understanding cancer: current scientific research on causes, diagnostics, and treatments
TRANSCRIPT
Understanding Cancer: Current Scientific Research on Causes, Diagnostics, and Treatments.
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In this presentation we’ll cover:
• How cancer develops and the role of genes and stem cells in its development.
• The effectiveness and limitations of current standard treatments.
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In this presentation we’ll cover:
• Diagnostic and imaging options that have been proven to enhance treatment effectiveness.
• The benefits and misconceptions of clinical trials.
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This presentation consists of two key sections:
1. Cancer 101 - Understanding Current
Issues In Cancer
&
2. Ensuring That You Are Making Informed
Choices
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Cancer 101
It is now widely accepted that all cancers
are caused by adult stem cells (or cells with
stem-cell like properties).
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What is an adult stem cell?
• The progenitor (originator) of a group of cells of a specific type
• Occur in roughly 1 out of 6 million body cells.
• Used to repair and replace body cells.
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What is an adult stem cell?
• Exist in regions referred to as stem cell niches, where they remain in a dormant state (quiescence) until activated.
• Each type of tissue contains it’s own stem cell niche.
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What is an adult stem cell?
• All stem cells have unique features that allow them to avoid destruction during treatment.
• However, it is their ability to exist in a dormant state (quiescence) until activated, that is currently inhibiting standard treatments.
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The 2 stages of stem cell activation
There are two key stages of stem cell
activation:
1. Proliferation.
2. Differentiation.
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The 2 stages of stem cell activation
In The Proliferation Stage:
The stem cell makes multiple copies of itself.
In The Differentiation Stage:
The multiple copies are converted into the
required cell type and given a Hayflick
number.
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The 2 stages of stem cell activation
• The Hayflick number is the number of times a normal cell will divide before it stops and dies.
• The important point here is that once a cell has differentiated, it has a finite lifespan.
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Stem cell life cycleProgenitor cell(proliferation)
Mature cell(differentiation)
Stem cell(dormant)
Self renewal
(Activation)
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Stem cell life cycle
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There are two imports points here:
1. A stem cell makes an exact copy of itself, which remains dormant in the stem cell niche.
2. A stem cell also produces a large amount of progenitor cells, which then differentiate into the required type of cells.
Stem cells and cancer
The problem with stem cells is that sometimes, due to mutations, a stem cell is not provided with the cues for differentiation and it gets stuck in a never ending cycle of proliferation, making many copies of itself.
This is what we call cancer.
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Genes and cancer
1. A gene is the DNA template that is used to make a protein or enzyme used by the body.
2. Genes are composed of 4 DNA molecules referred to as A, T, G and C.
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Genes and cancer
1. The exact order of these 4 DNA molecules determines the structure of the gene (and its final product).
2. Changing the order that the DNA molecules are arranged in can destroy the function of the gene and is called a mutation.
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Genes and cancer
1. A carcinogen is anything that can change the order of the DNA molecules in a gene.
2. Specific carcinogens can cause mutations that are specific to each type of cancer.
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Genes and cancer
There are two key types of genes involved
in cancer:
1. Oncogenes.
2. Tumor suppressors.
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Genes and cancer
Oncogenes (tumor causing genes):
1.Cause proliferation.
2. Are turned on (expressed) or over-expressed
in cancers.
3. Are mutated in such a way that causes them
to stay on. www.ctoam.com
Genes and cancer
Tumor suppressors (cancer preventing genes):
1. Initiate differentiation.
2. Are inhibited or under-expressed in cancers.
3. There are common mutations and deletions of
tumor suppressors that occur in specific forms
of cancer.
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Normal stem cell life cycleProgenitor cell(proliferation)
Mature cell(differentiation)
Stem cell(dormant)
Self renewal
(Activation) (Oncogenes) (Tumor supressor genes)
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Cancer stem cell life cycle
(Oncogenes) (Tumor suppressor genes)
Self renewal
(Activation)
Stem cell(dormant)
Progenitor cell(proliferation)
Mature cell(differentiation)
Tumor cellswww.ctoam.com
Why is this important?
There are hundreds of documented oncogenes and tumor suppressor genes in your body.
Only four of these genes need to be altered or mutated for cancer to develop.
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Why is this important?
Therefore, there are many 1000’s of possible combinations of gene alterations that can lead to cancer in each individual case.
The genes mutated are not the same for every person, even if they have the same cancer.
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Why is this important?
In order to treat YOUR cancer effectively, it is important to target the genes that have been mutated as they are unique to YOU!
This is why success rates for standard chemo/radiation can vary so greatly from one person to another!
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Development of cancer
Now let’s explore how cancer develops once the unregulated proliferation of stem cells has begun.
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Metastasis
When a cancer cell is stuck in proliferation
and hasn’t differentiated, it can live almost
anywhere in the body (metastasize)
But, how is it that cancer cells travel throughout
the body?
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Angiogenesis and metastasis
Cancer cells are constantly growing and therefore, need to consume a lot of resources. In other words, they require their own blood supply.
Angiogenesis is a process that cancers use to recruit their own blood vessels in order to enable their continued growth.
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Angiogenesis and metastasis
The process of angiogenesis is controlled by oncogenes and tumor suppressor genes.
Oncogenes are responsible for the initiation of angiogenesis while tumor suppressor genes inhibit it.
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Summary
• Stem cells remain dormant until activated.
• Cancer is a disease of the stem cells caused by reduced differentiation and increased proliferation.
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Summary
• The recruitment of blood vessels (angiogenesis) allows the tumor to grow and to metastasize.
• Proliferation, differentiation, and angiogenesis are all controlled by genes!
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The standardized approach to cancer treatment
utilizes the following three techniques:
1. Surgery: Removes diseased tissues.
2. Radiation: Creates DNA mutations in rapidly dividing cells.
3. Chemotherapy: Chemical interference of rapidly dividing cells.
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Standard treatment methods
Limitations of surgery
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Surgery is localized:
• Limited to treatment of localized disease.
• Potential to miss stem cells, cells that are in pre-cancerous stages, or cells that have already metastasized.
Limitations of radiation
Radiation is localized:
• Non-selective, affects all rapidly dividing cells and is very toxic.
• Radiation can create new DNA mutations that may lead to more aggressive cancers.
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Limitations of radiation
Radiation is localized:
• Angiogenesis (cancer cell recruitment of blood vessels) occurs directly after treatment.
• Only affects reproducing cells during course of treatment (not dormant cancer causing stem cells).
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Limitations of chemotherapy
Chemotherapy (generalized):
• Non-selective, affects all rapidly dividing cells and is very toxic.
• Chemotherapy can create new DNA mutations that may lead to more aggressive cancers.
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Limitations of chemotherapyChemotherapy (generalized):
• Angiogenesis occurs directly after treatment.
• Only affects active cells during course of treatment (not dormant cancer causing stem cells).
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Radiation and chemotherapy
The main difference between radiation and chemotherapy is that radiation is used locally and limited to specific regions of the body, while chemotherapy affects all of the cells in the body.
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Additional concerns: Surgery & Radiation
In order for surgery and radiation to be effective, the following concerns need to be addressed:
• Doctors need to target the stem cell niche as well as the malignant tissue (tumor).
• Doctors need to ensure they have accurate imaging prior to surgery and treatment to differentiate between normal and tumor tissues.
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Making informed choices: DIAGNOSTICS
Before your cancer to be effectively treated,
two important things MUST be determined!
1. The exact location of all of your tumors.
2. The unique genetic mutations that drive your cancer.
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Making informed choices: DIAGNOSTICS
This requires two diagnostic approaches:
1. Accurate imaging of your tumors.
2. Sequencing of your tumor DNA.
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Making informed choices: Imaging
PET/CT
• Combines CT imaging with positron emission tomography.
• Shows biological activity within organs and detects cancer in the earliest stages.
• Uses a cancer-specific glucose solution and a radioactive tracer agent that lights up cancerous hot spots.
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Imaging: PET-CT
According to the BC Cancer Agency;
In 87 % of cases in which a patient has had a PET-CT scan, the results of the test lead to changes in the initial decisions made by oncologists for planned cancer treatment.
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Making informed choices: Imaging
Imaging: PET-CT
In other words, without a PET-CT scan, current detection methods are only accurate 13% of the time!
PET-CT not only ensures proper targeting of the tumor during surgery and radiation treatments, it helps avoid over-treatment or under-treatment.
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Making informed choices: Imaging
Imaging: Normal CT scan
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Imaging: PET/CT
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CT Alone PET/CT
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Making informed choices: Imaging
NEW! PET-MRI
• Better imaging of soft tissues compared to CT.
• Combines the benefits of MRI and PET without the radiation exposure found in PET-CT.
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Making informed choices: Sequencing Of Tumor DNA
Recall that genes are encoded in DNA by the
order of the DNA molecules (A, T, C, and G).
Changes in the specific order of the DNA
molecules are called a mutations and affect
how the protein or enzyme functions.
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Making informed choices: Sequencing Of Tumor DNA
DNA sequencing is the process of
determining specific mutations in genes by
comparing the genes found in your tumor to
those found in normal functioning versions
of the same genes.
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Making informed choices: Sequencing Of Tumor DNA
Once we have identified the genes that are
mutated in your cancer, then we can make a
genetic map that provides you with a roadmap
to your recovery!
This what we call “Targeted Therapy”!
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Making informed choices: Example - Genetic Map
Available from www.kegg.jp
Why is this important?
Having a genetic map of YOUR tumor allows us to identify targeted drugs that will destroy ANY cell in your body with the specific mutation that the drug was designed to target.
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Why is this important?
The benefits of this approach is highly effective destruction of tumor cells without the harsh effects of standard chemo-radiation as the drugs will not affect normal cells that do not have the cancer specific mutation.
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Why is this important?
Furthermore, having a genetic map allows us to identify “off label drugs”, or drugs that were designed for a different condition or type of cancer, but happen to target the genetic mutations identified in YOUR cancer.
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Why is this important?
And finally, having a genetic map of your tumor allows us to identify diet and supplements that have a scientifically proven role in regulating the genes mutated in YOUR cancer.
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Why is this important?
You are probably asking yourself;
“But what if I can’t afford the drugs that the DNA sequencing has identified”?
In just about every case we have looked at, targeted drugs were available via FREE clinical trials.
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Clinical trials:
• Clinical trials represent leading-edge medical science. However, less than 5% of adults diagnosed with cancer each year are enrolled in clinical trails.
• While there are a number of various treatment approaches being offered through clinical trials, 8 out of 10 patients are not aware that this is a viable option for them.
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Benefits of clinical trials
• In order to be offered to the human population, each clinical trial must show that the approach being tested is superior to standard treatment.
• Patients are also provided with superior imaging and diagnostics not typically offered in public medical facilities.
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• Most do not replace standard treatment, they are a form of adjunct therapy, and as such are offered as an additional treatment to standard treatment.
• In most clinical trials the standard treatment for the type of cancer is typically used in place of the placebo (control group).
Benefits of clinical trials
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• Clinical trials are typically FREE.
• But best of all, their success depends
on your survival!
Benefits of clinical trials
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How we can help you
• Personalized options plan (POP)
• Consulting
• Advocacy
• Education
How we can help you
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