Description

Book Synopsis

The Molecular Biology of Cancer, Stella Pelengaris & Michael Khan

This capturing, comprehensive text, extensively revised and updated for its second edition, provides a detailed overview of the molecular mechanisms underpinning the development of cancer and its treatment.

Bench to Bedside: A key strength of this book that sets it apart from general cancer biology references is the interweaving of all aspects of cancer biology from the causes, development and diagnosis through to the treatment and care of cancer patients essential for providing a broader view of cancer and its impact.

The highly readable presentation of a complex field, written by an international panel of researchers, specialists and practitioners, would provide an excellent text for graduate and undergraduate courses in the biology of cancer, medical students and qualified practitioners in the field preparing for higher exams, and for researchers and teachers in the field.

For th

Trade Review

“An excellent didactic technical production. For medical students, trainees, cancer biologists, oncologists, pharmacologists and endocrinologists. Cancer remains a menace in modern times.” (Pediatric Endocrinology Reviews, 1 September 2013)

“This book will be invaluable for nursing and medical students, establishing a basic understanding and progressing to more complex issues. The end-of-chapter review questions are great preparation for exams.” (Nursing Standard, 1 September 2013



Table of Contents

Contributors vii

Preface to the Second Edition ix

Reviews of the First Edition x

Acknowledgments and Dedication xi

About the Companion Website xii

Introduction 1

1 Overview of Cancer Biology 3
Michael Khan and Stella Pelengaris

Introduction 5

Cancer incidence and epidemiology 8

Towards a definition of cancer 8

Causes of cancer 16

Cancer is a genetic disease 21

Cancers (and Darwin’s finches) evolve by mutation and natural selection 21

Blame the parents – inherited single gene defects and susceptibility to cancer 21

The cancer “roadmap” – What kinds of genes are epimutated in cancer? 23

Viruses and the beginnings of cancer biology 25

Hens and teeth or bears and woods? The hens have it – cancer is rare 25

The barriers to cancer 25

What is the secret of cancer developme . . . “timing” 28

Location location location – the cancer environment: nanny or spartan state 28

Cancer goes agricultural 29

Cancer superhighways – blood vessels and lymphatics 31

On your bike and turn the lights off before you go 31

Catching cancer 31

Hammering the hallmarks 32

Painting a portrait of cancer 33

The drugs don’t work 34

Mechanism of origin rather than cell of origin – towards a new functional taxonomy of cancer 35

Is it worth it? 36

Conclusions and future directions 36

Bibliography 37

Appendix 1.1 History of cancer 40

2 The Burden of Cancer 43
William P. Steward and Anne L. Thomas

Introduction 43

Lung cancer 45

Breast cancer 49

Colorectal cancer 53

Carcinoma of the prostate 56

Renal carcinoma 57

Skin cancer 58

Carcinoma of the cervix 60

Hematological malignancies 60

Conclusions and future directions 63

Outstanding questions 63

Bibliography 64

Questions for student review 66

3 Nature and Nurture in Oncogenesis 67
Michael Khan and Stella Pelengaris

Introduction 69

Risk factors 73

Preventing cancers 76

Cancer genetics – in depth 78

Cancer genomics 87

Gene–environment interactions 89

Mutations and treatment 89

Chemoprevention of cancer 90

Risk factors act in combination 90

Environmental causes of cancer 93

The clinical staging and histological examination of cancer 101

Screening and biomarkers 102

Somatic gene mutations epigenetic alterations and multistage tumorigenesis 105

Conclusions and future directions 107

Outstanding questions 107

Bibliography 107

Questions for student review 109

4 DNA Replication and the Cell Cycle 111
Stella Pelengaris and Michael Khan

Introduction 112

The cell cycle – overview 114

Phases of the cell cycle 120

The cell-cycle engine: cyclins and kinases 123

Regulation by degradation 126

Regulation by transcription 129

MicroRNAs and the cell cycle 131

Chromatin 131

DNA replication and mitosis 131

Checkpoints – putting breaks on the cell-cycle The DNA damage response (DDR) 136

The checkpoints 136

Cell-cycle entry and its control by extracellular signals 138

Changes in global gene expression during the cell cycle 139

Cell cycle and cancer 139

Drugging the cell cycle in cancer therapies 141

Conclusions and future directions 142

Outstanding questions 143

Bibliography 143

Questions for student review 144

5 Growth Signaling Pathways and the New Era of Targeted Treatment of Cancer 146
Stella Pelengaris and Michael Khan

Introduction 147

Growth factor regulation of the cell cycle 150

Growth homeostasis and tissue repair and regeneration 151

Regulated and deregulated growth 155

Cellular differentiation 157

Tissue growth and the “angiogenic switch” 158

Cancers and nutrients 158

Growth factor signaling pathways 160

A detailed description of signal transduction pathways and their subversion in cancer 160

Translational control and growth 184

Conclusions and future directions 185

Outstanding questions 185

Bibliography 186

Questions for student review 187

6 Oncogenes 188
Stella Pelengaris and Michael Khan

Introduction 189

The oncogenes 189

The discovery of oncogenes ushers in the new era of the molecular biology of cancer 191

Overview of oncogenes 191

Types of oncogenes 193

Oncogene collaboration – from cell culture to animal models 199

The c-MYC oncogene 199

The RAS superfamily 213

SRC – the oldest oncogene 228

BCR–ABL and the Philadelphia chromosome 232

The BCL-2 family 235

Biologically targeted therapies in cancer and the concept of “oncogene addiction” 235

Conclusions and future directions 235

Outstanding questions 236

Bibliography 236

Questions for student review 238

7 Tumor Suppressors 239
Martine F. Roussel

Introduction 239

The “two-hits” hypothesis: loss of heterozygosity (LOH) 240

Haploinsuffi ciency in cancer 240

Epigenetic events 242

Definition of a tumor suppressor 242

The retinoblastoma protein family 242

p53/TP53 250

INK4a/ARF 254

The p53 and RB pathways in cancer 257

Senescence and immortalization: Role of RB and p53 258

Tumor suppressors and the control of cell proliferation 258

Tumor suppressors and control of the DNA damage response and genomic stability 260

The microRNAs and tumor suppressors 260

Conclusions and future directions 263

Acknowledgments 263

Outstanding questions 264

Bibliography 264

Questions for student review 265

8 Cell Death 266
Stella Pelengaris and Michael Khan

Introduction 267

An historical perspective 267

Apoptosis in context 267

Apoptosis as a barrier to cancer formation 271

Apoptosis versus necrosis 271

Cell death by necrosis – not just infl ammatory 272

The pathways to apoptosis 272

The apoptosome – “wheel of death” 274

Caspases – the initiators and executioners of apoptosis 274

The IAP family – inhibitors of apoptosis and much more 276

The central role of MOMP and its regulators in apoptosis – the BCL-2 family 279

Mitochondrial outer membrane permeabilization (MOMP) 281

Endoplasmic reticulum stress 282

Stress-inducible heat shock proteins 282

Tumor suppressor p53 282

Oncogenic stress: MYC-induced apoptosis 283

Autophagy – a different kind of cell death and survival 287

Cell death in response to cancer therapy 290

Exploiting cell death (and senescence) in cancer control 290

Conclusions and future directions 292

Outstanding questions 293

Bibliography 293

Questions for student review 294

9 Senescence Telomeres and Cancer Stem Cells 295
Maria A. Blasco and Michael Khan

Introduction 296

Senescence 298

Conclusions and future directions 310

Outstanding questions 310

Bibliography 311

Questions for student review 312

10 Genetic Instability Chromosomes and Repair 314
Michael Khan

Introduction 316

Telomere attrition and genomic instability 321

Sensing DNA damage 323

Repairing DNA damage 325

Checkpoints 336

Microsatellites and minisatellites 343

Chaperones and genomic instability 344

Cancer susceptibility syndromes involving genetic instability 345

Genomic instability and colon cancer 346

Conclusions and future directions 346

Outstanding questions 347

Bibliography 347

Questions for student review 349

11 There Is More to Cancer than Genetics: Regulation of Gene and Protein Expression by Epigenetic Factors Small Regulatory RNAs and Protein Stability 350
Stella Pelengaris and Michael Khan

Introduction 351

The language of epigenetics 353

Epigenetics 353

Methylation of DNA 359

Acetylation of histones and other posttranslational modifications 360

Epigenetics and cancer 362

CIMP and MIN and the “mutator phenotype” 365

Imprinting and loss of imprinting 366

Clinical use of epigenetics 367

Regulation of translation 368

Noncoding RNA and RNA interference 369

Therapeutic and research potential of RNAi 371

Treatments based on miRNA 373

Regulating the proteins 373

Therapeutic inhibition of the proteasome 376

Receptor degradation 377

Wrestling with protein transit – the role of SUMO and the promyelocytic leukemia (PML) body 377

Conclusions and future directions 380

Outstanding questions 380

Bibliography 381

Questions for student review 382

12 Cell Adhesion in Cancer 383
Charles H. Streuli

Introduction 383

Adhesive interactions with the extracellular matrix 384

Cell–cell interactions 393

Critical steps in the dissemination of metastases 395

E-cadherin downregulation in cancer leads to migration 399

Epithelial–mesenchymal transitions 401

Integrins metalloproteinases and cell invasion 402

Survival in an inappropriate environment 404

Conclusions 406

Outstanding questions 406

Bibliography 407

Questions for student review 409

13 Tumor Immunity and Immunotherapy 410
Cassian Yee

Introduction 410

Endogenous immune response 411

Effector cells in tumor immunity 413

Tumor antigens 417

Antigen-specific therapy of cancer 420

Clinical trials in vaccine therapy 422

Cytokine therapy of cancer 423

Tumor immune evasion 424

Clinical trials in immunomodulatory therapy 425

Conclusions 425

Bibliography 426

Questions for student review 427

14 Tumor Angiogenesis 429
Christiana Ruhrberg

Introduction 429

General principles of new vessel growth 430

Pathological neovascularization: tumor vessels 430

Basic concepts in tumor angiogenesis: the angiogenic switch 432

Vascular growth and differentiation factors: stimulators of the angiogenic switch 432

Role of inhibitors in angiogenesis 436

Clinical outcomes and future directions 436

Acknowledgments 437

Bibliography 437

Questions for student review 437

15 Cancer Chemistry: Designing New Drugs for Cancer Treatment 438
Ana M. Pizarro and Peter J. Sadler

Introduction 439

Historical perspective 439

The drug discovery process and preclinical development of a drug 442

Questions remaining 457

Conclusions and future directions 457

Bibliography 458

Questions for student review 459

16 Biologically Targeted Agents from Bench to Bedside 461
Michael Khan Peter Sadler Ana M. Pizarro and Stella Pelengaris

Introduction 463

Targeted therapies 465

Cancer cell heterogeneity 466

Finding the molecular targets 468

Tumor regression in mice by inactivating single oncogenes 468

Targeted cancer therapies 473

Targeting oncogenes to treat cancer? 473

The concept of synthetic lethality and collateral vulnerability 475

Clinical progress in biological and molecular targeted therapies 476

Molecular targeted drugs – an inventory 479

DNA damage responses 490

Transcription factors 491

Targeting epigenetic regulation of gene expression 492

Hitting the extrinsic support network and preventing spread 493

Gene therapy antisense and siRNA 495

Resistance to targeted therapies – intrinsic resistance and emergence of secondary pathways and tumor escape 497

Negative feedback loops and failure of targeted therapies 500

Biomarkers to identify optimal treatments and tailored therapies 501

Pharmacogenetics and pharmacogenomics 505

Clinical trials in cancer 506

Conclusions and future directions 506

Bibliography 507

Questions for student review 508

17 The Diagnosis of Cancer 509
Anne L. Thomas Bruno Morgan and William P. Steward

Introduction 509

Clinical manifestations 510

Investigations in oncological practice 511

Non-invasive imaging techniques 516

Future novel uses of imaging 521

Proteomics and microarrays 523

Circulating tumor cells 523

Disease staging 523

Conclusions and future directions 524

Bibliography 524

Questions for student review 525

18 Treatment of Cancer: Chemotherapy and Radiotherapy 526
Anne L. Thomas J.P. Sage and William P. Steward

Introduction 526

Radiotherapy physics 526

Radiobiology 527

Treatment planning 528

Recent advances 529

Chemoradiation 530

Conclusion 540

Bibliography 542

Questions for student review 543

19 Caring for the Cancer Patient 544
Nicky Rudd and Esther Waterhouse

Introduction 544

Key concepts 544

Communication with the cancer patient 544

When is palliative care appropriate for cancer patients? 545

Palliative care assessment 545

Symptom control 545

Respiratory symptoms 547

Nausea and vomiting 547

Bowel obstruction 548

Constipation 549

Fatigue 549

Cachexia and anorexia 549

Psychological problems 549

The dying patient 550

Supportive care 550

An example of the care of a cancer patient 551

Questions remaining 551

Conclusions and future directions 551

Underlying problems 551

Comment 551

Underlying problems 552

Bibliography 552

Questions for student review 553

20 Systems Biology of Cancer 554
Walter Schubert Norbert C.J. de Wit and Peter Walden

Introduction 556

Information flow in cells 556

Model organisms and cancer models 557

Array-based technologies: genomics epigenomics and transcriptomics 559

SNPs the HapMap and the identification of cancer genes 559

Cancer mRNA expression analysis 562

CGH arrays CpG island microarrays and ChIP-on-Chip 564

Next-generation sequencing 564

Proteomics 566

Posttranslational modifi cations 567

Protein complexes and cellular networks 569

Clinical applications of proteomics 570

Toponomics: investigating the protein network code of cells and tissues 571

Processing the images from the cyclical imaging procedures 571

Structure code and semantics of the toponome: a high-dimensional combinatorial problem 573

Detecting a cell surface protein network code: lessons from a tumor cell 575

The molecular face of cells in diseases 576

Individualized medicine and tailored therapies 576

Discussion and conclusion 579

Bibliography 579

Internet resources 581

Questions for student review 582

Appendix 20.1 Techniques for the generation of genetically altered mouse models of cancer 582

Glossary 585

Answers to Questions 597

Index 603

Molecular Biology of Cancer 2e

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      View other formats and editions of Molecular Biology of Cancer 2e by Stella Pelengaris

      Publisher: John Wiley and Sons Ltd
      Publication Date: Publication Date: 26/04/2013
      ISBN13: 9781118008812, 978-1118008812
      ISBN10: 1118008812

      Description

      Book Synopsis

      The Molecular Biology of Cancer, Stella Pelengaris & Michael Khan

      This capturing, comprehensive text, extensively revised and updated for its second edition, provides a detailed overview of the molecular mechanisms underpinning the development of cancer and its treatment.

      Bench to Bedside: A key strength of this book that sets it apart from general cancer biology references is the interweaving of all aspects of cancer biology from the causes, development and diagnosis through to the treatment and care of cancer patients essential for providing a broader view of cancer and its impact.

      The highly readable presentation of a complex field, written by an international panel of researchers, specialists and practitioners, would provide an excellent text for graduate and undergraduate courses in the biology of cancer, medical students and qualified practitioners in the field preparing for higher exams, and for researchers and teachers in the field.

      For th

      Trade Review

      “An excellent didactic technical production. For medical students, trainees, cancer biologists, oncologists, pharmacologists and endocrinologists. Cancer remains a menace in modern times.” (Pediatric Endocrinology Reviews, 1 September 2013)

      “This book will be invaluable for nursing and medical students, establishing a basic understanding and progressing to more complex issues. The end-of-chapter review questions are great preparation for exams.” (Nursing Standard, 1 September 2013



      Table of Contents

      Contributors vii

      Preface to the Second Edition ix

      Reviews of the First Edition x

      Acknowledgments and Dedication xi

      About the Companion Website xii

      Introduction 1

      1 Overview of Cancer Biology 3
      Michael Khan and Stella Pelengaris

      Introduction 5

      Cancer incidence and epidemiology 8

      Towards a definition of cancer 8

      Causes of cancer 16

      Cancer is a genetic disease 21

      Cancers (and Darwin’s finches) evolve by mutation and natural selection 21

      Blame the parents – inherited single gene defects and susceptibility to cancer 21

      The cancer “roadmap” – What kinds of genes are epimutated in cancer? 23

      Viruses and the beginnings of cancer biology 25

      Hens and teeth or bears and woods? The hens have it – cancer is rare 25

      The barriers to cancer 25

      What is the secret of cancer developme . . . “timing” 28

      Location location location – the cancer environment: nanny or spartan state 28

      Cancer goes agricultural 29

      Cancer superhighways – blood vessels and lymphatics 31

      On your bike and turn the lights off before you go 31

      Catching cancer 31

      Hammering the hallmarks 32

      Painting a portrait of cancer 33

      The drugs don’t work 34

      Mechanism of origin rather than cell of origin – towards a new functional taxonomy of cancer 35

      Is it worth it? 36

      Conclusions and future directions 36

      Bibliography 37

      Appendix 1.1 History of cancer 40

      2 The Burden of Cancer 43
      William P. Steward and Anne L. Thomas

      Introduction 43

      Lung cancer 45

      Breast cancer 49

      Colorectal cancer 53

      Carcinoma of the prostate 56

      Renal carcinoma 57

      Skin cancer 58

      Carcinoma of the cervix 60

      Hematological malignancies 60

      Conclusions and future directions 63

      Outstanding questions 63

      Bibliography 64

      Questions for student review 66

      3 Nature and Nurture in Oncogenesis 67
      Michael Khan and Stella Pelengaris

      Introduction 69

      Risk factors 73

      Preventing cancers 76

      Cancer genetics – in depth 78

      Cancer genomics 87

      Gene–environment interactions 89

      Mutations and treatment 89

      Chemoprevention of cancer 90

      Risk factors act in combination 90

      Environmental causes of cancer 93

      The clinical staging and histological examination of cancer 101

      Screening and biomarkers 102

      Somatic gene mutations epigenetic alterations and multistage tumorigenesis 105

      Conclusions and future directions 107

      Outstanding questions 107

      Bibliography 107

      Questions for student review 109

      4 DNA Replication and the Cell Cycle 111
      Stella Pelengaris and Michael Khan

      Introduction 112

      The cell cycle – overview 114

      Phases of the cell cycle 120

      The cell-cycle engine: cyclins and kinases 123

      Regulation by degradation 126

      Regulation by transcription 129

      MicroRNAs and the cell cycle 131

      Chromatin 131

      DNA replication and mitosis 131

      Checkpoints – putting breaks on the cell-cycle The DNA damage response (DDR) 136

      The checkpoints 136

      Cell-cycle entry and its control by extracellular signals 138

      Changes in global gene expression during the cell cycle 139

      Cell cycle and cancer 139

      Drugging the cell cycle in cancer therapies 141

      Conclusions and future directions 142

      Outstanding questions 143

      Bibliography 143

      Questions for student review 144

      5 Growth Signaling Pathways and the New Era of Targeted Treatment of Cancer 146
      Stella Pelengaris and Michael Khan

      Introduction 147

      Growth factor regulation of the cell cycle 150

      Growth homeostasis and tissue repair and regeneration 151

      Regulated and deregulated growth 155

      Cellular differentiation 157

      Tissue growth and the “angiogenic switch” 158

      Cancers and nutrients 158

      Growth factor signaling pathways 160

      A detailed description of signal transduction pathways and their subversion in cancer 160

      Translational control and growth 184

      Conclusions and future directions 185

      Outstanding questions 185

      Bibliography 186

      Questions for student review 187

      6 Oncogenes 188
      Stella Pelengaris and Michael Khan

      Introduction 189

      The oncogenes 189

      The discovery of oncogenes ushers in the new era of the molecular biology of cancer 191

      Overview of oncogenes 191

      Types of oncogenes 193

      Oncogene collaboration – from cell culture to animal models 199

      The c-MYC oncogene 199

      The RAS superfamily 213

      SRC – the oldest oncogene 228

      BCR–ABL and the Philadelphia chromosome 232

      The BCL-2 family 235

      Biologically targeted therapies in cancer and the concept of “oncogene addiction” 235

      Conclusions and future directions 235

      Outstanding questions 236

      Bibliography 236

      Questions for student review 238

      7 Tumor Suppressors 239
      Martine F. Roussel

      Introduction 239

      The “two-hits” hypothesis: loss of heterozygosity (LOH) 240

      Haploinsuffi ciency in cancer 240

      Epigenetic events 242

      Definition of a tumor suppressor 242

      The retinoblastoma protein family 242

      p53/TP53 250

      INK4a/ARF 254

      The p53 and RB pathways in cancer 257

      Senescence and immortalization: Role of RB and p53 258

      Tumor suppressors and the control of cell proliferation 258

      Tumor suppressors and control of the DNA damage response and genomic stability 260

      The microRNAs and tumor suppressors 260

      Conclusions and future directions 263

      Acknowledgments 263

      Outstanding questions 264

      Bibliography 264

      Questions for student review 265

      8 Cell Death 266
      Stella Pelengaris and Michael Khan

      Introduction 267

      An historical perspective 267

      Apoptosis in context 267

      Apoptosis as a barrier to cancer formation 271

      Apoptosis versus necrosis 271

      Cell death by necrosis – not just infl ammatory 272

      The pathways to apoptosis 272

      The apoptosome – “wheel of death” 274

      Caspases – the initiators and executioners of apoptosis 274

      The IAP family – inhibitors of apoptosis and much more 276

      The central role of MOMP and its regulators in apoptosis – the BCL-2 family 279

      Mitochondrial outer membrane permeabilization (MOMP) 281

      Endoplasmic reticulum stress 282

      Stress-inducible heat shock proteins 282

      Tumor suppressor p53 282

      Oncogenic stress: MYC-induced apoptosis 283

      Autophagy – a different kind of cell death and survival 287

      Cell death in response to cancer therapy 290

      Exploiting cell death (and senescence) in cancer control 290

      Conclusions and future directions 292

      Outstanding questions 293

      Bibliography 293

      Questions for student review 294

      9 Senescence Telomeres and Cancer Stem Cells 295
      Maria A. Blasco and Michael Khan

      Introduction 296

      Senescence 298

      Conclusions and future directions 310

      Outstanding questions 310

      Bibliography 311

      Questions for student review 312

      10 Genetic Instability Chromosomes and Repair 314
      Michael Khan

      Introduction 316

      Telomere attrition and genomic instability 321

      Sensing DNA damage 323

      Repairing DNA damage 325

      Checkpoints 336

      Microsatellites and minisatellites 343

      Chaperones and genomic instability 344

      Cancer susceptibility syndromes involving genetic instability 345

      Genomic instability and colon cancer 346

      Conclusions and future directions 346

      Outstanding questions 347

      Bibliography 347

      Questions for student review 349

      11 There Is More to Cancer than Genetics: Regulation of Gene and Protein Expression by Epigenetic Factors Small Regulatory RNAs and Protein Stability 350
      Stella Pelengaris and Michael Khan

      Introduction 351

      The language of epigenetics 353

      Epigenetics 353

      Methylation of DNA 359

      Acetylation of histones and other posttranslational modifications 360

      Epigenetics and cancer 362

      CIMP and MIN and the “mutator phenotype” 365

      Imprinting and loss of imprinting 366

      Clinical use of epigenetics 367

      Regulation of translation 368

      Noncoding RNA and RNA interference 369

      Therapeutic and research potential of RNAi 371

      Treatments based on miRNA 373

      Regulating the proteins 373

      Therapeutic inhibition of the proteasome 376

      Receptor degradation 377

      Wrestling with protein transit – the role of SUMO and the promyelocytic leukemia (PML) body 377

      Conclusions and future directions 380

      Outstanding questions 380

      Bibliography 381

      Questions for student review 382

      12 Cell Adhesion in Cancer 383
      Charles H. Streuli

      Introduction 383

      Adhesive interactions with the extracellular matrix 384

      Cell–cell interactions 393

      Critical steps in the dissemination of metastases 395

      E-cadherin downregulation in cancer leads to migration 399

      Epithelial–mesenchymal transitions 401

      Integrins metalloproteinases and cell invasion 402

      Survival in an inappropriate environment 404

      Conclusions 406

      Outstanding questions 406

      Bibliography 407

      Questions for student review 409

      13 Tumor Immunity and Immunotherapy 410
      Cassian Yee

      Introduction 410

      Endogenous immune response 411

      Effector cells in tumor immunity 413

      Tumor antigens 417

      Antigen-specific therapy of cancer 420

      Clinical trials in vaccine therapy 422

      Cytokine therapy of cancer 423

      Tumor immune evasion 424

      Clinical trials in immunomodulatory therapy 425

      Conclusions 425

      Bibliography 426

      Questions for student review 427

      14 Tumor Angiogenesis 429
      Christiana Ruhrberg

      Introduction 429

      General principles of new vessel growth 430

      Pathological neovascularization: tumor vessels 430

      Basic concepts in tumor angiogenesis: the angiogenic switch 432

      Vascular growth and differentiation factors: stimulators of the angiogenic switch 432

      Role of inhibitors in angiogenesis 436

      Clinical outcomes and future directions 436

      Acknowledgments 437

      Bibliography 437

      Questions for student review 437

      15 Cancer Chemistry: Designing New Drugs for Cancer Treatment 438
      Ana M. Pizarro and Peter J. Sadler

      Introduction 439

      Historical perspective 439

      The drug discovery process and preclinical development of a drug 442

      Questions remaining 457

      Conclusions and future directions 457

      Bibliography 458

      Questions for student review 459

      16 Biologically Targeted Agents from Bench to Bedside 461
      Michael Khan Peter Sadler Ana M. Pizarro and Stella Pelengaris

      Introduction 463

      Targeted therapies 465

      Cancer cell heterogeneity 466

      Finding the molecular targets 468

      Tumor regression in mice by inactivating single oncogenes 468

      Targeted cancer therapies 473

      Targeting oncogenes to treat cancer? 473

      The concept of synthetic lethality and collateral vulnerability 475

      Clinical progress in biological and molecular targeted therapies 476

      Molecular targeted drugs – an inventory 479

      DNA damage responses 490

      Transcription factors 491

      Targeting epigenetic regulation of gene expression 492

      Hitting the extrinsic support network and preventing spread 493

      Gene therapy antisense and siRNA 495

      Resistance to targeted therapies – intrinsic resistance and emergence of secondary pathways and tumor escape 497

      Negative feedback loops and failure of targeted therapies 500

      Biomarkers to identify optimal treatments and tailored therapies 501

      Pharmacogenetics and pharmacogenomics 505

      Clinical trials in cancer 506

      Conclusions and future directions 506

      Bibliography 507

      Questions for student review 508

      17 The Diagnosis of Cancer 509
      Anne L. Thomas Bruno Morgan and William P. Steward

      Introduction 509

      Clinical manifestations 510

      Investigations in oncological practice 511

      Non-invasive imaging techniques 516

      Future novel uses of imaging 521

      Proteomics and microarrays 523

      Circulating tumor cells 523

      Disease staging 523

      Conclusions and future directions 524

      Bibliography 524

      Questions for student review 525

      18 Treatment of Cancer: Chemotherapy and Radiotherapy 526
      Anne L. Thomas J.P. Sage and William P. Steward

      Introduction 526

      Radiotherapy physics 526

      Radiobiology 527

      Treatment planning 528

      Recent advances 529

      Chemoradiation 530

      Conclusion 540

      Bibliography 542

      Questions for student review 543

      19 Caring for the Cancer Patient 544
      Nicky Rudd and Esther Waterhouse

      Introduction 544

      Key concepts 544

      Communication with the cancer patient 544

      When is palliative care appropriate for cancer patients? 545

      Palliative care assessment 545

      Symptom control 545

      Respiratory symptoms 547

      Nausea and vomiting 547

      Bowel obstruction 548

      Constipation 549

      Fatigue 549

      Cachexia and anorexia 549

      Psychological problems 549

      The dying patient 550

      Supportive care 550

      An example of the care of a cancer patient 551

      Questions remaining 551

      Conclusions and future directions 551

      Underlying problems 551

      Comment 551

      Underlying problems 552

      Bibliography 552

      Questions for student review 553

      20 Systems Biology of Cancer 554
      Walter Schubert Norbert C.J. de Wit and Peter Walden

      Introduction 556

      Information flow in cells 556

      Model organisms and cancer models 557

      Array-based technologies: genomics epigenomics and transcriptomics 559

      SNPs the HapMap and the identification of cancer genes 559

      Cancer mRNA expression analysis 562

      CGH arrays CpG island microarrays and ChIP-on-Chip 564

      Next-generation sequencing 564

      Proteomics 566

      Posttranslational modifi cations 567

      Protein complexes and cellular networks 569

      Clinical applications of proteomics 570

      Toponomics: investigating the protein network code of cells and tissues 571

      Processing the images from the cyclical imaging procedures 571

      Structure code and semantics of the toponome: a high-dimensional combinatorial problem 573

      Detecting a cell surface protein network code: lessons from a tumor cell 575

      The molecular face of cells in diseases 576

      Individualized medicine and tailored therapies 576

      Discussion and conclusion 579

      Bibliography 579

      Internet resources 581

      Questions for student review 582

      Appendix 20.1 Techniques for the generation of genetically altered mouse models of cancer 582

      Glossary 585

      Answers to Questions 597

      Index 603

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