The Biology of Cancer Second Edition Editedby JANICE GABRIEL MPhil,PgD,BSc(Hons),RN,FETC,ONC,CertMHS NurseDirector CentralSouthCoastCancerNetwork The Biology of Cancer The Biology of Cancer Second Edition Editedby JANICE GABRIEL MPhil,PgD,BSc(Hons),RN,FETC,ONC,CertMHS NurseDirector CentralSouthCoastCancerNetwork Copyright©2007 JohnWiley&SonsLtd,TheAtriumSouthernGate,Chichester, WestSussexPO198SQ,England Telephone (cid:2)+44(cid:3)1243779777 Email(forordersandcustomerserviceenquiries):[email protected] VisitourHomePageonwww.wiley.com AllRightsReserved.Nopartofthispublicationmaybereproduced,storedinaretrievalsystemor transmittedinanyformorbyanymeans,electronic,mechanical,photocopying,recording,scanningor otherwise,exceptunderthetermsoftheCopyright,DesignsandPatentsAct1988orunderthetermsofa licenceissuedbytheCopyrightLicensingAgencyLtd,90TottenhamCourtRoad,LondonW1T4LP,UK, withoutthepermissioninwritingofthePublisher.RequeststothePublishershouldbeaddressedtothe PermissionsDepartment,JohnWiley&SonsLtd,TheAtrium,SouthernGate,Chichester,WestSussexPO19 8SQ,England,[email protected],orfaxedto(+44)1243770620. Designationsusedbycompaniestodistinguishtheirproductsareoftenclaimedastrademarks.Allbrand namesandproductnamesusedinthisbookaretradenames,servicemarks,trademarksorregistered trademarksoftheirrespectiveowners.ThePublisherisnotassociatedwithanyproductorvendormentioned inthisbook. Thispublicationisdesignedtoprovideaccurateandauthoritativeinformationinregardtothesubjectmatter covered.ItissoldontheunderstandingthatthePublisherisnotengagedinrenderingprofessionalservices.If professionaladviceorotherexpertassistanceisrequired,theservicesofacompetentprofessionalshouldbe sought. OtherWileyEditorialOffices JohnWiley&SonsInc.,111RiverStreet,Hoboken,NJ07030,USA Jossey-Bass,989MarketStreet,SanFrancisco,CA94103-1741,USA Wiley-VCHVerlagGmbH,Boschstr.12,D-69469Weinheim,Germany JohnWiley&SonsAustraliaLtd,42McDougallStreet,Milton,Queensland4064,Australia JohnWiley&Sons(Asia)PteLtd,2ClementiLoop#02-01,JinXingDistripark,Singapore129809 JohnWiley&SonsCanadaLtd,6045FreemontBlvd,Mississauga,ONT,L5R4J3 Wileyalsopublishesitsbooksinavarietyofelectronicformats.Somecontentthatappearsinprintmaynot beavailableinelectronicbooks. AnniversaryLogoDesign:RichardJ.Pacifico LibraryofCongressCataloginginPublicationData Thebiologyofcancer/editedbyJaniceGabriel.—2nded. p. ; cm. Includesbibliographicalreferencesandindex. ISBN978-0-470-05759-9(pbk.:alk.paper) 1.Cancer. I.Gabriel,Janice. [DNLM:1.Neoplasms—Nurses’Instruction.QZ200B61532007] RC262.B472007 616.99(cid:2)4—dc22 2007012096 BritishLibraryCataloguinginPublicationData AcataloguerecordforthisbookisavailablefromtheBritishLibrary ISBN-13:978-0-470-05759-9 Typesetin10/12ptTimesbyIntegraSoftwareServicesPvt.Ltd,Pondicherry,India PrintedandboundinGreatBritainbyTJInternationalLtd,Padstow,Cornwall Thisbookisprintedonacid-freepaperresponsiblymanufacturedfromsustainableforestryinwhich atleasttwotreesareplantedforeachoneusedforpaperproduction. Contents List of Contributors vii Preface ix Acknowledgements xi Introduction xiii PART I Understanding Cancer 1 1 What is Cancer? 3 JaniceGabriel 2 Predisposing Factors to Developing Cancer 11 JaniceGabriel 3 Cancer: What Does a Diagnosis Mean for an Individual and What Are the Implications for Society? 23 JaniceGabriel PART II The Science of Cancer 31 4 The Cell 33 LouiseKnight 5 Cytotoxic Chemotherapy 45 DebbieWright 6 What Are DNA and RNA? 55 ScottC.Edmunds 7 Genetics and Cancer 63 ScottC.Edmunds 8 The Immune System 79 HelmoutModjtahediandAilsaClarke 9 Tumour Markers 99 FrancisG.Gabriel vi CONTENTS 10 Monoclonal Antibodies 111 HelmoutModjtahedi PART III From Research to Treatment 125 11 What is Translational Oncology Research? 127 ElaineLennan 12 The Application of Research Methodology to Cancer Research 135 CarmelSheppard 13 Research Ethics Relating to Cancer 153 DavidCarpenter Glossary 167 References 171 Index 195 List of Contributors David Carpenter Principal Lecturer, University of Portsmouth Ailsa Clarke LecturerinBiosciences,EuropeanInstituteofHealthandMedicalSciences,Univer- sity of Surrey Scott C. Edmunds Assistant Editor, BioMed Central, London Francis G. Gabriel ResearchScientist,TranslationalOncologyResearchCentre,PortsmouthHospitals NHS Trust Janice Gabriel Nurse Director, Central South Coast Cancer Network Louise Knight Post Doctoral Research Scientist, Translational Oncology Research Centre, Portsmouth Hospitals NHS Trust Elaine Lennan Consultant Nurse, Southampton University Hospitals NHS Trust Helmout Modjtahedi Visiting Clinical Lecturer, Postgraduate Medical School, University of Surrey Carmel Sheppard Consultant Breast Care Nurse, Portsmouth Hospitals NHS Trust/University of Southampton Debbie Wright Pharmacist, Central South Coast Cancer Network/Directorate Pharmacist, Southampton University Hospitals NHS Trust Oncology Preface Every day we, as cancer nurses, care for patients with life-threatening conditions, and every day we are responsible for the delivery of complex treatments to our patients. We witness at first hand the impact a diagnosis of cancer has for an individual and those around them. We also see how determined our patients are to overcome their diseases. The delivery of treatments to patients in our care necessitates us to have an understanding not only of what they entail, but also of how they work. Theapplicationofbiologyisplayinganeverincreasingroleincancercare.There areanumberoftextsandspecialistpapersavailableaboutthebiologyofcancer,but theyarenot,inthemain,aimedatcancernurses,thatisthehealthprofessionalswho actually deliver the majority of treatments. The aim of this book is to be an infor- mative text for students, newly qualified nurses and practising oncology/palliative carenurses.Itwillalsobeausefultextforotherhealthcareprofessionalsworking inthefieldofcancer,forexampleradiographers,physiotherapists,dieticiansandso on,sothatsomeofthequestionsaskedbypatientsandtheircarerscanbeanswered with a clear understanding of what the latest advancements are in the management of an individual’s illness. The aims of this book are: • To describe what cancer is and its disease process. • To identify some of the predisposing factors for certain types of cancer. • To identify the composition of the cell and its functions. • To discuss the current research and developments relating to biology of cancer. • To apply the research to the management of an individual patient. • To summarize current Department of Health guidance to improve access to and quality of cancer care. Janice Gabriel March 2007 Acknowledgements Iwouldliketothankallthecontributorstothistext,manyofwhomcontributedto the first edition in 2004. I would also like to congratulate those who have recently completed their PhDs, or are about to complete them, and still found time to meet thedeadlinesforthisedition.Withouttheirsupportandenthusiasmthisbookwould not have been possible. I would like to dedicate this edition to Imogen and Bethany − the more you learn,themoreyougrow−andtomycolleaguesandpatientsintheCentralSouth Coast Cancer Network. Janice Gabriel Introduction Every member of the cancer multidisciplinary team plays a crucial role in the management of their patient. Therefore, each of us has a responsibility to our patients to ensure we have a sound knowledge base, reflecting the latest research and the application of this research to patient care. This book is written by experienced, practising health care professionals to provide a ‘readable’ and meaningful text that can easily be applied to patient care. Thebookisdesignednottooverwhelmthereaderwithexcessiveinformationonthe diseaseprocess,buttoillustratehowthedevelopmentsrelatingtotheunderstanding and application of the biology of cancer can be applied to the management of an individual’s care. The book is divided into three parts, all of which are evidence based and fully referenced. The first part looks at cancer generally and discusses the disease processes,thatisthedevelopmentofacancerandmetastaticspread.Italsoseeksto identify and explain why there are predisposing factors linked to the development of some cancers, and concludes with a summary of how Department of Health guidance has improved access to cancer services in England. Thesecondpartlooksindetailatthecell,itscomposition,functionsandresponse tocytotoxicagents.Italsoexaminestherolesoftheimmunesystemandgeneticsin thedevelopmentofcancer.Thissectionofthebookwillalsodiscusstheincreasing importance of ‘tumour markers’ in managing a patient’s disease, including their response to treatment. The final section of the book will tackle the area of research. It takes into accountthelatestresearchguidelines,includingstorageofpathologymaterial,and applies these to patient care so that health care professionals can have a greater understanding of the potential implications for those patients who are considering participating in research studies. Janice Gabriel