels, and
invasion or metastasis metastasize to different sites

Time
Mutation Cells Mutations Proto-oncogenes More mutations,
inactivates proliferate inactivate mutate to more genetic
suppressor DNA repair oncogenes instability,
gene genes metastatic
disease R
 Cancer Tends to
Corrupt Surrounding Environment
Growth factors = proliferation
Invasive

Matrix

Proteases
Fibroblasts,
adipocytes Cytokines
Blood vessel

Cytokines, proteases = migration & invasion

What can people do to prevent cancer?

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What can people do to prevent cancer?

Carcinogenic
chemicals
Carcinogenic
radiation

Cancer viruses
or bacteria

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What can people do to prevent cancer?

Lung Cancer Risk Increases

with Cigarette Consumption
15x

10x
Lung
Cancer
Risk
5x

0 15 30
Non-smoker
Cigarettes Smoked per Day
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What can people do to prevent cancer?

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What can people do to prevent cancer?

Combination of Alcohol and Cigarettes

Increases Risk for Cancer of the Esophagus
40x

30x
Risk
Increase
20x

10x

Alcoholic Drinks
Consumed per Day
AND
Packs of Cigarettes
Consumed per Day
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 What can people do to prevent cancer?

Correlation Between Meat Consumption and

Colon Cancer Rates in Different Countries

40

30
Number of Cases
(per 100,000
people)
20

10

0 80 100 200 300

Grams (per person per day)
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What can people do to prevent cancer?

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What can people do to prevent cancer?

HPV Infection Increases

Risk for Cervical Cancer
High

Cervical
Cancer
Risk

Low
Noninfected Women
women infected
with HPV
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What can people do to prevent cancer?

Some Carcinogens in the Home and Workplace

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Does industrial pollution cause cancer?

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Does industrial pollution cause cancer?

Incidence of
Most Cancers

1930 1950 1970 1990

Year
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Is There a Cancer "Epidemic"?

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Is There a Cancer "Epidemic"?

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Write a paragraph to answer
each of these questions. R