Epigenetics and Cancer Medicine

Cancer genomics is the study of the complete set of DNA sequence and differences between gene expression of tumor cells and normal host cells. It aims to understand the genetic basis of tumor cell proliferation and the evolution of the cancer genome under mutation and selection by the body environment, the immune system and therapeutic interventions. Epigenomics is the study of the total epigenetic modifications on the genetic material of a cell.

Cancer is suspected in a view of a person’s symptoms, screening tests. Affirmation that Cancer is present requires diagnostic tests which are followed by staging. Staging is way of analysing the tumor, its size, location and the treatment depending on the Cancer stage. It helps to determine the Prognosis of the patient i.e., treatment prediction, disease outcome and patients recovery chances.

Throughout history, countless causes of cancer have been proposed including: angering the gods, fermenting or acidic lymph, chronic irritation, trauma, and infection. From the Humoral theory in the middle ages to the discovery of DNA structure in the mid-20^th century, science has found many types and the causes of cancer. These theories stood unchallenged until when Galileo and Newton began to use the scientific method, which laid the foundations for the modern scientific study of disease.

Those theories and beliefs have evolved when you fast forward time nearly 200 years to 2012. And the World Health Organization’s International Agency for Research on Cancer (IARC) identified more than 100 chemical, physical, and biological carcinogens (agents that cause cancer by damaging DNA or disrupting cell metabolism).

To identify causes and develop strategies for prevention, diagnosis, treatment, and cure for cancer, the scientific community is indulged in research work all over the world. May it is research centers, institutes, companies, and hospitals, all contributions account a step by step progress against cancer.

Ranging from molecular bioscience to the clinical trials, Cancer research evaluates and compares applications of various Cancer treatments. Surgery, radiation therapy, chemotherapy, hormone therapy, immunotherapy and combined treatment modalities such as chemo-radiotherapy being such applications. The mid-1990s marks the shifting of clinical cancer research to therapies derived from biotechnology research, such as cancer immunotherapy and gene therapy.

The Active Pharmaceutical Ingredient (API) is the part of any drug that is biologically active. All drugs are made up of two core components: the API, which is the central ingredient, and the excipients (chemically inactive substances such as lactose or mineral oil) that help deliver the medication to our system. Abiraterone acetate, Anastrozole, Bendamustine are few names among the anti-cancer API products.

The end step in a long process that begins in a research lab is Clinical Trials. After many years of research work to understand its effects on cancer cells in the lab and in animals, a new treatment is used for people in clinical trials.

Through clinical trials, doctors determine whether the new treatments are safe and effective and work better than current treatments. It helps in finding new ways to prevent and detect cancer and also to improve the quality of life for people during and after treatment.

Early treatments focused on improving surgical techniques for removing tumors. It was the 1900s when Radiation therapy and Chemotherapeutics came into the picture and were refined throughout the 20th century.

Emerging topics in cancer treatment research include:

• Anti-cancer vaccines
• Newer forms of chemotherapy
• Gene therapy
• Photodynamic therapy
• Radiation therapy
• Reoviridae (Reolysin drug therapy)
• Targeted therapy
• Natural killer cells can induce immunological memory

Research is being developed to modify their action against cancer.

Oncology nursing care is also an important aspect in the treatment of cancer which meets the various needs of oncology patients during the time of their disease including appropriate screenings, preventive practices, symptom management, care to retain as much normal functioning as possible, and supportive measures upon end of life. These nurses need advanced certifications and clinical experiences in oncology further than the typical bachelorette nursing program provides.

Oncology nurses can work inpatient settings such as hospitals, outpatient settings, in hospice services, or in physician offices in a variety of specialties such as radiation, surgery, pediatric, or gynecologic. Oncology nurses have advanced knowledge of assessing the client’s status which will help the multi-disciplinary medical team to develop a treatment plan.

A case study is a research method involving an up-close, in-depth, and detailed examination of a concerned subject/topic (or the case), as well as its related contextual conditions. Case studies can be produced by following a formal research method which may be by an individual, organization, event, or action, existing in a specific time and place. Here we are inviting case studies based on cancer and followings are the focused streams. You can present your studies on any other type of cancer as well. The presenter in this category will receive a 30% discount on registration.

• Childhood Cancer
• Breast Cancer
• Lung Cancer

Epigenetics refers to the heritable change in gene expression that does not involve changes to the underlying DNA sequence. DNA methylation, histone modifications and non-coding RNAs (ncRNA) play fundamental roles in epigenetic regulation.

The study of epigenetic modifications of the Cancer cell genome that does not involve a change in the nucleotide sequence is called Cancer Epigenetics. Risk expectation, Prediction and Cancer prevention, growth counteractive actions are also promising and encouraging areas of Epigenetics. A high adequacy of demethylating agents was accounted for essentially in haematological malignancies in view of new conventions with the low dose and long exposure, and their utilization is presently being striven for strong tumors.

During the cell transformation to a cancerous cell, Epigenetic modifications are also important like genetic mutations. Their manipulation brings a promising approach for prevention, detection, and therapy of Cancer.

The application of molecular biology techniques in detection of alterations in DNA methylation or histone modification to diagnose or study disorders characterized by heritable defects in the expression of a gene or genome is referred to as Clinical epigenetics.

Chromatin is a complex of DNA, RNA, and protein which packages very long DNA molecules into a more compact, denser shape, preventing the strands from becoming tangled, preventing DNA damage, and regulating gene expression and DNA replication. Epigenetic modification of the structural proteins in chromatin via methylation and acetylation also alters local chromatin structure and thus gene expression. The structure of chromatin networks is currently poorly understood and hence is an active area of research in molecular biology.

Epigenetic therapy is the use of drugs or other epigenome-influencing techniques to treat medical conditions such as cancer, heart disease, diabetes, and mental illnesses. Epigenetic therapies are among the most active areas of preclinical and clinical cancer research evidence to their potential of specifically targeting chromatin-mediated disease mechanisms. It is expected that these therapies will have fewer side effects than conventional cytotoxic chemotherapies. Several classes of drugs have emerged, and several are on-going development.

The DNMT inhibitors 5-azacytidine and 5-aza-20-deoxycytidine have both been approved by the FDA for the treatment of various forms of cancer. These drugs have been evident to reactivate the cellular antitumor systems which are repressed by cancer, hence enabling the body to weaken the tumor.

A cancer biomarker is a biological marker which indicates the presence of cancer in the body. Genetic, epigenetic, proteomic, glycomic, and imaging biomarkers are used for diagnosis, prognosis, and epidemiology of cancer.

Because they are expressed against a person's genetic background and environmental exposure, and epigenetic events occur early in cancer development, Epigenetic biomarkers are more advantageous over other types of biomarkers.

Epigenetic biomarkers potentially have numerous clinical applications in cancer intervention and treatment and significant implications for public health.

Types of epigenetic biomarkers:

• DNA methylation, circulating or noncirculating
• MicroRNA and other noncoding RNA
• Protein markers

For e.g., DNA methylation is one of the major epigenetic mechanisms and it is a genetic feature better reflecting disease development and, consequently, has the potential to become a more conclusive biomarker for detection and diagnosis of different diseases.

Chromatin remodeling is the rearrangement of chromatin architecture to allow access of condensed genomic DNA to the regulatory transcription machinery proteins, allowing transcription factors or other DNA binding proteins to access DNA and control gene expression. Targeting chromatin remodeling pathways is evolving as a major therapeutic strategy in the treatment of several cancers.

Chromatin remodeling provides fine-tuning at crucial cell growth and division steps, like cell-cycle progression, DNA repair and chromosome segregation, and hence exerts tumor-suppressor function.

Cancer is considered to have a clonal origin but cancer tissues are comprised of a heterogeneous group of cells with different functional potential. Alterations in the modifications of histones have been linked to deregulated expression of many genes with important roles in cancer development and progression. Histones are the class of proteins bundled within a DNA that promote the effects of DNA methylation on gene expression indirectly. In contrast to the stable effects of DNA methylation, histone modifications have greater plasticity in determining the expression or silencing of specific genes in response to stimuli.

When cancer is detected early, it is more likely that the treatment will be successful. But more often, cancers are diagnosed at a late stage when they are much harder to treat. The biggest challenge in cancer treatment is the ever-changing nature of tumours with cancers often evolving to a drug-resistant form. If doctors can predict the evolution of a tumour, they could intervene earlier to stop cancer in its tracks before it gets the chance to evolve or develop resistance, thereby increasing the patient’s chances of survival.

Artificial Intelligence has been used by scientists to predict how cancers will progress and evolve, so that doctors can design the most effective treatment for each patient. For e.g., a new technique was developed called REVOLVER (Repeated evolution of cancer), which picks out patterns in DNA mutation within cancers and uses the information to forecast future genetic changes.