Cancer Biology: Pathogenesis, Prognosis, Target Therapy, and Biomarkers


Added on  2022-11-28

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Cancer Biology: Pathogenesis, Prognosis, Target Therapy, and Biomarkers_1

Cancer is a state of abnormal, uncontrolled multiplication of cells, which results in the
formation of tumors. The tumor can be of two types – benign and malignant. Benign tumors
are localized tumors associated with much lesser aggressive symptoms. It restricts its
influence in its tissue or organ of origin (Rosenzweig et al. 2017). While benign tumors are
less aggressive, have better prognosis and can be managed well with medical interventions –
the malignant tumors exhibit metastasis that is an extensive process of aggressive invasion
and infiltration of the normal cells of the body (Bu et al. 2019). Metastasis is a core
characteristic of malignancy and the level or extent of involvement of the lymph nodes – is
often indicative of its progression. Malignant cancer has two types of spread
haematogenous (Gasparri et al. 2016) and lymphatic (Holm-Rasmussen et al. 2015). Blood
cancer have a hematogenous influence. And breast cancer is a classic example of lymphatic
spread where higher the severity of the breast cancer, the more number of lymph nodes are
involved. TNM is the most commonly used grading throughout the globe. Biopsy and
imaging are important techniques to understand the features of the tumor (Polifka et al.
2019). In this essay, two different cases of cancer – a breast cancer and chronic lymphocytic
leukemia has been discussed with respect to the pathogenesis, prognosis, target therapy and
Response to Case study 1
Chronic lymphocytic leukemia is a very usual form of leukemia in Western world
(Thompson et al. 2018). It has an incidence of 5.5 cases per lakh men in Italy and 4 cases per
1lakh women. Australia, Ireland and United states have a higher incidence from 7 to 10. Risk
diagnosis of chronic lymphocytic leukemia have been reported to increase significantly with
the age. Population above 70 years age show an incidence rate of twenty cases every one-lakh
Cancer Biology: Pathogenesis, Prognosis, Target Therapy, and Biomarkers_2

people. Prevalence data is available for the country Italy that is calculated from men survival.
Performing census of CLL patients ideates from the critical need of estimating the affected
population and the census serves an alternative purpose of analyzing the different ways of
treating the same disease, prevalent in different countries. CLL have been reported as the
most usual form of leukemia in United States that has a higher incidence in the Caucasians
when compared to the population of African Americans (Robbins et al. 2015). Although
having a lower rate in African Americans, many studies have reported that the disease
progresses more rapidly in African Americans than the Caucasians. Genetic variation play an
important role in incident rates of CLL.
Different cell types, over the years, is recognized as the normal counterparts of
chronic lymphocytic leukemia. The complex suggestions reflected on sophistication in
technology not available or available during that time. CLL affects the immunological system
by accumulating the incompetent cells, which in microscopy analyses revealed that, the cells
are of uniform size that fits the clinical observations of slow, unavoidable elevation in
lymphocyte numbers. Advent of the flow cytometer, availability of safer and the convenient
ways that label the multiplication of cells – have made the critical understandings feasible.
CLL clones begin from follicular mantle B lymphocyte cells that is based on the shared
surface expression (membrane) of CD23 and CD5 (Maďarová et al. 2018). This was then
altered when the scrutiny of DNA sequencing determine the fifty percent of Chronic
lymphocytic leukemia. CLL is involved with IGHV mutations and follicular B cells and
IGVs. CLL is considered as a one-cell disease and the fact being researched vigorously
Among the various prognostic markers that are reviewed, the chromosomal
aberrations are validated mostly to predict the CLL prognosis. Patients who have a 17p13.1
chromosome deletion shows a poor response when given with chemotherapy and hence, for a
Cancer Biology: Pathogenesis, Prognosis, Target Therapy, and Biomarkers_3

better prognosis, the patient must be treated with an allogeneic transplantation in the first
remission. In Jacob, the deletion is present and allogeneic transplantation can be considered.
As because ZAP-70 status in Jacob is positive and he is also diagnosed with unmutated
IGHV, this might have an adverse prognosis. As Jacob has been diagnosed with Rai stage 1,
it means the subject exhibits enlarged lymph nodes and lymphocytosis, the liver and spleen is
not enlarged yet and red blood cells and thrombocyte count is normal. Because of
lymphocytosis - the immunological prognosis can be poor, if not treated properly. Otherwise,
the normal thrombocyte and erythrocyte count will stabilize the positive prognostic outcomes
effectively. Ibrutinib treatment over a longer time, have been reported to increase the
complete response with time. Deletion of chromosome 13 parts (Stilgenbauer et al. 2016)
without any chromosome abnormalities, have been reported as the more suitable prognostic
factor for CLL. Deletion of chromosome 17 or 11 parts is considered as a less suitable
prognostic factor. Again, the pro-lymphocytes numbers in blood that indicates a
prolymphocytic transformation is a less suitable or favourable prognosis. Lymphocyte
doubling time if more than 6 months have a better prognosis.
Targeted therapies has found great emphasis over the last decades and it comprises of
the drugs that particularly targets the cancer cells. Unlike the standardized chemotherapy
drugs, that attacks the normal cells and the oncology cells together. These drugs attack the
major proteins in CLL cells. In CLL, target therapy is a priority line of oncology treatment
(Byrd et al. 2016). The kinase inhibitor relay grow signals that aid cells to grow. Using,
Venetoxac in a relapsed chronic lymphocytic leukopenia achieving a complete remission
have shown the most durable responses.
Chronic lymphocytic leukaemia has different clinical courses. The clinical variability
in CLL’s clinical course have an intensified effort in identification of molecular markers for
chronic lymphocytic leukaemia prognostication. There are many reasons that affects the wide
Cancer Biology: Pathogenesis, Prognosis, Target Therapy, and Biomarkers_4

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