CANCEr US

1. Edition #1June 20, 2012 10 Ways To ReduceYour Chance Of Cancer! CANCErUS The Future for Cancer Treatment Associate Professor Mick Foley on shark antibodies Exclusive Interview with Professor Andy Coley The latest in cancer cell research! $4.95

2. A Note From The Team: This magazine was created by three Year 9 students from Ivanhoe Grammar School, who participated in Professor Nick Hoogenraad’s Outreach Program at La Trobe University. For five years, the School and La Trobe have worked hard to spark a scientific interest in students. 14 year old Elizabeth McGrath says, “I chose cancer because society today doesn’t explain what cancer actually is, and I wanted to know more. I specifically chose to study lung cancer because I know people who smoke, and it has affected me personally”. Fellow teammates Madeline Donis and Ashton Turner agree wholeheartedly: “I chose cancer because it’s something that affects everyone in our community yet I feel so helpless, I just needed to know what hope we have for a cure.” We hope to enlighten our readers and give them hope for a brighter future.

3. CONTENTS • What Is Cancer? • Current Treatment-skin-lung-breast • 10 Ways To Lower Your Risk of Cancer • Interview – Mick Foley • On Campus • On Campus – Page 2 • Signs and Symptoms • Campaigns Against Cancer • Interview - Andy Coley • Future Treatment -skin-lung-breast • Bibliography

4. W H A T I S The official definition of cancer is “The disease caused by an uncontrolled division of abnormal cells in a part of the body.” Skin cancer: A malignant neoplasm (tumour) of the skin. Lung cancer: Cancer (malignancy) that originates in the tissues of the lungs or the cells lining the airways. Lung cancer originates when normal lung cells become abnormal, usually after a series of mutations, and begin to divide out of control. Breast cancer: Breast cancer is a malignant tumour that starts in the cells of the breast. CANCER?

5. The current treatment for melanoma: The main treatments for skin cancer are surgery, chemotherapy, radiotherapy and alternative/complementary treatments. Surgery: After the melanoma and surrounding skin has been sent for pathology testing and melanoma has been confirmed, a second procedure will occur. This procedure includes the removal of more normal skin around the melanoma (‘margin of safety’). The margin differs from 5mm-2cm depending on the depth of the melanoma. The aim is to remove any cancer cells in the surrounding skin and prevent the melanoma returning to the same site. Radiotherapy: Uses radiation to destroy/injure cancer cells. Radiotherapy is aimed to do as little harm as possible to normal body tissue. It is common to have radiotherapy once a day every weekday over several weeks, the treatment itself only takes a few minutes however there may be a waiting period before each session. Chemotherapy: Is the treatment of cancer with anti-cancer drugs. Its goal is to destroy cancer cells with least amount of damage to normal cells. The drugs works by stopping cancer cells from growing and reproducing. It is used as a palliative treatment to try to control cancer growth, it will not usually cure. It is most commonly given as intravenous treatment however there are other types including tablets.

6. The current treatment for lung cancer: Lung: There are four main treatments for lung cancer and they are; surgery, chemotherapy, radiotherapy, multimodality therapy and complementary/alternative treatments. Surgery: The two surgeries include Curative surgery(removal of the tumour) and Palliative surgery which involves removing obstructions Chemotherapy: best for patience with small cell carcinoma . Strong drugs that stop cancer cells reproducing. Chemotherapy is good because it also kills cells that have metastasized because it travels around the body through the blood. Chemotherapy doesn’t actually destroy tumours it only stops the cancer from growing and spreading. If you had a tumour you would want to have a different type of treatment. The down side of chemotherapy is that after you use it if the cancer comes back (recurrent cancer) your body will have built up a immunity and the chemicals may not have the same effects Chemotherapy drugs have not been perfected so they often attack healthy cells as well as cancer cells this results in a huge amount of side effects. Radiotherapy : used in the early stages of lung cancer or to assist chemotherapy by containing it to the lungs and lymph notes. High energy rays like X-rays but much stronger that kill or shrink cancer cells. This treatment is painless and only takes 2-3 min. Also includes severe side effects. Targeted therapy (biological agents) – In some patients case (usually those who are non-smokers) they are suitable to use a new kind of drug that targets the growth genes and/or blood-vessel forming genes of the cancer cells. Usually targeting therapy will be used if chemotherapy no longer controls the disease. These drugs are good because they tend to have almost no side effects except for a rash.Complementary and alternative medicines and theories– Many people give complementary and alternative medicines a shot because they feel more natural and ‘in control’ of their bodies and treatment. Complementary therapies are a variation of relaxation strategies and medicines used together for a more natural approach. Alternative therapies are unproven remedies some herbal or dietary which are used instead of medical treatment. Complementary theories are usually a good way to cope with medical treatment but alternative treatments are generally dangerous and ill-advised because they are not commonly effective so they waist your money and some herbs used may be harmful to you.

7. The current treatment for breast cancer: A breast cancer in the form of a tumour is usually removed surgically and typically, the patient is giving post-surgery chemotherapy and radiation therapy, to kill any cancerous cells that survived surgery. Chemotherapy and radiation therapy treat cancers by killing any cells that rapidly divide or grow, hopefully targeting cancer cells. This means that the therapy kills your immune system. Other side effects include hair loss and digestion disruptions. Some tumours are hormone positive, and require hormones to grow, and in recent years, a treatment has been developed to completely treat tumours such as these. These can be identified by the presence of hormone receptors. For example, tumours with receptors for the hormone estrogen are known as ER+ tumours. Similarly, tumours with progesterone receptors are PR+. Three treatments are available to treat different types of hormone-positive tumours. They work by blocking the hormones that allow the tumours to grow. If a breast cancer patient has surgery, they can have one of three different procedures: a mastectomy (removal of the entire breast), a quadrantectomy (removal of one quarter of the breast) or a lumpectomy (where just a small part of the breast is removed). After surgery, radiation is often given to the tumour region and surrounding lymph nodes. In the case of a lumpectomy, radiation treatment is essential.

8. 10 Ways to lower your risks of cancer • Wear sunscreen • Exercise regularly • Don’t smoke • Limit your alcohol intake • Don’t expose yourself to asbestos • Don’t expose yourself to second-hand smoke • Limit your UV exposure • Maintain a healthy diet and weight • Wear protective clothing when in the sun • Regulate visits to the doctor for check-ups

9. Our interview with Associate Professor Mick Foley: When do you expect the studies will be finished? Well, they’re never really finished. When will a shark antibody be used in the clinic? Will you get it from your doctor? If everything went perfectly, if there were no problems, it would probably take five years, probably closer to ten. That’s if everything works and all the money comes in. That’s just how long it takes to find the right antibody, to modify it so it works in the human blood, plus all the clinical studies to prove that they’re safe can take many, many years, so it’s hard to say. But there are some shark antibodies already in the clinic. It’s a slightly faster process now, but it still takes a long time. When it is developed, what form will it take? Either a tablet, or ‘magic bullet’, or an injection. Something you can get from your doctor. Maybe a vaccine. Like the human papilloma virus, where you get vaccinated. That took a long time to develop. In the early stages, it’s hard to say. Even if it’s in the clinic, will it be costly? It is expensive, but it will progressively get cheaper. Like when the iPod first came out. They were very expensive, but now they’re cheaper, so we can afford. When DVD players first came out they were thousands of dollars, and televisions, even. As more people make them, they get cheaper. So the medicine will get cheaper and the better they will be made. Along with breast cancer and malaria, do you think there’s any other diseases they’ll cure? I think they could be used in all sorts of diseases. Things like inflammation are very good targets for those. They could be applicable to almost any disease, but the question is where they are best suited. We here have limited resources, so we need to target the most important diseases. Even though you could target anything, what we want to do is create an area for diseases that human antibodies aren’t very good at curing. But they could also be used for diagnostics in the future. Sugar detection for diabetics, pregnancy testing…they’re diagnostic tests. These antibodies might be very good at that because they’re very, very stable and will last longer. It’s not just good in therapy but it good be very useful in diagnosis. The problem is focusing on diagnosis is difficult – it’s hard to get funding because the margins in the diagnostics industry are very, very low. Whereas, people are looking at cures. Cures bring in billions of dollars a year. If you have a new diagnostic, your profit might only be in the hundred thousands. It’s difficult for people to want to fund you. It’s much easier to get them with cures. Could you see these being commonly available? Yes, definitely. There will be treatments like this. Whether it’s the shark antibody or the camel antibody, these treatments will be around. Certainly in your lifetime. I’ve no doubt about that. But I think these will be more use for therapy rather than vaccination. There are already cures for certain diseases using antibodies. What it’ll look like, however, I’m not so sure.

12. Signs and SKIN: It is important to follow the ABCDE rules when monitoring a mole, freckle or growth. A- for asymmetry.B- for irregular edges or borders. C- for colour. Moles should be one colour only. D- for diameter. The mole or the skin tumour should be no larger than 6mm.E- for elevation. Any mole that is elevated or develops a lump should be checked out. BREAST The first noticeable symptom is typically a lump on the breast. Other than a lump, symptoms of breast cancer may include: • Thickening on one breast • One breast becoming larger or lower than the other • Skin of the breast puckering or dimpling • Nipple changing position or shape • Rash and/or discharge on or around the nipple • Constant pain in the breast or armpit • Swelling in the armpit or collarbone area LUNG: (In chest) • Intense or persistent coughing • Pain in chest, shoulders or back • A change in the colour or volume in sputum(saliva mixed with mucus or pus) • Shortness of breath • Changes in voice or being hoarse • Harsh sounds with each breath • Recurring bronchitis or pneumonia • Coughing up phlegm or mucus (perhaps with blood in it) • Coughing up blood Symptoms

13. Campaigns against cancer The “Slip,Slop,Slap,Sleek,Slide” campaign features a seagull encouraging Australians to “slip” on a shirt, “slop” on some sunscreen, “slap” on a hat, “seek” shade and “slide” on some sunnies. For more than a decade, the Mother’s Day Classic fun run and walk has provided communities with a great way to celebrate Mother’s Day and raise funds for breast cancer research This is an ad run by the Australian Government to discourage smoking and features the quitline number . IT is part of the quitnow campaign

14. Our interview with Professor Andy Coley: What needs to be done for a cancer cure to be developed? “My impression of cancer, from a pathology perspective, is that it’s not just one disease. It’s many diseases. It’s not like the flu or liver disease. [It is] many different diseases caused by a similar process, and affects many different organs […] Many cancers will metastasize, they’ll spread, that’s often the problem. You can have benign cancers, which don’t spread. Breast tumours will spread to the lymph nodes. Melanomas will spread to the brain, liver, gut. First thing we want to do is stop the primary tumours from spreading. We can stop the spread, and there are therapies that do that.” What about prevention? “Obviously prevention is the best way to stop people from having cancer, to stop them getting it in the first place, and we’re relatively good at that. People have stopped smoking. If you go back thirty years, many, many more people used to smoke and smoking is a real problem when it comes to cancer. So don’t smoke. People used to go out in the sun all the time and then we had a high level of melanoma, and now people are very aware of that. We slip slop slap. And obviously that’s a good thing to do. We’re eating better than we used to. But we are eating a lot of fatty foods and red meat which might not be so good. Having said that, we’re eating more vegetables and that can prevent cancer.” How far has cancer treatment come in recent years? The management of cancer, we’ve gotten better and better at it. Of course, that depends on the type of cancer. If someone has pancreatic cancer, for instance, they’d probably have the same survival rate as they would 20, 30 years ago, because we don’t understand it. But if someone had leukaemia they’d probably live for a lot longer, because treatment for that has developed hugely in the last twenty or thirty years. Breast cancer, we have new therapies. There are other cancers that we can’t treat at all. We don’t know how. Some tumours are more easily treated than they were, and some aren’t. Generally, cancer is a disease of the elderly. One in three people will have it sometime in their life. What is the property that makes some cancers curable and some not? “Understanding is the first and most important step to that. In order to fix something, you have to understand it. If I want to fix my car, I have to know what all the parts do in order to isolate the problem. Some cancers we understand, others we don’t understand at all. Generally speaking, we have therapies for the ones we understand, and not for the ones we don’t.” How does the cancer actually start? “Cancer is when cells mutate. So in a genome, when cells divide, they are sometimes miscopied. Usually, that’s not a problem. Except when the mutation is in an important gene, then that mutation might have a cancerous effect. The longer you’ve been on the planet, the more likely you are to get it. Also, if you live in a hot place, or in the tropics, you are far more likely to get skin cancer. Many, many, many people in Australia get skin cancer and many of them are over seventy. Because when they were twenty, they’d go out into the sun with no hat, no sunscreen, no shirt on, and now they’re developing cancer. That would have instilled mutations in their cells.” So if you spend more time in the sun now, are you more likely to get cancer later in life? The more time you spend around areas that have a high effect on the reproduction of cells, such as being in the sun too much, the more cell mutations you’ll have, and the more chances you’ll have of one or more of those mutations becoming cancerous.

15. The Future Treatments for melanoma: There are 3 main new-found treatments for melanoma, these are; Vemurafenib: New Scientist 2011According to New Scientist June 2011 two new drugs that have been dubbed as the biggest breakthrough in cancer therapy in 30 years have been discovered. The first is a drug called, vemurafenib. Half of all melanomas have been found to be linked with a mutated gene called BRAF. Vemurafenib inhibits BRAF and shuts down these tumours by targeting and blocking the BRAF protein. After a six month trial, survival was 84% for those taking vemurafenib compared to 64% of those taking dacarbazine (standard chemotherapy drug). Dr Chapman states, “This is the beginning of personalized medicine in melanoma”. Doctors say the drug could be approved and on the market in just 6 months. IIpilimumab: New Scientist 2011Caroline Robert and her team at the GustaveRoussy Cancer Institute in France found that in a trial of 250 patients who received dacarbazine along with ipilimumab survived for two years compared to the 17.9% of patients taking dacarbazine alone. Ipilimumab is an antibody that works by boosting the immune system’s response to a tumour. The firms behind each drug aim to combine the drugs in a trial. Yervoy: Yervoy is a drug that works by stimulating the body’s immune system to fight off cancer. It is a man-made antibody that blocks a crucial switch on immune cells, cancer would use this switch to turn off the body’s anti-cancer immune response. Yervoy has shown that it increases survival rate by one third. A complete course of Yervoy includes four infusions over 3 months. In a trial of 676 late-stage melanoma patients, patients taking Yervoy survived an average of 10 months after treatment had commenced, others taking an experimental vaccine survived approximately 6 months. However, this drug does have possible sideffects. One of them being that the Yervoy could stimulate the immune system to destroy healthy cells. In clinical trials, nearly %13 suffered from severe or fatal autoimmune reactions.

16. The future treatments for breast cancer: In the future, the primary goal is to stop the spreading of the tumours in all cases. One of the biggest advancement currently in potentially curing cancer is the use of antibodies to target the cells. They are extremely specific and only affect their ‘target cells’. Antibodies operate using a lock and key model, which means if they are developed successfully, this type of treatment will not have any side effects, which is extremely impressive when compared to current treatments such as chemotherapy. Instead of using human antibodies however, scientists in Australia and the U.S. are investigating using the antibodies from sharks and camels. They are being used for multiple reasons. Firstly, because cancer is a cell mutation disease and not a foreign substance, the body doesn’t recognise it as dangerous and does not develop a line of defence for it. Also, human antibodies cannot yet be used because in order for them to be created, there would have to be human testing, and the research is not yet at that stage. Shark and camel antibodies are also far more stable, and although they do not last as long in the human body, they can withstand much higher temperatures, which might make them available for use in the field of diagnosis. This would be a huge advance. Shark antibodies are also very small, which means the immune system won’t detect them at times. In future, there are hopes that once a cancer is discovered, a patient can have a tablet or be injected with the appropriate antibodies that will latch onto the cancer and, sometimes with the help of an added toxin, kill it. It may also one day be available in the form of a vaccine. It is believed that developing the drug to its ‘market phase’ could take probably ten years or maybe more, and could be costly, but over time, it will hopefully decrease in price, as many people are likely to produce it because the need is so high. It is also believed that the full version of the treatment will be available widely in our lifetime. Currently, the antibody Herceptin has been identified and has cured some cases of breast cancer, but there are many cures still in progress.

17. The future treatments for lung cancer: • Scientists are looking into the following fields for possible cures/treatments for lung cancer. • Early detection • CT scans or chest x-rays to detect lung tumours • Chemotherapy regime : different combos of exciting chemotherapy medicines • Vaccines • Gene therapy

18. Acknowledgments We would like to thank Professor Nick Hoogenraad of La Trobe University for not only sharing his knowledge with us but for also inviting us into the university and allowing us to participate in the Outreach Program. We would also like to thank all the lecturers and academics but in particular the following: Associate Professor Mick Foley, Dr. Andrew Coley and Dr. Mark Hulett. Lastly, we would like to express our thanks to Ivanhoe Grammar School for giving us the opportunity to partake in this spectacular program.

19. Bibliography: http://freeimagesarchive.com/data/media/48/No+Smoking+Sign+Clip+Art.png http://www.bozined.com/breast-cancer-awareness-ribbon.html http://brianmaines.com/wp-content/uploads/2012/01/diet-and-exercise.jpg http://www.drlopo.com/secure/wpstore/wp-content/uploads/sunscreen-girl-e1280640044825-300x200.jpg http://www.24x7bulletin.com/wp-content/uploads/medical-exam-checkup-doctor-thumb4322398.jpg http://upload.wikimedia.org/wikipedia/commons/thumb/6/6c/Melanoma.jpg/250px-Melanoma.jpg http://www.latrobe.edu.au/staff-profiles/images/photos/mfoley.jpg http://4.bp.blogspot.com/-yiWzyeOIbgA/T5S_ZeTY_sI/AAAAAAAAHVw/G9F3dKKsTxQ/s1600/mothers-day-classic.png http://resources1.news.com.au/images/2009/08/21/1225764/682173-quit-this-warning-first-appeared-on-australian-t-6062383-jpg.jpg http://www.meddean.luc.edu/lumen/meded/medicine/pulmonar/cxr/atlas/images/71bl.jpg http://www.virtualmedicalcentre.com/uploads/VMC/DiseaseImages/739_ct_scan.jpg Websites Page Name URL Breast Cancer – Wikipedia http://en.wikipedia.org/wiki/Breast_cancer Lung Cancer http://www.lungcancer.org/reading/ Untitled Radio Conversation http://www.abc.net.au/pm/content/2010/s2953697.htm Lung Foundation Statistics http://www.lungfoundation.com.au/lung-information/statistics Cancer Australia http://www.canceraustralia.gov.au/node/466 NBCF www.nbcf.org Melanoma – Cancer Council www.actcancer.org/sun-smart/skin-cancer.aspx Melanoma www.melanoma.com/sign.html Melanoma www.melanoma-symptoms.com/melanoma-symptoms_1.html Melanoma Risk Factors www.cancer.org/Cancer/SkinCancer-Melanoma/DetailedGuide/melanoma-skin-cancer-risk-factors Cancer Drugs Raise Hope For Survival http://abcnews.go.com/Health/cancer-drugs-raise-hope-survival/story?id=13767742#.T-AqaReP8Ta FDA approves New Melanoma Treatment http://www.webmd.com/melanoma-skin-cancer/news/20110325/fda-approves-new-melanoma-treatment-yervoy Books/Journals Title Author(s) Publisher Year Published Treatment of Early Breast Cancer Vol. 1 (Medical Journal) Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) La Trobe University 1990 Breast Cancer – A Psychological Treatment Manual Sandra Haber Harper Collins Publishers 1995 Melanoma Cancer Council N/A 2002 Lung Cancer – The Facts Chris Williams Oxford University Press 1994 Preventing Breast Cancer Dr Cathy Read Unknown 1992 Complimentary and alternative cancer therapies Cancer Council N/A 2004 Magazines Title Date Published NewScientist 11 June 2011