27 Jun BIO – A Case Study of Ovarian Cancer
Question
A Case Study of Ovarian Cancer
PROVIDE ANSWERS ON ANSWER SHEET!!
An introduction to the Abbys situation
Abby has been having abdominal pain.
She has gone to see Dr. Allen.
An ultrasound has indicated a mass on her right ovary.
She is preparing to have the mass and ovary removed surgically.
QUESTION 1:
If you were Abby, what questions would you ask?
QUESTION 2:
Do you know someone personally that has had cancer?
Trends: Cancer (all types) incidence and mortality trends in the USA
Trends: Ovarian cancer in the USA
QUESTION 3:
Abby wondered: what is the difference between cancer and tumor? What do you think?
A: The two terms can be used interchangeably as they are synonymous.
B: Cancer is a disease that eventually disrupts body functions whereas a tumor is
a mass of cells with no apparent function in the body.
C: Cancer is a disease which affects men whereas a tumor may affect both men
and women.
E: Cancer is a disease of the digestive tract whereas a tumor may develop
anywhere in the body.
What is cancer?
Simplest definition from the American Cancer Society:
cancer is a group of diseases characterized by uncontrolled growth and
spread of abnormal cells. If the spread is not controlled, it can result in
death.
Then there are two distinct types of cancer tumor:
Benign (non-cancerous) this is not cancer.
Does not spread; it can eventually become malignant in some
cases.
Malignant (cancerous) this is cancer.
Has the potential to spread to other parts of body.
Role of cell division in cancer
Malignant
If tumor invades
surrounding tissue
(cancerous)
Benign
If tumor has no effect on surrounding tissue
(non-cancerous)
Metastatic
If individual cells break away and start a new
tumor elsewhere
(cancerous)
QUESTION 4:
Normal CA-125 levels are indicated by values of 35 u/ml or less. Abbys CA-125 levels
taken at two different times are indicated below. Is Abby likely to have a cyst or cancer?
A. Cyst
B. Cancer
700
600
500
400
300
CA-125 level
200
100
0
Normal
patient
Abby
Abby-2
weeks
later
Preparing for surgery
Before the surgery, Dr. Allen came in to talk to Abby about her test results.
I am really sorry, but your CA125 level is high and it looks like your ovary
actually does not have a cyst, but instead has a tumor. It is best now to go
ahead and remove both of your ovaries.
Dr. Allen explained she
had consulted with a
pathologist to verify the
diagnosis. She pulled out
a brochure titled Ovarian
Cancer and opened it to
show Abby three
photographs. One
showed normal ovarian
tissue; the other two
showed benign and
malignant ovarian tissue.
The genetics of ovarian cancer
Abby had already learned a lot about ovarian cancer so she followed Dr. Allens
explanation.
Im only 20 years old. How did I get ovarian cancer? Isnt this a disease of older
women?
Typically ovarian cancer does affect older women. However, you may have a
genetic predisposition for it. Cancer cells have mutations in specific genes that
regulate cell division. When they are mutated, cell division becomes
uncontrollable, the doctor explained.
I learned about those genes on the Internet! Is it true that some ovarian cancers
are associated with mutated copies of genes called BRCA1 or BRCA2? asked
Abby.
Yes, said Dr. Allen. You likely were born with one a mutated copy of these
genes already. A mutation of the second copy could have occurred more recently,
triggering the development of your tumor.
QUESTION 5:
Why does cancer primarily affect older people rather than young people?
A)
Because the immune system of older people is not as effective in
distinguishing normal cells from cancer cells.
B)
Because older people have been exposed to more carcinogens.
C)
Because cancer develops after multiple mutations have occurred which
takes years to happen.
D)
None of the above.
Cancer is a genetic disease
Cancer arises from the accumulation of genetic changes (mutations).
Most cancers have a minimum of 6-9 different genes mutated.
Not a hereditary disease we do not pass on cancer to offspring.
We can inherit dispositions (susceptibility) to cancer.
Many genes that are mutated in cancer are involved in regulating the cell cycle.
The cell cycle has four phases and controls cell division
Interphase, which consists of:
Two gap or growth phases (G1 and G2)
S phase – DNA synthesis
M phase – Mitosis
Cell cycle checkpoints
Three checkpoints in cell cycle
G1-S transition
G2-M transition
Exit M phase transition
Checkpoints are where the cell assesses whether conditions are favorable
for cell division.
When the environment is not favorable (for example, when the cells DNA is
damaged), a protein called p53 can stop the cell cycle and cause the cell to die.
When the proteins that regulate the cell cycle are mutated or absent, cells can
divide uncontrollably, leading to cancer.
QUESTION 6:
What would you expect cells to be like if they did not have properly functioning p53?
A: The absence of p53 inside cells would cause them to divide more rapidly.
B: The absence of p53 could cause cells to replicate with damaged DNA that
could ultimately lead to cancer.
C: The absence of p53 could cause cells to skip mitosis (M phase) and stay in S
phase of the cell cycle.
D: The absence of p53 would have no effect on the cells.
Tumor suppressors and oncogenes
Mutations in oncogenes and tumor suppressor genes can lead to cancer.
http://science.education.nih.gov/supplements/nih1/cancer/activities/activity2_ani
mations.htm (Animation #5)
QUESTION 7:
The BRACA1 and BRACA2 genes that may be mutated in Abbys cells would be
considered?
A: An oncogene
B: A tumor suppressor gene
From benign to malignant
Cancer cells divide too quickly and can leave the original site and enter the blood,
lymph, or tissues.
Most cells divide a set number of times, then they stop dividing (programmed cell
death!).
This usually limits benign tumors to small sizes.
Cancer cells can divide indefinitely.
QUESTION 8:
How do cancer cells travel through the human body?
A: Cancer travels through the body by way of sexual intercourse between a
healthy person and one affected by the disease.
B: The circulatory system only is responsible for relocating cancer cells.
C: The lymphatic system collects fluids from capillaries and with it cancer cells,
which are then delivered by the circulatory system.
D: They are moved around on neurons throughout the body.
Abbys treatment options
Dr. Allen came to see Abby after her surgery.
Everything went really well. Now we need to think about preventing this from
ever coming back. Typically we use a combination of various types of therapy,
which includes radiation and chemotherapy.
Radiation – Uses high-energy rays to kill cancer cells. A large machine directs
radiation at the body.
Chemotherapy – Uses anticancer drugs to kill cancer cells.
A possible ovarian cancer treatment
One common chemotherapy for ovarian cancer
is Taxol, which was first isolated from Yew
bark in 1962 by the National Cancer Institutes
(NCI).
Taxol blocks a cell’s ability to break down the
mitotic spindle during mitosis. With the spindle
still in place, the cell can’t divide into daughter
cells and therefore the cancer cant grow.
Cancer detection and treatment
Earlier detection and treatment of cancer greatly
increase the odds of survival.
Therefore, knowing the warning signs of cancer
is important to health.
QUESTION 9:
Can surgery successfully cure a cancer that has metastasized?
A. No, all body cells are dividing uncontrollably
B. Yes, it could remove all cells with defective cell-cycle regulation
C. No, cancer cells are no longer localized in one spot
D. Yes, if the tumor is benign
Concluding Abbys story
Abbys ovarian cancer has been in remission for 10 years.
She graduated from college with a BA in Anthropology.
Three years later she married, and today she is living happily with her husband
Charles and their four-year-old adopted daughter.
This case study was modified from documents provided by Nancy Rice (Western Kentucky
University) and Bruno Borsari (Winona State University) and shared through the
National Science Foundation (NSF) funded National Center for Case Study Teaching in
Science.
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