Trends in cancer treatment and prevention

The development of cancer vaccines

Project Report, 2019

34 Pages, Grade: 10




1.1 Properties of Cancer Cells
1.2 Types of Cancer :
1.3 Causes of Cancer
1.4 Role of Immune system

2.1 Surgery
2.2 Radiation therapy
2.3 Chemotherapy
2.4 Vaccines

3.1 Alcohol
3.2 Tobacco
3.3 Diet and Obesity
3.4 Viruses and infectious agents
3.5 Occupational factors
3.6 Socioeconomic status
3.7 Sun exposure
3.8 Sedentary lifestyle
3.9 Population changes in risk
3.10 Cancer vaccines
3.11 Monoclonal antibodies
3.12 Cytokines
3.13 Resveratrol
3.14 Retinoids
3.15 Nonsteroidal anti-inflammatory drugs
3.16 Tea
3.17 Statins
3.18 Vitamin D
3.19 Lycopene
3.20 Berry fruits
3.21 Ayurveda
3.22 Homeopathy
3.23 Unani




The application of biology is playing an ever increasing role in cancer care. There are a number of texts and specialist papers available about the biology of cancer, but they are not, in the main, aimed at cancer nurses, that is the health professionals who actually deliver the majority of treatments. The aim of this book is to be an informative text for students, newly qualified nurses and practicing oncology care nurses. It will also be a useful text for other health care professionals working in the field of cancer, for example radiographers, physiotherapists, dieticians and so on, so that some of the questions asked by patients and their careers can be answered with a clear understanding of what the latest advancements are in the management of an individual’s illness. As much as we fear and loathe cancer, this disease has been a driving force behind innumerable studies that have not only led to the discovery of oncogenes but have helped us understand the inner world of the cell. This knowledge has provided us with the ammunition we need to fight cancer but, more importantly, it has paved the way for many powerful therapies that will someday rid the world of other noxious diseases, such as AIDS, Alzheimer’s disease, and the infirmities that strike us as we grow old.

The past 20 years has seen an explosion of epidemiologic material on the causes of cancer. Examples include the growing number of studies of physical activity and colon cancer which have emerged and the numerous studies of components of diet such as alcohol and the risk of specific cancers. Major shifts in resource allocation now focus on translation of this new knowledge to actual cancer prevention programs. Researchers, practicing clinicians, and those who write and implement public health policy need this information summarized in an easily accessible format. The abundance of knowledge, increasing understanding of how to communicate risk of cancer to the public, and greater public awareness of cancer, make the coming years ones in which we will see many new attempts at widespread cancer prevention programs. This book, explores the many facets of cancer research from basic genetic and cellular mechanisms to the influence of lifestyle and various strategies for predictive, preventive and personalized medicine in cancer.


Cancer became a big question for scientific community as no existing treatments could solve the problems related to this dreadful disease. Research is in well progress since half century but it failed to give a right solution to fight against it. However the developments in science and technology facilitated scientists to develop new methods of treatment. One such mile stone treatment for cancer that is giving good hope to the people is cancer vaccines. The aim of cancer vaccines is to stimulate the immune system to be able to recognize cancer cells as abnormal and destroy them. Majorly, cancer vaccine research is in progress to develop universal as well as specific cancer vaccines. Immunologic approaches to cancer therapy rely on two distinct capabilities of the immune system: targeting the tumour microenvironment by recognizing molecules expressed to a greater extent on tumour cells than normal cells and generating immune responses that can kill tumour cells. Immunologic approaches to cancer therapy rely on two distinct capabilities of the immune system: targeting the tumour microenvironment by recognizing molecules expressed to a greater extent on tumour cells than normal cells and generating immune responses that can kill tumour cells. Immunocytokines, which are fusion proteins composed of a recombinant monoclonal antibody and a cytokine, capitalize on both of these capabilities by combining the ability of tumour-specific antibodies selectively to target tumours with the broad-based immunomodulatory activities of cytokines. In the present work the developments in cancer therapy especially by emphasizing vaccine development against cancer, development of immunocytokines for cancer and discusses preclinical and clinical data on specific immunocytokines being investigated as potential cancer therapies is discussed.


Cancer is the name given for those diseases in which the body cells become abnormal and divide without control. Cancer cells may invade nearby tissues and they may spread through the bloodstream and lymphatic system to other parts of the body. Its two main characteristics are uncontrolled proliferation of the cells in the human body and ability of these cells to migrate from the original site and spread to distant sites. If the spread is not controlled, cancer can result in death. Cancer, by definition, is a disease of the genes. A gene is a functional unit of DNA, which is the master molecule of the cell. Genes make ‘proteins’, which are the ultimate workhorses of the cells that allow our bodies to carry out all the processes that permit us to breathe, think, move, etc. Throughout people’s lives, the cells in their bodies are growing, dividing, and replacing themselves. Many genes produce proteins that are involved in controlling the processes of cell growth and division. An alteration to the DNA molecule can disrupt the genes and produce faulty proteins. This causes the cell to become abnormal and lose its restraints on growth. The abnormal cell begins to divide uncontrollably and eventually forms a new growth known as a ‘tumour’ or neoplasm (medical term for cancer meaning ‘new growth’). In a healthy individual, the immune system can recognise the neoplastic cells and destroy them before they get a chance to divide. However, some mutant cells may escape immune detection and survive to become tumours or cancers.

The human body is made up of tiny building blocks called cells. Cells look and function differently throughout the body, but reproduce and repair themselves in the same way. This process normally happens in an organised and controlled manner. If cells become cancerous they start to divide in an uncontrolled way.

1.1 Properties of Cancer Cells

1) Cancer cells show uncontrolled mitotic divisions causing unorganized growth.
2) Due to uncontrolled growth and division of cells, a tumour is generally formed.
3) Cancer cells are far less adhesive than the normal cells, so these generally wander through the tissues to cause cancerous growth in different parts of the body. This ability of cancer cells to invade new sites is termed as Metastasis.
4) Cancer cells exhibit a number of alterations on cell surface, cytoplasm and in their genes.
5) Cancer cells don’t undergo differentiation.

1.2 Types of Cancer :

Cancer is of different types based on their site of origin

Carcinomas: are cancers that arise in the epithelium (the layers of cells covering the body's surface and lining the internal organs and various glands). Ninety percent of human cancers fall into this category. Carcinomas can be further divided into two subtypes: Adenocarcinomas, cancers that develop in an organ/gland. Squamous cell carcinomas refer to cancers that originate in the skin. Eg: prostrate cancer, cervical cancer, lung cancer, liver cancer, colon cancer, kidney cancer, thyroid cancer, pancreatic cancer.

Melanomas: originate in the skin, usually in the pigment cells. Eg: Melanoma Cancer.

Sarcomas: are cancers of the supporting tissues of the body, such as bone, muscle and blood vessels. Eg: Bone cancer, breast cancer and soft tissue cancer.

Leukemias and Lymphomas: are the cancers of the blood and lymph glands respectively. Eg: ALL, AML, CLL, CML, Hodgkins and Non Hodgkins.

Gliomas: are cancers of the nerve tissue. Eg: Brain cancer.

1.3 Causes of Cancer

Cancer may arise both from genetic or environmental factors that lead to aberrant cells growth regulation of a stem cell population, or by the dedifferentiation of more mature cell types [7]. Normally, cells sites proliferate only in response to injury, immune responses, or, in a few cases, to replace cells that have undergone apoptotic cell death. Mutations in DNA that lead to cancer appear to disrupt this orderly process. A master majority of cancers are caused by changes in the cell's DNA because of damage due to the environment. Environmental factors that are responsible for causing the initial mutation in the DNA are called carcinogens and there are many types, for eg: UV rays, industrial pollutants bodies are growing, dividing and replacing themselves etc.

1.4 Role of Immune system

The immune system sometimes has difficulty recognising cancer cells, and does not destroy them. The cancer cells then continue to grow. The immune system protects the body against infections by bacteria, viruses and other parasites [8]. The cancer can weaken the immune system by invading the bone marrow where the cells that help to fight infection are made, which happens mostly in leukaemia or lymphoma. Chemotherapy and radiotherapy can weaken immunity by causing a drop in the number of white blood cells made in the bone marrow. Some cells of the immune system can recognise cancer cells as abnormal and kill them. Unfortunately, this is not enough to get rid of a cancer altogether. But some new treatments aim to use the immune system to fight cancer.


Cancer is a nearly invincible disease that has plagued humankind for centuries. Only in recent decades have doctors found effective ways to treat it and also found better methods for early detection of this devastating disease. But there are still years away from any possible cure for cancer [9, 10], something that many scientists think is impossible. While early detection is the best form of prevention, there are several techniques that are used to treat cancer. These techniques include surgery, radiation therapy, chemotherapy, hormone therapy and immunotherapy [11, 12].

Trends in Cancer Care near the End of Life …..

Even though most patients with advanced cancer prefer care that minimizes symptoms, many still receive intense treatment and are not admitted into hospice care until their last three days of life, according to research from the Dartmouth Atlas Project [13]. Although hospice care for Medicare patients with advanced cancer is increasing, so are the rates of treatment in intensive care units. Hospice days have also increased, but a growing proportion of patients begin receiving hospice services in the last three days of life, a time period often too short to provide patients the full benefit of hospice care.

2.1 Surgery

Surgery is the oldest and most widely used treatment available for cancer patients. If a growth is found early, there is a good chance to remove an entire tumour before it spreads. Surgery is rarely used as a stand-alone treatment [25]. Usually, it is combined with radiation therapy and/or chemotherapy.

2.2 Radiation therapy

The specific part of the body containing cancerous growth is exposed to radiation energy to attack reproducing cancer cells, to shrink a tumour so that it can be removed through surgery, or to prevent tumour growth following surgery. However, radiation affects normal cells along with the cancer cells which lead to several unpleasant side effects, including fatigue, dryness and peeling of skin, nausea and vomiting [26].

2.3 Chemotherapy

The treatment of cancer through drugs is an effective treatment method for fighting cancerous cells that have spread to other parts of the body and that cannot be treated with any other method. Similar to radiation therapy, chemotherapy also can affect normal cells, causing the same kinds of side effects. Two more recent treatments for cancer are hormone therapy and immunotherapy [24]. Hormone therapy involves anything that deals with manipulating the body’s hormones to treat the cancer, including administering hormones and drugs. It may also involve removal of hormone glands to kill cancer cells or prevent further cancerous growth. Immunotherapy also manipulates the body’s normal functions. During immunotherapy, patients are given medication to stimulate the body’s immune system to fight cancerous cells. Many different compounds of biological origin that are used in the immune response can now be made in the laboratory; these are interferons, Interleukin-2 (IL-2), Monoclonal antibodies. Interferon-alpha and IL-2 might act by boosting the immune response to help the body kill off cancer cells.

2.4 Vaccines

Vaccines have been used for many years as a way of preventing certain infectious illnesses: for example, 'flu, tuberculosis (TB), measles, mumps, typhoid and German measles. Vaccines stimulate the body's immune system to recognise and fight abnormal 'foreign' cells in the body, such as viruses and bacteria [27].


3.1 Alcohol

Use of alcohol interacts with tobacco smoking in the causation of cancers of the upper respiratory and gastrointestinal tracts. Moreover, alcohol also causes cancer of the breast and large intestine. Because epidemiologic findings are complicated, advice to minimize risk is complex. The US dietary guidelines recommend no more than one drink per day for women and no more than two drinks per day for men [5]. In addition to causing cancer, youth drinking is responsible for a large burden of premature mortality through motor vehicle accidents and violence. School based prevention education needs to be reinforced through a community-based coalition that seeks restrictions on irresponsible alcohol advertising and marketing, strict enforcement of laws to reduce youth access, and new polices to reduce alcohol availability, including higher excise taxes. In addition to providing prevention messages, mass media campaigns can be used to enhance school based and community programs, encouraging public debate on policy initiatives to reduce alcohol consumption, and expose new laws and regulations or increased enforcement efforts.

Community wide responsible beverage service programs, for example, can be effective in preventing alcohol service to minors, decreasing the number of patrons who become intoxicated, and preventing those who are impaired from driving. Alcohol control programs should go beyond awareness and education to bring about basic change at the institutional, community and public policy level to create an environment that discourages youth drinking and excessive alcohol consumption. Public health advocates should work for a wide range of policy initiatives that reduce the availability of alcohol, strongly enforce minimum age laws, eliminate irresponsible advertising and marketing practices, and require responsible beverage service programs. Public health advocates should look to increased alcohol excise taxes to find comprehensive community-based campaigns for effective alcohol control.

3.2 Tobacco

Decades of epidemiologic research have demonstrated that tobacco is a uniquely hazardous substance. It is known to cause over two dozen chronic diseases (many of which are major contributors to overall mortality), acute respiratory diseases such as pneumonia and influenza, and various persistent respiratory symptoms such as cough and wheezing which, while not deadly by themselves, may greatly reduce quality of life with cancer. The overall effect of tobacco use on public health is thus enormous [29]. Scientific consensus on the causal relationships between smoking and cancer was first reached in the 1960s, and was documented in the first Surgeon General's Report on Smoking and Health, released in 1964.

An estimated 30 percent of all cancer deaths can be attributed to smoking. Thus, stemming the epidemic of tobacco smoking is our most effective means of preventing cancer. Tobacco smoking causes cancer both by initiating cellular changes that lead to cancer, and also through action late in the carcinogenic process, promoting the growth of tumors such as lung cancer. We therefore address smoking both in terms of adult cessation from smoking, and also prevention of youth uptake of the habit. We conclude that the shift to a public health perspective on smoking cessation has resulted in a successful increase in the rate of cessation from smoking. Behavioral programs and pharmacotherapies such as nicotine replacement therapies are the major individual level cessation strategies currently used. Health care provider advice and support along with community level regulations that support non-smoking norms can impact smoking cessation by enhancing motivation to quit and by preventing relapse among those who achieve initial cessation. At the individual level it is important to have both behavioral and pharmacological interventions available to smokers. Health care providers have a responsibility to their patients to ask about tobacco use, giving strong advice to quit and provide support for their efforts. Individual and health care provider efforts must be supported by organizational and community level investment of resources in providing training and supportive material to health care providers and in enforcement of regulations. With regard to the initiation of smoking by youth, a comprehensive approach to youth smoking prevention is required [4].

We need to integrate youth smoking prevention into schools, community, media, and policy efforts to create an environment that consistently discourages tobacco use. A well-structured mass media campaign can be focused on youth and used to reinforce awareness and educational messages; to support school and community programs; encourage public debate on the cost, availability and promotion of tobacco, and to create a climate of support for policy changes that will discourage tobacco use. Public health advocates should look to increased tobacco excise taxes to fund comprehensive state anti-tobacco campaigns. Prevention programs should go beyond awareness and education to bring about basic change at the institutional, community, and public policy level. A well-funded mass media campaign should be central part of prevention efforts aimed at youth, both at the state and national level.

3.3 Diet and Obesity

Dietary differences have long been suspected as a cause of the large international variations in cancer rates. However, until the last two decades, there has been little scientific evidence with which to evaluate these suspicions. This is a field of active research, and many associations between particular foods and nutrients and specific cancers are controversial. These have been extensively reviewed in a report by the World Cancer Research Fund [1]. Nevertheless, broad consistency has emerged on a sensible "prudent" dietary pattern which, if adopted for many years, is likely to reduce personal risk of some cancers: An estimated 25 percent of all cancer deaths can be attributed to diet in adult life, including its effect on obesity. Evidence indicates that a diet that reduces cancer risk should be high in fruit and vegetables, high in whole grains, low in red meat, and low in salt. There is clear evidence that intensive educational and behavioral interventions are effective for teaching and persuading motivated individuals and small groups to change their diets. However, no single type of intervention has proven consistently successful [30].

The most intensive strategies such as those implemented in clinical trials have produced the greatest effects on dietary change. The cost per person increases with greater intensity of the intervention. On the other hand, policy interventions and changes in food and nutrient supply have great potential to enhance the effect of individual focused interventions.

Dietary change research should aim toward specifying the minimum necessary level of intervention to achieve a meaningful impact on dietary behavior. There is need for continued advances in the areas of design, measurement, and analysis in dietary change research. Innovative communication technologies should be adopted and tested for their impact on cancer preventive dietary change. Health care providers should counsel patients regarding dietary change to reduce the risk of cancer.

3.4 Viruses and infectious agents

There is substantial evidence that a number of infectious agents play a causal role in a variety of human malignancies. These cancers include lymphomas, as would be expected from animal models, as well as other surprisingly diverse sites including the liver, cervix, stomach, nasopharynx, bladder, skin (Kaposi’s sarcoma), and bile duct. Most of the oncogenic agents involved are viruses [1]. These viruses include two herpes viruses, Epstein Barr virus (EBV) and human herpes virus 8/ Kaposi’s sarcoma virus (HHV-8) [2]; the so-called high-risk strains of human papilloma viruses (HPV) [3]; two hepatotropic viruses, hepatitis B virus (HBV) and hepatitis C virus (HCV) [4]; and the retrovirus human T-cell lymphotropic virus type I (HTLV-I) [5]. In addition, two chronic parasitic infections, the blood fluke Schistosoma haematobium and the liver fluke Opisthorchis viverrini, have long been thought to be human carcinogens, and recently a bacterium, Helicobacteri pylori, has been implicated [6]. Among the more significant agents are human papilloma viruses (HPV), which cause cancer of the uterine cervix, and hepatitis B virus (HBV) which causes in liver cancer.

Sexually transmitted viruses are a major preventable cause of cancer. Primary prevention can be achieved through delaying onset of sexual activity, abstaining from sex with individuals not known to be infection free, regularly using latex condoms, and being vaccinated against hepatitis B. Secondary prevention is possible through screening, early detection and treatment of cervical cancer. Policy makers must provide leadership and resources to make healthy sexual behaviors a standard part of cancer prevention strategies [31].

3.5 Occupational factors

Occupational epidemiology studies have played an important role in identifying causes of human cancer. Most of the chemicals classified as carcinogens by the International Agency for Cancer Research (IARC) were first identified in the occupational setting. Occupational investigations have been informative because exposures in the workplace are often heavy and prolonged in contrast to other resources of chemical exposures [28].

Reviews conducted since 1970 by the International Agency for Research on Cancer (IARC) indicate that most of the exposures that have been judged to cause cancer in humans have occurred in the workplace. In the workplace, people are likely to be exposed to a broad spectrum of carcinogens at high concentrations; therefore, epidemiologists and physicians are more likely to identify these cancer-causing agents. In contrast, it has been estimated that six to ten percent of cancer (and at most 15 percent) in men and one percent of cancer in women (and no more than five percent) can be attributed to occupational factors. This apparent discrepancy relates to the quantity and quality of information available on human carcinogens as well as the fact that most of us have minimal exposure to potentially carcinogenic chemicals in the workplace. The control of occupational exposure to carcinogens represents an important triumph in the primary prevention of cancer. Collectively, occupational factors are thought to cause about five percent of cancer deaths, mostly of the lung, bladder, and bone marrow. Application of a systematic hierarchy of controls is effective in reducing this risk of occupational exposure to carcinogens. Manufacturers, employers, workers, unions, health care providers, and occupational health professionals all play important roles in workplace cancer prevention.

Regulatory standard setting and enforcement are an essential complement to voluntary efforts. Approaches that emphasize controlling workplace carcinogen exposures to the extent feasible should be broadly applied in individual, community, and regulatory interventions Expanded efforts in pre-market testing, occupational exposures and disease surveillance, and epidemiology are needed to characterize and control recognized carcinogens as well as to identify and prevent exposure to new ones. Renewed political and budgetary support for ASHA and NIOSH are needed to protect workers from preventable work-related cancers.

3.6 Socioeconomic status

For as long as health statistics have been collected, researchers have recognized that socioeconomic status (SES) is linked to health. Individuals higher on the socioeconomic hierarchy – whether measured by income, educational attainment, or occupational status – enjoy better health than those below [1], cancer is no exception. Who gets cancer and dies of the disease is not a matter of a random lottery, but is systematically patterned by one’s position in the SES hierarchy.

Cancers of the lung, stomach, uterine cervix, and possibly other sites are particularly common among poor and underprivileged population groups. Poverty may be thought of as an important underlying cause for these cancers since it is associated with increased exposure to tobacco smoke, alcoholism, poor nutrition, and certain infectious agents. The primary prevention of cancer among the poor ultimately depends on altering the social environment that systematically stratifies cancer risk according to socioeconomic position. Reducing the increasing socioeconomic disparity in smoking prevalence will require stronger efforts aimed at influencing government action such as raising taxes and banning cigarette advertising. Strategies to eliminate socioeconomic differentials in cancer must involve intersectoral collaboration -- government, business, and communities -- to modify the structural cancer risks encountered by disadvantaged populations.


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Trends in cancer treatment and prevention
The development of cancer vaccines
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Praveen Kumar Vemuri (Author), 2019, Trends in cancer treatment and prevention, Munich, GRIN Verlag,


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