CANCER LOGISTICS 1

Cancer Logistics

Christopher Lee

Lincoln Trail College

April 29, 2014

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Cancer Logistics

Normal cells underwent cell division to reproduce and maintain health. Mutations

happened when cells did not go through the checkpoints of cellular division properly. Mapping

genes helped to determine future problems. Oncologists helped doctors in determining the best

way to treat each type of cancer and the statistics for a survival rate after five years. Along with

genetic manipulation came ethical and moral questions about whether scientists should be able to

manipulate genes. Within the past couple of decades, genetic mapping and manipulation are a

huge part in predicting and treating cancer.

Normal Cells, Mutations, and Genetic Mapping

The whole purpose of cell cycle checkpoint was to regulate cell growth and reproduction.

Most damaged cells went through apoptosis, which was programmed cell death. However, when

the cell cycle signaled positive regulators or lost negative regulators the cell started to reproduce

at a rapid rate. With one of the mechanisms not working properly, cancer took place (Funk,

2013). Cancer started out in cell division.

There were several checkpoints in cellular division. If these checkpoints are skipped or

not performed correctly, cancer occurred. Two main proteins that helped with the cell cycle were

oncogenes and tumor suppressor genes, "The pathways regulating the cell cycle incorporate both

oncogenes and tumor suppressor genes..."(Funk, 2013, para. 12). These two helped prevent

cancer by making sure the checkpoints were performed correctly. If the checkpoints were not

done correctly the cell underwent apoptosis.

An online database article described how cells turned into cancerous cells and how the

cells were affected by different tumors:

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Normally, cells divide and replace themselves at a controlled rate. A malignant, or

cancerous, tumour is a mass of abnormal cells that divide excessively quickly and do not

carry out the normal functions of their tissue. These cells are often irregular in size and

shape and bear little resemblance to the normal cells from which they arose. This

irregular appearance is often used to diagnose cancer during microscopic examination of

a small sample of tissue taken from a tumour. A tumour gradually enlarges, crowding out

normal cells, pressing on nerves, and infiltrating blood and lymph vessels. It is important

to distinguish a malignant tumour from a non-malignant one, because cancerous cells can

spread to other parts of the body. (Cancer, 2009, para. 2)

Cells that were classified as cancerous were said to have a genetic mutation. These mutations

have been successfully coded and mapped.

DNA

Deoxyribonucleic acid (DNA) was the genetic information that was passed down from

parent to offspring. In the grand scheme of everything, scientific DNA was fairly new. DNA was

first discovered in 1871, and the structure was developed in 1953 (Scheurle, 2005). It was called

a double helix, because there were two phosphate strands. Everything that people were, was

passed on in their genes. Inheritance (2009) described genes as, "Every gene carries a 'blueprint'

to make a particular product" (para. 1). Genes controlled how people look, and even how they

acted (Scheurle, 2005).

Genetics for cancer was not new. Dr. Aldred Scott Warthin, who was referred to as the

"father of cancer genetics" started doing research in 1895 (Fields & Johnston, 2010). He

discovered a mutation in a family's genes, even though DNA was not discovered for another fifty

years. Dr. Warthin paved the path for Gregor Mendel and a lot of future scientists who worked

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with genetics (Fields & Johnston, 2010). Mendel was famous for his genetic testing with pea

plants. Also, Mendel was the first person to explore individual genes. He became famous for

cross-breeding different pea plants and then being able to predict different characteristics

(Scheurle, 2005). Mendel defined genes as, "A piece of genetic information that operates

independently from other pieces, that defines a specific single physical characteristic, and that is

inherited in a predictable manner" (Scheurle, 2005, p. 67).

Mutations

Mutations happened by complete chance, "There is no way to predict that a particular

mutation will happen. There is no way to prevent a mutation from happening"(Scheurle, 2005, p.

67). Many mutations were not even noticed, because they were either repaired by the cell or they

were in a spot that was not important to function. Three major mutations occurred and they were

dominant mutation, recessive mutation, and sex-linked mutation. Mutations played a big role in

the biology of an organism. Different ways of finding mutations and researching them were

developed in recent years. However, it was different to test for a known mutation, than a

mutation that was not discovered, yet. The difference was how the genes were tested. DNA

scanning was used for unknown mutations, while diagnosing genotypes were used for known

mutations (Scheurle, 2005).

Some mutations were beneficial to humans, while others caused cancer (Cotton, 2013).

Mutations were caused by the changes in the sequences of a person's DNA. Dr. Freddrick Sanger

and a group of scientists came up with a method to code DNA, so it could be sequenced. They

called it the Sanger Method. The Sanger Method was the standard method that was used for

sequencing. Even though it was expensive, it led to numerous mutation discoveries since 1985

(Cotton, 2013). All methods for detecting mutations have their advantages and disadvantages.

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However, some features that were controlled by genes have been predicted. Some genes

were controlled by the works of many different genes, and that made predicting these genes even

more complicated. The only problem with inheritance was that it was not always predictable.

What this meant was that mutations played a part in genetic inheritance. Different factors have

cause mutations at the cellular and DNA level (Inheritance, 2009).

Even though everybody's genetic makeup was 99.9% similar, there were over a few

million known mutations (Fields & Johnston, 2010). People reacted differently to each mutation.

A mutation in one person went unnoticed, while some mutations caused cancer in another. This

proved that genetic mutations were impossible to predict mutations and to be prepared for them.

Also, researchers found that mutated genes were 28% to 44% longer than normal genes with no

mutations. "The difference is highly significant, but the difference is small with disease genes

having approximately 5% lower intron divergence than non-disease genes" (Eyre-Walker &

Eyre-Walker, 2014).

Gene Testing

With advances in technology, scientists and doctors coded DNA and see if a person

carried a gene that made them prone to a disease (Fields & Johnston, 2010). Even though DNA

was structurally simple, the genetic make-up was complex. DNA was composed of the bases:

Adenine, cytosine, guanine, and thymine (Fields & Johnston, 2010). Adenine and thymine were

always paired together, while cytosine was paired with guanine. If one of these bases were

incorrect, it was called a mutation. Gene mutations have caused a numerous amount of health

problems.

Even though genetic mapping looked bleak, the future was where genetic mapping will

flourish. Along with The Human Genome Project was The Cancer Genome Atlas (Strausberg,

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2013). The Cancer Genome Atlas allowed scientists to study cancer cells and see how and why

the normal cell turned into a cancerous cell. With the help of genetic testing and The Cancer

Genome Atlas, doctors have supplied people with the proper medicine and treatment options for

their cancer. Genetic testing and mapping have been made for more than 3,000 diseases.

However, despite the advances in genetic testing, scientists have only found the genetic makeup

for a small amount of the diseases. A lot of testing was based on speculation, and could be

invalid.

Inheritance

Scientists have determined if the parents have a dominant trait for cancer, then the

likelihood was the offspring would get cancer. They were able to do this by the use of a Punnett

Square. Two squares for each parent and one square for each chromosome, dominant and

recessive. To change a trait, in this case cancer, treatment was involved before and after

fertilization occurred. The Cancer Sourcebook described hereditary cancer as complex, and

causes that are not understood (Bellenir, 2011). According to the Bellenir (2011) "Recent

advances in cancer genetics have led to the identification of genes that, when altered, create a

significantly increased risk for certain cancers" (p. 85).

The most common cancer passed through heredity was breast cancer (Bellenir, 2011).

One in 8 women in their lifetime would be diagnosed with breast cancer, that is about 200,000

cases a year (Bellenir, 2011). Angelina Jolie did not even have breast cancer, and she had a

double mastectomy performed to reduce her risk for breast cancer. Jolie did this because she

favored the BRCA1 and BRCA2 genes. These genes were passed down from her mom to her,

and codes for breast cancer. Jolie believed in early detection and was screened for the two breast

cancer genes, because of familial occurrence. With early detection cancer was easier to treat and,

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hopefully, cure . The two screenings for breast cancer were mammograms and a clinical breast

examination. A mammogram was a low powered x-ray of the breast. Even though it was a rare

occurrence, breast cancer could also be found in males (Bellenir, 2011).

In some instances the cancerous traits could not be detected, because they arouse from

both genetics and the environment. Some people would not even know that they have a genetic

problem until a doctor runs through the family's pedigree. Pedigrees determine the traits or

diseases that pass on through inheritance. If the doctor found a mutation, it came to shock some

people. However, it gave them genetic information about the chronic health problem (Scheurle,

2005). With the information that was gathered from the pedigree, the person would be aware

about future offspring. According to Scheurle (2005), "An embryo can come to have a dominant

mutation in one of two ways: inheritance from a parent, or a new mutation in the sperm or egg"

(p. 52).

Even though genetic testing and mapping were somewhat new, it still helped scientists

predict cancer rates. Since 2008, cancer caused 30% of deaths worldwide, so it was no joke and

was a major focus point for all health organizations (Teckle, 2013). Mapping genes required a

type of tissue from the body. These tissues could be blood or anything that contained DNA. In

The Bucket List, Carter Chambers (Morgan Freeman) had a genetic test done (Reiner & Reiner,

2007). Chambers was at work one day when he got a phone call saying he had been diagnosed

with cancer. The doctor asked if anyone in Chambers' family had cancer and Chambers said that

his dad had cancer before it killed him. The genetic test was accurate enough to predict the

Chambers had a heightened chance at getting cancer, but it was not good enough to cure it.

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Oncology and Statistics

Oncology was the study of cancer (Longo, 2014). Scientists were focused on 5 areas of

oncology and they were: etiology, prevention, biology, diagnosis, and treatment (Longo, 2014).

Oncology was described as, "The approach to the study of cancer is multidisciplinary because

cancer is a fundamental problem in biology. Oncology has led to major progress in the

understanding not only of cancer but also of normal biology" (Longo, 2014, para. 1). Oncology

had three basic treatment options. The first option was surgery, which allowed doctors to remove

the tumor or cancerous cells. Next, radiotherapy used isotopes and radiation to kill the cancer

cells. The final option was chemotherapy. Chemotherapy was an important and successful way

to treat some forms of leukemia and lymphoma (Longo, 2014).

Treatment

To determine what treatment option should be used, there were six steps to determine the

seriousness of the cancer. They were: duration of exposure, level of exposure, timing of

exposure, sensitivity, mechanism of teratogenicity and for pregnant women, the metabolism of

the mother or how well her body could protect the fetus (Scheurle, 2005). The only downfall to

teratology is the vaccines were rare, and doctors would not give the vaccines to pregnant women

(Scheurle, 2005). Vaccines used chemicals that have a specific toxic effect on the cancerous

cells.

Substances that caused cancer in people and birth defects in children were called

teratogens. Teratogens were outside agents that cause pregnant women to give birth to children

with birth defects and cancer. Scheurle (2005) defined teratology as, "The study of birth defects

caused by such things is teratology" (p. 45). Common teratogens were substances like: radiation,

alcohol, lead, and mercury (Scheurle, 2005). With all of the different types of teratogens and

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carcinogens in the world experts have agreed that smoking was the leading cause of cancer and

birth defects (Bellenir, 2011). Some staggering numbers were that one fourth of all cancer deaths

were caused by smoking and 50% of smokers would die if they continued to smoke (Bellenir,

2011). Tobacco was so dangerous that, "...scientists estimate that tobacco will kill about one

billion people in the twenty-first century (Bellenir, 2011, p. 52).

Smoking

The people that were at the highest risk for lung cancer were people that smoked and

people who breathed second hand smoke (Bellenir, 2011). Smoking would also make people

develop cancer of the bladder and cervix, leukemia, and many other types of cancers (Bellenir,

2011). Most types of cancers related to smoking could be prevented. Studies showed that even

people who quit smoking later in life would gain years back and cut down on the risk of cancer.

Second hand smoke would elevate the risk for cancer in both adults and children (Bellenir,

2011).

Smoking harmed people that never even smoked. One study showed that spouses to

people that smoke were 27% more likely to get lung cancer (Bellenir, 2011). Results from a

study of 300,000 people showed that children who were exposed to second hand smoke were

more likely to get lung cancer as adults, even if they never smoked (Bellenir, 2011). Pregnant

women that smoked would affect the overall health of the baby, and cause the baby to get cancer.

Women who were exposed to second hand smoke during pregnancy can also affect the overall

health of the baby (Bellenir, 2011).

Alcohol

The American Institute for Cancer Research said that even the smallest amount of alcohol

increases a person's risk for cancer. Having alcohol on a daily basis increased the risk for liver

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cancer (Bellenir, 2011). Bellenir (2011) said, "The risk increases with the amount of alcohol that

a person drinks" (p. 390). In order to cut down on liver cancer risks, the person should drink

alcohol in moderation, or not at all. Numerous medical professionals said that women should not

drink more than one drink per day, while men should have no more than two.

Prevention

On the positive side, most cases of these cancers could be prevented. A lot of chemicals

and teratogens could be avoided, which would mean less birth defects and lower rates of

childhood cancer. The biggest factor that would help lower these rates would be the mother

knowing that she was pregnant (Scheurle, 2005). Statistics played a big role in being able to

predict the outcome of the patient's cancer. Major attributes to the prognosis was the type of

cancer and the stage (Bellenir, 2011). There were 4 main statistics when talking about cancer: the

survival rate, the five year survival rate, disease free, and recurrence free survival rates. The only

discrepancy in survival rates was that they were gathered from a large amount of patients, and

would not predict an individual patient's outcome (Bellenir, 2011).

Genetic Projects and Ethics

One of the most important fields of study in cancer research and treatment was genomics.

The World Health Organization described genomics as a growing field of study that has a

positive outlook for the future in cancer treatment,

Genomics is the study of all the genetic structure of a living organism. The

Human Genome Project is an international research effort to identify the genome

of human life through a complete mapping and sequencing of the human DNA.

Researchers are also mapping the genomes of some of the important pathogens,

disease vectors, and plants. It is hoped that studies of the genetic structure of

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living organisms will produce benefits for human health. (Department of Chronic

Disease and Health Promotion, 2013, para. 1)

The Cancer Genome Anatomy Project helped doctors in being able to detect and diagnose cancer

faster than ever before in history (Strausberg, 2013). Spectral karyotyping led to not only the

expression of individual genes, but the genetic makeup of genes. The Cancer Genome Anatomy

Project used two methods that could be easily shared with the public because they were digital.

The methods were the expressed sequence tags and SAGE (Strausberg, 2013).

Since the development of the Human Genome Project scientists have almost been able to

create a complete full map of all of the genes in the human body (Human Genome Project,

2013). This project started back in 1990 and was funded by $200 million a year for 15 years

(Human Genome Project, 2013). The first genome sequenced was that of the E. coli bacteria. As

time passed scientists figured, "that the human genome contained about 3 billion base pairs

making up an estimated 50,000 to 100,000 genes" (Human Genome Project, 2013, para. 3). With

the Human Genome Project being near completion, scientists were able to receive new insight

about chromosomal changes. These changes included: translocations, deletions, point mutations,

as well as gene expression (Strausberg, 2013). The completion of the cancer genome gave

scientists the ability to study how cancer started and how it spread.

Humans have around 75,000 genes on average (Scheurle, 2005). All of these genes coded

for RNA or a protein (Scheurle, 2005). Two big projects were The Human Genome Project and

the Proteome Project. Even though they were different projects, both were looked at as gene

products, disorders, and mutations. Along with genes came chromosomes. Humans contain 23

pairs of chromosomes. The 23rd chromosome was the sex chromosome, men had xy and females

had xx (Scheurle, 2005).

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There were a lot of ethical questions being asked when it came to genetic testing for

cancer. The Masterton's lost a little girl to cancer and wanted to have another little girl. After the

wife became pregnant, both parents were genetically tested. The results came back and showed

the wife had a cancer gene that would more than likely be passed on to the unborn child. They

then decided to have an abortion.

In that story, it was unethical to kill an unborn child. The results could have been

completely wrong and they would have killed a perfectly healthy baby. Sometimes genetic

testing gave people too much power. They started thinking that they were God and knew

everything. However, genetic testing was very helpful in predicting future genetic problems, like

cancer in families.

Along with genetic testing, engineering, and manipulation came a moral and ethical

issue. Many people disagreed with genetic manipulation, because they felt that men were trying

to be God (Green, 2009). Paul Ramsey, a conservative Christian bioethicist said, "Men ought not

to play God before they learn to be men, and after they have learned to be men they will not play

God" (Green, 2009, p. 171). Since the 1980's, two-thirds of the American people believed that

genetic manipulation was against God's will (Green, 2009).

The biggest concern was not gene manipulation to cure diseases, but gene enhancement

to give people enhanced abilities (Green, 2009). Pope John Paul II said that he approved of

genetic interventions, but not gene enhancement (Green, 2009). With genetic mutations

becoming more common, scientists pushed for a cure for mutations. Genetic manipulation went

too far when people just wanted to enhance abilities. However, if genetic manipulation found a

cure for cancer, most people would feel morally right about it.

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Conclusion

Genetics are a major part of biology and were playing a big role in the ability to map

chromosomes. Most cases of cancer would be prevented if people would change a simple

characteristic in their lifestyle. With the help of the different genetic projects, the Human

Genome Project was near completion and scientists could be able to map an assortment of new

cancers and diseases alike. With genetics came some ethical questions about manipulation of

genes and playing "God". However, there was no denying that genetic mapping have helped with

the diagnosis and treatment of cancer in the past few years.

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