types of research in cancer

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What are the types of cancer research?

In any battle, knowing and understanding your adversary is crucial. This is true for our fight against cancer as well, and research is the key to our combat strategy. Cancer research plays a vital role in gaining insights into the nature of the disease. Through systematic investigation and the creation of new knowledge, we can enhance our understanding of cancer. Armed with this knowledge, we can then develop more effective strategies for the prevention and treatment of cancer.

Researchers study every stage of the cancer journey, from causes (called etiology) and prevention to screening, diagnosis, and treatment (therapy) as well as survivorship and quality-of-life (palliative) care. This is called the cancer continuum. 

What we know about cancer—how to reduce cancer risk, how it develops, how to treat it, and how to help people cope with it—all depends on different types of research and what is discovered as a result. 

The Masonic Cancer Center, University of Minnesota, is a community of more than 600 researchers who study cancer. The things they study are broken down into six research areas that are organized around specific themes spanning the cancer continuum. The programs interact with one another and with groups throughout the world to uncover better ways to treat and prevent cancer. These six areas, and the portions of the cancer continuum they span, are shown below. 

Within these research programs, MCC scientists conduct research at different levels and settings. We use these different levels and settings to group cancer research into four main types: basic, clinical, population-based, and translational. Below, we take a closer look at each of the four types.

Basic research

The first level of research is called basic research, also known as laboratory research or bench science. Basic researchers study the cells, molecules, and genes that are the building blocks of life, working to understand how healthy cells grow and then identifying the differences between those healthy cells and cancer cells. 

This approach allows researchers to control and test for many different factors, for example, turning specific genes on or off, or exposing cells to a specific substance, condition, or possible treatment—and then measuring the effects of whatever is tested. Researchers can even use the cells from healthy volunteers to do this testing—and the volunteers definitely don’t have to be human. Cells from animals like mice, or even lab grown cells, are commonly used in cancer research.

After finding a promising idea that works in cells, researchers need to take that idea to the next level. But, it’s not safe or practical to move directly from cells to people. That’s where animal research comes into play—because animal models have certain similarities to humans, researchers can carry out and repeat important experiments that would be practically or ethically impossible to test initially in people. Scientists will often use mice, fruit flies, or even zebrafish to try out an idea, test, or treatment! 

Findings from laboratory, or basic, research are an essential starting point for informing future tests and treatments. However, even the best lab research has its limitations. That’s because humans are complex creatures, and no animal model can perfectly predict how a specific type of cancer will progress, or how a particular treatment will work in patients. This is where another level of research, translational research, becomes crucial. We’ll tackle translational research a bit later in this blog.

Translational research

During translational research, researchers take what they have learned in the lab and apply it in patient care. The knowledge gained from this work then goes back to the lab to inform even further investigations. Many people say that translational research “bridges the gap” between basic and clinical research by bringing together a number of different specialists to refine and advance the application of a discovery. 

Translational research seeks to produce more meaningful, applicable results that directly benefit human health—in other words, that directly benefit patients. The goal of translational research is to move basic science discoveries into practice with patients more quickly and efficiently. 

Masonic Cancer Center researchers play a key role in designing and developing medicines that inform future treatment strategies, thanks in large part to our Cancer Research Translational Initiative (CRTI) . For example, CRTI has facilitated the translation of TriKE GTB-3550—a cancer therapy that uses special killer cells to attack cancer cells—led by MCC’s Dr. Jeff Miller. The first generation TriKE, or the initial design, was developed to study its effects on a specific set of drug-resistant leukemias in a first-in-human trial led by Dr. Mark Juckett. Thanks to that trial, MCC’s Dr. Martin Felices and team developed a more potent second-generation TriKE, and MCC’s Dr. Nicholas Zorko and team have used lessons from this process to create a third special TriKE dedicated to examining the response of drug-resistant solid tumors such as prostate cancer and sarcoma. 

And the benefits of translational research don’t stop with patients—this research provides a crucial pivot point after clinical trials are conducted as well. That’s because researchers can explore how the trial’s resulting treatment or guidelines can be implemented by physicians in their practice. And, the clinical outcomes might also motivate basic researchers to re-evaluate their original assumptions or find new things to test that their original research hadn’t yet explored. 

Clinical research

In clinical research, promising treatments or tools are carefully studied in people. Clinical research studies, also known as clinical trials , explore whether new treatments, medications, and diagnostic techniques are safe and effective. 

Clinical research includes more than new drug development—it can be used to test anything that helps prevent, find, predict, treat, or manage cancer. That could include testing a phone app to monitor symptoms, an exercise program to help patients stay active, or a questionnaire to help doctors and nurses monitor potential health issues like pain. 

Clinical research is a critical step in the research pipeline because it ensures that what is being tested is safe and will work well for large groups of people. Clinical trials are often designed to learn if a new treatment is more effective or has less harmful side effects than existing treatments. At MCC, our Clinical Trials Office (CTO) tackles this process in partnership with physician researchers. The CTO is a large team of cancer center professionals who are dedicated to meeting the needs of researchers and their patients by providing exceptional trial management services. Clinical research teams prioritize patient safety, and are focused on ensuring the highest level of data integrity and regulatory compliance. 

Today’s clinical trials often become tomorrow’s new standard of care, boosting many patients' quality of life now, and helping ensure that future patients have continuously higher standards of care. Participation in a clinical trial provides qualified patients with early access to cutting-edge therapies. Rigorous regulatory standards ensure that patient care while on these trials is as good and often better than standard treatments. 

Want to read more about clinical trials and the phases they go through? Check out our explainer blog to learn more about clinical trials and why they’re so important.  

Population-based research

While cancer affects all population groups, studies show it often has a larger or more severe impact on some groups over others. So, understanding and addressing these health disparities is crucial. 

Population-based research explores the causes of cancer, cancer trends, and factors that affect the delivery and outcomes of cancer care in specific populations. This field of cancer research brings together scientists whose research focuses on cancer prevention, early detection, health outcomes, and how to best share with people, especially diverse communities, the information uncovered. 

Many of our researchers focus on cancer risks for vulnerable populations—children, people with severe mental illness, medically-underserved communities, and patients from across Greater Minnesota who are geographically isolated due to cost of treatment and long travel distances. This is evidenced by initiatives like the 10,000 Families Study , a study of family health in Minnesota that invites families from across the state to participate over time with the purpose of understanding the influences of genetics, lifestyle, and environment on health and illness, including cancer.

At the end of the day, the reason our scientists and doctors are able to provide the most cutting-edge cancer treatments, prevention education, and diagnosis tools is because all of these types of research—from the very beginning stages in a lab all the way to the clinic—work together. Solving the problem of cancer is a collaborative effort, and we’re proud and humbled to have such a strong legacy of support from partners, community members, and beyond to continue writing cancer’s last chapter.

Want to get updates on what our researchers and doctors are up to? Sign up today for our Community Matters e-newsletter to receive a monthly round-up of MCC’s top stories and events . And, if you’re looking for education and training opportunities, get on the list for Career Connections, a monthly collection of all career-related offerings at the cancer center. 

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What Is Cancer Research?

Home > Patients, Caregivers, and Advocates > About Cancer > What Is Cancer Research?

Cancer research transforms and saves lives.

The purpose of studying cancer is to develop safe and effective methods to prevent, detect, diagnose, treat, and, ultimately, cure the collections of diseases we call cancer. The study of cancer is called oncology.

Why Cancer Research Is Important

Cancer research is important because the better we understand these diseases, the more progress we will make toward diminishing the tremendous human and economic tolls of cancer.

Research has helped us accumulate extensive knowledge about the biological processes involved in cancer onset, growth, and spread in the body. Those discoveries have led to more effective and targeted treatments and prevention strategies.

Breakthroughs in prevention, early detection, screening, diagnosis, and treatment are often the result of research and discoveries made by scientists in a wide array of disciplines over decades and even generations. Ultimately, cancer research requires partnerships and collaborations involving researchers, clinicians, patients, and others to translate yesterday’s discoveries into today’s advances and tomorrow’s cures.

The Cancer Research Cycle

Research progress is often not linear, but cyclical and ongoing. Advances are the result of constantly building on earlier discoveries and observations.

The research cycle flows from observations with medical relevance to the patient’s bedside and back to the lab. Progress in cancer research depends on the participation of basic and population scientists, physician-scientists, and clinical cancer researchers, as well as patients, their caregivers, and health care providers. Insights from one discipline influence others, and discoveries made in one cancer can offer new ideas to better address others.

Categories of Cancer Research

Cancer research can be divided into several broad categories:

Basic Research

Basic research is the study of animals, cells, molecules, or genes to gain new knowledge about cellular and molecular changes that occur naturally or during the development of a disease. Basic research is also referred to as lab research or preclinical research.​

Translational Research

Translational research seeks to accelerate the application of discoveries in the laboratory to clinical practice. This is often referred to as moving advances from bench to bedside.

Clinical Research

Clinical research involves the application of treatments and procedures in patients. Clinical cancer researchers conduct clinical trials, study a particular patient or group of patients, including their behaviors, or use materials from humans, such as blood or tissue samples, to learn about disease, how the healthy body works, or how it responds to treatment.

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Understanding Cancer Research Terms

The Glossary for Nonscientists 

Get more out of American Cancer Society studies on epidemiology, statistics, genetics, and other complex topics with this glossary of terms used in cancer research, explained in plain language for nonscientists. 

5-year cancer survival rate: The percentage of people with the same type and stage of cancer who are alive at least 5 years after diagnosis. A 5-year survival rate does not mean that people can’t live more than 5 years, nor does it mean that those who live at least 5 years are cured. A high percentage for a 5-year survival rate may mean treatment works well for most people. A low percentage for a 5-year survival rate may mean treatments aren’t very effective.

138% of Federal poverty line: The maximum yearly income the Affordable Care Act (ACA) supports for people to qualify for Medicaid. In 2022 for example, the federal poverty line (FPL) for a family of 3 was $23,030. The ACA provides financial incentives that allow parents in a family of 3 to have a yearly income up to 138% of the FPL, which was $31,781 [$23,030 + (38% of $23,030)], and still qualify for Medicaid.

In 2022, 37 states had 138% FPL as their Medicaid income eligibility limit. But states can set their own income limits for Medicaid eligibility, and they can be below, at, or above the FPL. In 2022, Washington, DC had the most generous Medicaid income eligibility limit—221% of the FPL—for a family of 3. Texas had the least generous—16% of the FPL. 

Abstinence:  The practice of choosing not to do a certain behavior or give into a desire or addiction, such as using tobacco or alcohol.

Advanced cancer:  A general term describing the late stages of cancer, when the disease has spread from where it started (the primary site) to other parts of the body. When the cancer has spread only to the nearby areas, it is called  locally advanced cancer . If it has spread to distant parts of the body, it is called  metastatic cancer . See also  metastasis, metastasize.

African American/Black:  People in the United States who can trace their lineage to Africa. Some Black people do not identify as African American. The Black lineage contains many histories, cultures, and experiences, including Afro-Caribbean and Afro-Latino populations.

Age-adjusted cancer death rates:  A cancer death rate that has been adjusted with a math calculation to allow for differences in age so that 2 populations can be more directly compared. See also Understanding the Cancer Death Rate. 

American Indian and Alaska Native (AIAN):  A person with origins in any of the First Peoples in North, Central, and South America who maintains tribal affiliation or community attachment. These include Navajo, Blackfeet, Inupiat, Yup’ik, and Central and South American Indian groups. The AIAN is a federally recognized tribal entity with certain rights of self-government and are entitled to receive US federal benefits, services, and protections.

Aneuploid/Aneuploidy: Cells that have either more, or less, than the normal 23 pairs of chromosomes. Most cancer cells are aneuploid. It’s rare for a normal cell to have aneuploidy. See also chromosome, diploid, and ploidy. 

Apoptosis: Programmed cell death. Apoptosis is controlled by genes that cause cells to die at certain times, for example, when DNA is damaged. This type of cell death is different from the process of cell death by decay. Some drugs used to treat cancer cause apoptosis.

Asian American: A broad term that refers to a person having origins in the Far East, Southeast Asia, or the Indian subcontinent. This group includes, but is not limited to, Asian Indians, Cambodians, Chinese, Filipinos, Hmong, Japanese, Koreans, Pakistanis, Thai, and Vietnamese.

Behavioral research: Research into what motivates people to act the way they do. The results of such research can be used to help encourage people to adopt healthy lifestyles and follow life-saving screening and treatment guidelines.

Bioinformatics: Bioinformatics has been called a marriage of biology and information technology. This scientific, interdisciplinary field uses computer technology, mathematics and statistical methods, physics, engineering, and biology to make super large sets of complex life-sciences data more understandable and useful.

Scientists with specialization in bioinformatics use tools of computation and analysis to retrieve, analyze, manipulate, and interpret the massive, unprecedented amounts of diverse, and complex data (described as "big data") that are now available due to advances in systems and techniques like next-generation sequencing.  

Bioinformatics comprises 3 components:

• Creation of databases
• Development of algorithms and statistics
• Analysis of data and interpretation

Bioinformatics is part of computational biology.

Biologic age/biological aging (also known as epigenetic age/epigenetic aging): Biological aging is a gradual and progressive process of aging to the body’s cells driven by epigenetic changes to the DNA. Those changes to the DNA result from such things as:

The accumulation of damage to your body’s cells caused by the natural wear of your body, as well as your lifestyle (like how you eat, sleep, and exercise)

Your life experiences (like where you live and what kind of work you do) 

• Your exposure to harmful environments (like cigarette smoke and air pollution)

Increased biological age increases the risk for developing cancer and other age-related diseases. Your biological age can be younger or older than your chronological age, which increases with each birthday.

Biomarker (also called molecular marker or signature molecule):  A measurable molecular (such as a protein), genetic, chemical, or physical characteristic in the blood or other bodily fluids, such as sweat and tears, that is a sign of a normal or abnormal process or of a health condition or disease. Biomarkers can help in early diagnosis, disease prevention, drug target identification, and drug response. The US Food and Drug Administration (FDA) classifies 7 categories of biomarkers: susceptibility biomarkers, diagnostic biomarkers, response biomarkers, safety biomarkers, prognostic biomarkers, monitoring biomarkers,  and predictive biomarkers.

Biorepository:  A facility that collects, catalogs, and stores samples of biological materials. The ACS Cancer Prevention Studies biorepository includes blood, urine, buccal cells (from the inside of the cheek), cancer tissue, and stool.

Biospecimen:  A sample of a biological material, such as blood, urine, tissue, cells, or stool collected from participants for research.

BRCA1:   A gene which, when damaged (mutated), puts a person at higher risk of developing breast, ovarian, prostate, and other types of cancer, compared to people who do not have the genetic mutation. See also gene , mutation .

BRCA2:  A gene which, when damaged (mutated), puts a person at higher risk of developing breast, ovarian, prostate, and other types of cancer, compared to people who do not have the genetic mutation. See also gene , mutation .

Breast cancer genes: The genes most commonly mutated in hereditary breast cancer are the breast cancer 1 ( BRCA1 ) and breast cancer 2 ( BRCA2 ) genes.

C-reactive protein (CRP): The liver releases CRP into the bloodstream in response to inflammation. Blood levels of CRP increase with inflammatory conditions like severe tissue damage from injury, rheumatoid arthritis, some heart diseases, infection, and progressive cancer. 

Cancer burden: How the number of cancer cases and results of cancer affect a country, community, family, or one person. For example, the cancer burden for a specific person depends on their risk factors for cancer, how well they manage their modifiable risk factors, how closely they follow the recommended cancer screening schedule, if they develop cancer, and their access to high-quality cancer treatment. See What Is Cancer Control?

The national or a state's cancer burden is measured by:

• Screening rates
• Stage at diagnosis
• Incidence (new cases)
• Prevalence (all existing cases)
• Financial costs of cancer care or because of having cancer
• Mortality (deaths from cancer)
• Survival (how long people survive after diagnosis)
• Morbidity (cancer-related health complications)
• Survivorship (including quality of life after cancer treatment)

Cancer care continuum:  The full scope and progression of cancer care, from promoting good health (wellness) to preventing cancer, detecting it early, diagnosing it, treating it, and surviving it.

Cancer control: Organized programs that focus on reducing the number of people who develop cancer, have complications from it, and die from it. It uses approaches that have been tested through research to control the number of cancer cases as well as the effects of cancer. Programs may include cancer prevention and early detection, treatment, palliative care, patient and family services, professional education and training, and cancer survivorship care. A cancer control program is successful when it assures that people are as healthy as possible, regardless of race, age, gender, location, social level, or economic status. See  What Is Cancer Control?

Cancer deaths (see cancer mortality )

Cancer death rate (see cancer mortality rate )

Cancer disparities/Cancer health care disparities:  Harmful, unfair differences in cancer prevention services, screening, detection, treatment, and follow-up care between population groups that affect how well people do after a diagnosis of cancer (their outcomes). These differences may be in the number of people receiving care, having nearby access to care, having sufficient health care insurance, and the quality of care available or received.

Cancer disparities result from economic, environmental, and social disadvantages. Populations most likely to experience cancer disparities are the same as those that experience health disparities . 

These differences between population groups can lead to certain groups bearing a disproportionate cancer burden. 

See Cancer Disparities ACS Research Highlights.  See also  health disparity.

Cancer epidemiology research:  Studying the distribution and determinants of cancer—who gets it, where they live, and the risk factors that contribute to its development.

Cancer incidence ( also called cancer occurrence): The number of new diagnoses of cancer, or new cases, in a group. Incidence counts can give information about a specific group but can’t be used to compare groups because the numbers alone don’t account for the size of the group or age ranges of the people in it. Comparing groups requires cancer incidence rates.  Compare to prevalence .

Cancer incidence rate: The number of people who have a new diagnosis of cancer within a defined population (such as people aged 65 and older) and during a specified period of time (like 2019-2021). Incidence rates are usually given as the count per 100,000 population and are adjusted to account for differences in age.

Cancer mortality ( also called cancer deaths ) : The number of people who die from cancer. Death counts can give information about a single group but can’t be used to compare groups because the counts don’t account for the size of the group or age ranges of the people in it. Comparing groups requires cancer death rates. See Understanding Cancer Death Rates.

Cancer mortality rate ( also called cancer death rate ) : The number of people who die from cancer within a defined population such as Black women (but not limited to Black women with cancer) during a specific time period. The cancer death rate is not confined to people with cancer, it includes all people in the population. Cancer death rates are given as the number of deaths per 100,000 of the population. Researchers account (adjust) for age when they calculate death rates so they can track trends over time, and so they can compare groups. Cancer death rates are the best measures researchers use to track progress against cancer. See Understanding Cancer Death Rates.

Cancer occurrence (see cancer incidence )

Cancer-predisposition genes:  Genes that are vulnerable to cancer-causing changes (mutations), which are sometimes inherited from a parent. Several dozen cancer-predisposition genes have been identified, and about 5% to 10% of all cancers result directly from those inherited. For example, BRCA1 and  BRCA2  are inherited cancer predisposition genes, and mutations on them increase the risk of developing certain cancers, including breast, ovarian, and prostate.

Cancer prevalence:  The number of people in a population with a history of a cancer diagnosis.

Cancer-related outcomes:  The results of a cancer diagnosis—how it affects health, quality of life, and length of survival. These outcomes are influenced by: a patient’s overall health, access to quality health care, cancer type and stage, response to provided treatments, complications, and follow-up care.

Cancer   relative 5-year survival rate: An estimate of the percentage of people who will be alive 5 years after a diagnosis of cancer compared with people who haven’t been diagnosed with cancer. The relative survival rate shows whether a disease shortens life and is used as a way to approximate the expected lifetime. For example, a relative 5-year cancer survival rate of 80% means that compared to the number of people without cancer who are alive, 80% of people with cancer will be living 5 years after their diagnosis.

Cancer surveillance research:  Ongoing and systematic collection, analysis, interpretation, and reporting of cancer data about the new cancer cases, extent of disease, screening tests, treatment, survival, and death. Its goal is to use data to guide public health policy and action, such as the distribution of health care resources.

Cancer survival rate: The percentage of people who survive a certain type of cancer for a specific amount of time (often 5 years). For example, if a 5-year survival rate is 77%, it means that of all the people who have that type of cancer, 77 out of every 100 will be living at least 5 years after their diagnosis.

Cancer survivor:  The American Cancer Society describes anyone who has been diagnosed with cancer as a cancer survivor, regardless of whether they are actively receiving treatment. 

Cancer treatment outcomes: How well a person is doing after being treated for cancer, which can depend on how well they respond to treatment, the treatment's side effects, their other health issues, and follow-up care, as well as on the facility where they received care and its geographic location.

Carcinogen: A substance known to cause cancer in living tissue, such as certain substances in cigarette smoke, alcohol, ultraviolet rays, processed meats (including bacon, ham, hot dogs, and lunch meat), radon, and asbestos. Most carcinogens start the process of carcinogenesis by interacting with a cell's DNA to produce mutations that damage the cell.

Carcinogenesis ( also known as oncogenesis and tumorigenesis ) : The development of cancer. The process that changes healthy, normal cells to cancer cells. Carcinogenesis has three phases: initiation caused by cell damage, promotion led by uncontrolled replication of cells, and progression, which may involve the development of blood vessels around a tumor, migration of cancerous cells through the bloodstream or lymphatic system, and invasion of cancerous cells into normal tissue of nearby organs or those further from the tumor, causing new tumors (metastases) to develop.

Cell therapy: The prevention or treatment of certain diseases using specifically selected cells rather than chemical compounds like those used in chemotherapy and some targeted therapies. The cells can come from a donor or the patient, multiplied, genetically or pharmacologically altered in a lab, and returned to a patient, often by IV infusion. 

Bone marrow and stem cell transplants are the most frequently used cell therapy. They’re used to treat cancers in the blood. Another more recently discovered cell therapy is CAR (chimeric antigen receptor) T-cell therapy, which is being used to treat certain blood cancers. Scientists are studying how to use cell therapy in solid tumors. See Stem Cell or Bone Marrow Transplant and CAR T-cell Therapy and Its Side Effects .

Chromosome: Long thread-like strands of DNA in the nucleus of each cell. Each chromosome is made up of DNA tightly coiled many times around proteins (called histones) that support its structure. Each chromosome contains hundreds or thousands of individual genes. Most human cells have 23 pairs of chromosomes. In normal cells, one of each pair comes from the mother, and the other from the father. The exception is that males only have 1 copy of sex chromosomes. See also DNA, gene.

Cohort: A group of people, including groups of people who are in a study. See prospective cohort study.

Complete response: When tests after treatment show no signs of disease. A period when a disease is under control. A complete response may not be a cure.

Computational biology: This scientific, interdisciplinary field addresses theoretical and experimental questions in biology, behavior, and social systems by analyzing exceptionally large sets of data.

Computational biologists use data-analytical and -theoretical approaches, mathematical modeling (like algorithms), and computer simulations to understand and model the structures and processes of life.

Correlation/Correlational research: The process of establishing a relationship or connection between 2 or more measures.

Correlational research design investigates the relationship between 2 or more variables without interfering with or manipulating them. Results of a correlational study may find a positive or negative relationship, a linear or non-linear relationship, or a partial or multiple relationship. An example of a positive correlation is height and weight—taller people tend to be heavier, and vice versa. In some cases, positive correlation exists because one variable influences the other—such as ice cream sales and temperature. In other cases, the 2 variables are independent from one another and are influenced by a 3rd variable which may or may not be identified. Scientists can calculate the strength of a relationship between variables, but they cannot assume cause and effect.

CRISPR (stands for Clustered Regularly Interspaced Short Palindromic Repeats, also called CRISPR-Cas9, which stands for CRISPR-associated protein 9):  One type of gene editing tool that gives scientists the ability to change DNA by adding, removing, or changing genetic material at particular spots in the genome. When the genome is edited, the characteristics of a cell or an organism may be changed.

CRISPR is faster, cheaper, easier to use, and more accurate than previous techniques of editing DNA. The method has profoundly changed biomedical research.

CRISPR-Cas9 is the most common, cheap, and efficient system used for genome editing.

Deep learning: Deep learning is a subset of machine learning. It's a family of machine-learning models based on layers of artificial neural networks, which can be a combination of hardware and software. Deep learning uses machine-learning techniques to solve real-world problems. It requires massive data sets to train machines to do what the brain does naturally. Deep-learning systems permit a machine to train itself and create new content—like images, text, or audio. In medicine, deep learning is used to classify skin cancer and identify diabetic retinopathy. See also machine learning.

Diagnostic biomarkers: A biomarker  used to help identify and diagnose conditions. High glucose levels are a diagnostic biomarker for diabetes.

Diploid/Diploidy: Ploidy refers to the number of chromosome pairs in a cell. Normal cells have 23 pairs, known as diploidy. See also ploidy and aneuploidy .

DNA (deoxyribonucleic acid): The hereditary material, sometimes referred to as the genetic blueprint, in humans and almost all other organisms. DNA holds genetic information on cell growth, division, and function and is passed from one generation to the next. Nearly every cell in a person’s body has the same DNA.

Most DNA is located in the cell nucleus, but a small amount of DNA can also be found in the cell’s mitochondria. When cells divide, each new cell needs to have an exact copy of the DNA that was in the old cell.

DNA chains coil into 46 chromosomes, 23 from each parent. See also RNA.

Discovery research:  Experiments with genes, cells, animals, or people to find a new or improved understanding of an action, health behavior, process, technique, technology, or model to improve care.

Disparity  (See cancer disparity and health disparity )

Epidemiology:  The study of the occurrence, distribution, and possible causes of diseases (like cancer) in a group of people.  

Epigenetic age/epigenetic aging (see biologic age )

Epigenetic changes (see epigenetics )

Epigenetic mark (see epigenetics )

Epigenetic signature (see epigenetics )

Epigenetics/epigenetic changes (also known as epigenetic marks or signatures): The study or process of how a person’s behaviors (like diet and exercise) and environment (like toxins, healthy or unhealthy stress management, and draining or inspiring school/work environments) can cause changes that add or remove special marks on a gene’s DNA that affect the way your genes work and how active they are. 

Epigenetic changes affect how your body reads a DNA sequence but doesn’t change the sequence as genetic changes do. Specifically, epigenetic changes, turn genes “on” and “off.” Different genes are more active in some cells than in others. Even within a certain cell, some genes are active at some times and inactive at others. Epigenetics has a strong influence on how a person develops and can alter individual traits.

Behaviors that may change epigenetic patterns/marks:

• Alcohol consumption
• Environmental pollutants
• Nutrition/diet
• Physical activity
• Psychological Stress
• Working habits (like working night shifts)

Some epigenetic changes increase your risk of developing cancer and other health conditions. It may be easier for scientists to find and remove bad epigenetic marks, though, compared to fixing a hardcopy genetic mutation. For example, reversing epigenetic changes may reveal a potential target for new treatments. 

Other helpful things to know about epigenetics: 

• Epigenetic modifications are heritable and can be passed between generations.
• Epigenetic changes may be reversible (unlike genetic changes). 
• Your epigenetics change throughout your life. 
• Epigenetics explains how early experiences can have lifelong impacts.
• Young brains are particularly sensitive to epigenetic changes.
• Epigenetics explains how people with identical DNA can have dramatically different looks and behaviors (phenotypic differences).

Epigenome: A collection of chemical marks that accumulate on a gene’s DNA as the body develops (also known as epigenetic marks or epigenetic signatures ). Known as the epigenome, this collection of marks “tells” the gene what to do, where to do it, and when to do it.

Etiology: The study of the causes of a disease. There are many possible causes of cancer. Research is showing that both genetics (genes passed on from your parents) and lifestyle (including exposures to carcinogens) are major factors involved in the development of many cancers. See also carcinogen , gene .

Experimental study:  When researchers introduce an intervention and study the effects. Randomized controlled trials are a type of experimental study. Unlike correlational research  where a scientist looks for associations among naturally occurring variables, in experimental studies, the researcher may introduce a change and then monitor its effects. 

Federal Poverty Line (FPL): The income level that’s used to set eligibility limits for several programs and benefits in the United States. It’s published each year by the US Department of Health and Human Services. These programs include Medicaid, Children’s Health Insurance Program (CHIP), Supplemental Nutrition Assistance Program (SNAP), Supplemental Nutrition Program for Women, Infants, and Children (WIC), and other “welfare” programs.

FPL (see Federal poverty line) 

Functional precision medicine:  A  pre-clinical research  platform where scientists use live tumor cells taken from patients to identify new drugs, including the identification of biomarkers to personalize the use of these drugs.

Gene: A piece of DNA. Genes have information on inherited traits such as hair color, eye color, and height, as well as susceptibility to certain diseases. Every person has more than 20,000 genes.

Most genes are the same in all people and they vary in size based on how many DNA bases they include. Less than 1% of genes are slightly different between people.

Some genes carry instructions to make proteins, which are required for the structure, function, and regulation of the body’s tissues and organs.

All the genes in a cell aren’t needed all the time. So the body has ways to turn them “on” (gene expression) and turn them “off.” For instance, actions such as coiling and uncoiling the DNA can turn a gene on or off based on how close it is to other genes. The mechanisms that turn the genes on and off can be influenced by lifestyle, environment, and age.

Gene editing (see CRISPR )

Gene expression: The process of the body turning encoded information in a gene into a function. For instance, a gene may have the code for making a certain protein. When the gene is “expressed,” a protein is made. Proteins dictate a cell’s function. 

The term gene expression communicates how many, how often, and when proteins are created from the instructions within the genes. Some researchers describe gene expression as volume control. Epigenetic changes affect gene expression to turn genes “on” and “off” (compared genetic changes can alter which protein is made, but not how much or when). 

Genetic changes (see genetic mutation )

Genetic mutations  ( also known as   genetic variants and genetic changes ): Permanent changes in the DNA sequence of a gene are called  gene mutations.  Some scientists think that “gene variant” is a more accurate term because changes in DNA do not always lead to disease. Sometimes the terms are used as synonyms.

Genetic predisposition  or  genetic susceptibility:  People   who inherit certain changed genes that make them more likely (more disposed or more susceptible) to develop cancer are said to have a genetic predisposition to a cancer or certain types of cancer. Sometimes this is referred to as having a  family cancer syndrome.  But having a genetic predisposition doesn’t mean that person will develop cancer. And if they do develop cancer, it may not be caused by the inherited genetic mutation.

Genetic susceptibility  (see  genetic predisposition)

Genetic variants  (see  genetic mutations )

Genome: A complete set of DNA. Almost all of our cells contain two copies of a person’s genome.

Genome editing (see CRISPR )

Genomics: (see human genomics )

Germline pathogenic variations:  A type of mutated gene that gets passed down from a parent to child and that causes disease, such as cancer. The  BRCA1   and  BRCA2   mutations are examples because they are passed down by parents and increase the risk of developing several types of cancer.

Germline variations:  The type of mutated gene that are passed from a parent to a child. Germline variations that cause disease are  germline pathogenic variations.

Global cancer burden: An assessment of the number of cancer cases and the effects of cancer across the world. The global cancer burden may be lowered by improving cancer prevention programs, broadening cancer screening programs, expanding high-quality treatment and patient support, and prioritizing public health awareness and education campaigns in every country. See ACS Global Cancer Control Work.

Gut microbiome: A collection of microorganisms like bacteria, viruses, and fungi that mostly live in the digestive tract. Every person's gut microbiome is uniquely shaped by their diet, lifestyle, genetics, and environment. Gut bacteria help with day-to-day functions like synthesizing vitamins, digesting food, and metabolizing drugs. They also help regulate the immune system and protect the body from potentially harmful bacteria. Recent findings have shown that the gut microbiome can help cancer grow and also help keep it from growing.

Health care barriers:  Factors that prevent a person from getting to (accessing) quality health care and services, which may include lack of adequate health insurance, location of health centers, available transportation, and time off from work.

Health disparity:  Health disparities are usually noticeable and significant differences between population groups in regard to their health, health care, or both, in ways that are not fair or equal. Health disparities contribute to health inequalities. Differences can be in the number of people receiving care, access to nearby care, sufficient health insurance, quality of care, and more.

Such differences are preventable, as they're closely linked with economic, political, social, and/or environmental disadvantages. Health disparities may occur because of:

• Discrimination or exclusion, or both
• Gender (or gender identity)
• Geographic location
• Mental health
• National origin
• Race or ethnicity
• Sexual orientation or gender identity
• Socioeconomic status

Cancer disparities are one type of health disparity.

Health equality:  Providing everyone with the same tools and resources for health care. Compare with  health equity.

Health equity:  The state in which everyone is able to reach their full health potential, and no one is at a disadvantage for attaining this potential on the basis of race/ethnicity, gender, health insurance coverage, disability, place of residence, or other social circumstances, such as lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care.

Equity is the fair treatment, access, opportunity, and advancement for everyone while addressing needs and eliminating barriers that prevent the full participation and success of all people.

Achieving health equity requires removing obstacles to health such as poverty and discrimination, as well as their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care.

Health equity is not the same as  health equality.  Equity acknowledges that people have different circumstances or barriers they need to overcome, often through no fault of their own. These barriers are often because of deeply rooted, longstanding inequities at all levels of society that will take an intentional effort to address in order to have equal cancer outcomes. Because of this, the tools and resources needed for health care need to be different from one person to the next.

High-thoughput sequencing (see next-generation sequencing )

Hispanic:  A broad term that refers to people descended from Spanish-speaking countries or with Latin American (South America, Mexico, Central America, and certain Caribbean islands, including Cuba, Jamaica, and others.) ancestry. The term Hispanic is more commonly used in the Eastern US and is generally preferred by those of Caribbean and South American ancestry or origin.  Hispanic  is considered an ethnicity, as Hispanic people can be of any race. See also Latino.

Human genomics:  The study of a person’s genome—a complete set of DNA, including all of its genes.

Incidence  (See cancer incidence )

Interleukins: Proteins required for controlling acute inflammatory responses in the body. Interleukins are the body’s defense against “invaders,” like wounds, viruses, or diseases. 

Interleukin-6 (IL-6): A protein produced by various cells in the body to help regulate immune responses. The production of c-reactive protein (CRP) is thought to be linked with the production of IL-6. Testing the levels of interleukin-6 is a potentially useful mark of how well the immune system is functioning. Too much IL-6 has been linked with diabetes, rheumatoid arthritis, and cancer. Both physical and psychological stress can cause temporary increases in IL-6.

Internet of Everything (IoE): A 21st century digital system is an intelligent network of people, process, data, and things (objects, devices, appliances, and so forth that use implanted sensors to communicate across the network). This interconnectedness allows data from all devices to be analyzed and processed together. IoE works in sync with technologies such as artificial intelligence, machine learning, and the cloud. These processes ensure the correct information is relayed to the right destination across the network and to leverage data faster.

Internet of Things (IoT): A subset of the Internet of Everything, which includes those devices with sensors or other technology that are connected by a network and that can exchange data over the internet without human intervention. Examples of IoT devices include pacemakers, smart thermostats, home security systems, and self-driving cars.

Intervention: A program or set of activities designed to help people or populations change a particular behavior (like sitting too much or forgetting to put on sunscreen) that increases their risk for a particular disease.

In vitro:   A Latin term that means grown and studied in a dish, or in the lab, compared to being grown in a living being—in vivo.

In vivo:   A Latin term that means grown and studied in a living being, such as a lab mouse or human

Latino:  A broad term that refers to people in the US with Latin American ancestry. Unlike  Hispanic,   Latino  includes people from Brazil, who speak Portuguese.  Latino  has replaced the terms Chicano and Mexican American and is used primarily west of the Mississippi River. Like the word Hispanic, the word Latino identifies an ethnicity, as Latino people can be of any race.  Latino  is used for males,  Latina  for females, and  Latinx  to be gender neutral. See also Hispanic.

Longitudinal study: A research design that involves repeated observations or measurements of the same variables—such as weight, existence of a disease, like cancer, and foods eaten (diet)—over a short or long period of time—sometimes lasting decades. Researchers don't interfere with the participants' day-to-day activities but only collect qualitative and quantitative responses through surveys, interviews, or other tools. Longitudinal studies are a method of correlational research, meaning it helps scientists discover the relationship between variables in a specific population.

Machine learning:  Machine learning is a subfield of artificial intelligence. It’s a technology that uses current and historical data along with algorithms and statistics formulas to train computers to recognize patterns to perform tasks without having a specific set of instructions (like software or code) to follow. It can analyze and make decisions about large amounts of complex data exponentially faster than people can, and it can improve with experience. Machine learning is used for such things as fraud detection and recommending products based on previously bought items. See also deep learning.

Medicaid expansion:  The part of the Affordable Care Act that called for increasing the number of low-income people in the United States who qualify for the health insurance coverage provided by Medicaid, a government program run by each state.

Metabolites: Small molecules that are made and stored when the body breaks down food, drugs, or its own tissue and that are affected by the environment and diseases like cancer.

Metabolomics : The study of small molecules, called metabolites, that are made and stored when the body breaks down food, drugs, or its own tissue and that are affected by the environment and diseases like cancer.

Microenvironment (see tumor microenvironment)

Mitochondria:  Structures in normal and tumor cells that generate most of the energy needed to power the cells’ (or tumors’) biochemical reactions required to function and grow. Mitochondria act like a digestive system that takes in nutrients, breaks them down, and creates energy for the cell.

Molecular marker (see biomarker ) :

Monitoring biomarkers: Biomarkers that   help recognize the status of disease or side effects of treatment.  Tumor DNA (ctDNA)  is a monitoring biomarker for certain  metastatic cancers .

Mutation (see genetic mutation )

Native Hawaiian and Other Pacific Islander (NHPI):  A broad term that refers to a person having origins in Hawaii (Hawaiʻi), Guam ( Guåhan ), Samoa (Sāmoa), Fiji or other Pacific Islands throughout Polynesia, Micronesia, and Melanesia.

Natural killer cells (NK cells): These immune cells typically patrol the bloodstream, seeking out cells infected with viruses and tumor cells that they destroy in their early stages before viruses or cancer cells spread. They’re called “natural” killers because they can recognize potentially harmful cells and kill them without ever having seen them before.

NK cells work by scanning cells for markers that indicate whether the cells are healthy or diseased. When they detect harmful cells, NK cells release deadly chemicals and kill them.

NK cells are highly efficient at killing tumor cells within the circulating blood and can help block metastasis, but they are less efficient at killing tumor cells in the microenvironment.

Another class of NK cells communicate rather than kill. They release cytokines, which “alert” other immune cells to attack harmful cells. 

Next-generation sequencing (also known as NGS and High-throughput sequencing): Technology that allows for simultaneous sequencing of DNA and RNA in multiple people at the same time. Compared to traditional sequencing, which determines the sequence one section at a time, next-generation sequencing in much faster, less expensive, and delivers a much larger magnitude of information. Making sense of these huge datasets requires bioinformatics and computational biology . NGS has revolutionized the field of personalized medicine ( precision medicine ).

NGS (see next-generation sequencing )

Observational study : When researchers observe the effect of a risk factor, diagnostic test, treatment, or other intervention without trying to change who is or isn't exposed to it.

Oncogenes: A group of genetic mutations that have the potential to cause cancer and that give cancer cells an advantage to grow and survive.

Oncogene addiction: The dependency of certain tumor cells on a specific, individual oncogene to grow and survive.

Oncogenesis (See carcinogenesis )

Oncogenic fusion gene: A hybrid gene formed from 2 or more previously independent genes that plays a leading role in the development and progression of cancer. These hybrid, fused genes are read (transcribed) and translated as a single unit, which may lead to the production of defective proteins that cause cancer to grow and spread.

The prevalence of fusion genes varies widely across different cancers, and many fusion genes are specific to certain cancer sub-types. Rapidly and accurately identifying fusion genes can be an important part of diagnosis because specific gene fusions characterize cancer subtypes. A stratified diagnosis can predict a patient's prognosis, response to treatment, and survival.

Fusion genes are potentially excellent sites for new treatments to target. Several drugs have been successfully developed to inhibit fusion genes.

Pathogenic mutations (see pathogenic variants)

Pathogenic variants (PVs, also known as pathogenic mutations): Genetic variants or mutations that lead to disease.

Pharmacokinetics: The study of how the body interacts with medicines from the time a person takes a drug throughout its journey in the body. 

Ploidy: The number of sets of chromosomes contained in a cell, whether it’s a normal cell or cancer cell. See also aneuploid , diploid.

Precision medicine (also called personalized medicine): A clinical approach for medical prevention and treatment that's tailored based on a person's lifestyle, environment, and the specific genes, proteins, and other substances in their body. Precision medicine is the opposite of the one-size-fits-all approach to prevention and treatment, where an average strategy applied to everyone. A personalized approach  helps doctors and researchers more accurately predict which prevention and treatment methods will work for a specific disease in a particular person.

The 2 types of treatment most often used in precision medicine are:

• Targeted therapy, which uses medicines designed to attack a specific target on cancer cells
• Immunotherapy, which uses medicines that help the body’s immune system attack the cancer

Preclinical studies: Research that takes place before any testing in humans is done—before clinical trials. Preclinical studies may study if a drug, procedure, or treatment is likely to be useful. In the commonly used description about the research continuum, “bench to bedside,” preclinical studies are the bench—meaning they occur in a lab setting. Preclinical studies may be conducted in a test tube or cell culture ( in vitro) or in animals, such as mice  ( in vivo).

Predictive biomarkers: Biomarkers that signal the likelihood a person has to develop a reaction after exposure to a disease, treatment, or substance in the environment. For instance, presence of the  hormone ER (ER+)  in a breast tumor is a predictive biomarker that  tamoxifen  may be an effective treatment.

Predisposition genes ( see  cancer-predisposition genes and genetic predisposition)

Prevalence (see cancer prevalence )

Prognostic biomarkers: Biomarkers that indicate the chances of a disease progressing or recurring. For instance, the  protein HER2  is a prognostic biomarker for breast cancer.

Promoter (also known as DNA promotor): A region of DNA where transcription (copying the information in DNA to mRNA) of a gene is initiated. Promotor regions describe the direction of transcription and point out which DNA strand will be transcribed.

Promoters work with DNA regions known as enhancers to ensure a good copy of that gene. DNA bends to put the enhancer section close to the promotor section. Mutations can occur in the coding (enhancer region) or in the promotor region. Many studies suggest that DNA promotors may be the main cause of many human diseases, especially diabetes.

Prospective Cohort Study:  A long, on-going ( longitudinal ) research study that captures and compares years of data from a group of people ( cohort ) to learn how specific characteristics or risk factors affect the rate of developing diseases such as cancer.   Prospective   means data is collected before anyone has developed cancer. Cohort studies are a type of observational study.

Research continuum: The full scope of research—often referred to as bench to bedside. Research may start in a research lab (pre-clinical research or research at the bench), occur as part of clinical trials, be done by health care providers or within health care systems (at the bedside), and be conducted within communities.

Response biomarkers: Biomarkers that help confirm whether a prevention method or treatment worked. For instance, after vaccination, antibodies are the response biomarkers.

Ribonucleic acid: See RNA.

RNA (ribonucleic acid): RNA is found in all living cells of the body. Its most notable role is to act as a messenger (mRNA) by contains instructions from DNA that are translated by the cell to make proteins. When RNA does not carry a code for a protein, it’s called non-coding RNA (ncRNA). There are many additional types of RNA with various functions within the cell.

RNA, like DNA, is made of nucleotides (chains of nucleic acids). See also DNA.

RNAseq: See RNA sequencing.

RNA sequencing (RNAseq):  A technique used to learn the exact order of the nucleotides that make up RNA molecules in healthy or diseased tissue or cell. It provides a picture of how the blueprint (DNA) is being read.

RNAseq is a powerful tool for understanding cancer at the molecular level (how individual cells employ their mRNA and proteins) and for developing new strategies to prevent or treat cancer. For instance, RNAseq allows scientists to compare how genetic instructions change before and after drug treatment.

RNAseq can reveal gene fusions, splicing variants, mutations, and differences in gene expression between cell samples.

Scientists can use RNA sequencing for analysis of:

• Cell collections
• Tissue sections, called bulk RNA sequencing
• Liquid biopsies (See Biopsy Types and  Liquid Biopsy: Past, Present, Future. )
• Single cells, called single-cell RNA sequencing or scRNA-seq, which can distinguish single-cell RNA biology up to 20,000 individual cells simultaneously, and show how cells change over time.

Single nucleus RNA (snRNA seq): A technique to isolate RNA from the nucleus of a cell.

Single-cell resolution/Single-cell analysis (scRNA-seq, also known as single-cell imaging): The use of new methods and technologies that show more details than a microscope, allowing researchers to see a different view of single cells in tissue. This technique reveals the specific population of cells in a selected area of tissue. With these tools, scientists can analyze each cell individually and learn how the position of each cell has a role in the tissue’s architecture. This detailed information is critical to better understanding the biological function of both normal and diseased tissues.

Spatial RNA sequencing, spRNAseq,   also called spatial transcriptomics): This method allows scientists to view a specific region within a cell, then sequence all RNA transcripts (copy of DNA instructions) found in that region. Using this, scientists can map the variation of gene expression (which proteins are made by the cells) across the region of interest.

Organisms function based on the spatial organization and spatial of cells. If spatial orientation is disrupted, there could be a loss of biological function.

A better understanding of spatial information will help scientists better understand how tumor cells communicate with each other, escape tracking by the immune system, become resistant to drugs, and metastasize.

For spatial sequencing, scientists use immunofluorescence microscopy and next-generation sequencing to determine the transcripts in the region. 

Safety biomarkers: Biomarkers   that help identify possible toxic responses to treatment or harmful environmental exposures. For instance, creatinine is a safety biomarker for drugs that can potentially affect the kidney.

Screening prevalence: The number of people in a population who receive cancer screening.

Sedentary:  Sitting, reclining, or lying down while awake and expending very little energy. 

Signature marker (see biomarker )

Social determinants of health:  Social determinants of health are non-medical factors that influence health, the ability to function, risk for health problems, and quality of life. These include conditions in the environments where people are born, live, work, play, learn, worship, and age, as well as the social, economic, and political systems that shape those conditions of daily life. 

The occurrence of cancer can be positively or negatively affected by social determinants of health based on how they affect educational and job opportunities, income, housing, transportation, public safety, food security, social inclusion and non-discrimination, and access to affordable health services of high quality. 

Social determinants of health are closely linked with health disparities .

Stroma: The cells and tissues that support and give structure to organs, glands, or other tissues in the body. It’s made mostly of connective tissue (made mostly of fibroblasts), blood vessels (lined by endothelial cells), lymphatic vessels, immune cells, and nerves.

The stroma provides nutrients to other tissues and organs, removes waste and extra fluid, and may be involved in the body's immune response, modulating inflammation levels. When stromal cells secrete growth factors, they promote tumor growth, invasion, and metastasis.

Structural racism/Systemic racism: Normalized historical, cultural, political, and institutional practices that govern society and benefit White people and disadvantage people of color. These can include housing policies, educational systems, and employment practices that reinforce and perpetuate inequities among racial groups.

Survival rate: The percentage of people who are alive at a certain time after diagnosis of a life-threatening disease, like cancer. The survival rate doesn’t determine how long a person will live after a diagnosis of cancer, but it may help people better understand how likely it is that treatment will be successful.

For cancer, it’s common to see a 5-year period after diagnosis as the marker, referred to as a 5-year survival rate. 

Survivorship: The time in a person's life from the diagnosis of cancer until death. The study of survivorship evaluates a person's quality of life, physically, mentally, and spiritually.

Susceptibility biomarker: A biomarker that signals the potential, or risk, a person has to develop a disease before they have symptoms. For instance, low-density lipoprotein (LDL) cholesterol is a susceptibility biomarker for heart disease.

Targeted therapy:  A type of cancer treatment that uses drugs or other substances designed to “target” a specific aspect of cancer cells, like a mutated gene, and kill them without harming normal cells. Targets may also be in the tumor’s microenvironment, such as a protein that sends messages to tell the cancer cell to grow and copy itself.

Different targeted therapies work differently. For example, a targeted therapy can block or turn off signals that make cancer cells grow, or it can signal the cancer cells to destroy themselves.

Targeted therapy is an important type of cancer treatment, and researchers will develop more targeted drugs as they learn more about specific changes in cancer cells. 

tbNGS (see next-generation sequencing )

TNBC (see triple-negative breast cancer )

Triple-negative breast cancer (TNBC): A subtype of breast cancer that grows faster and is more likely to spread and recur. It is more common in women younger than age 40, who are Black, or who have a BRCA1 genetic mutation. 

It’s called triple negative because the cancer cells in TNBC don’t have receptors for the hormones estrogen (ER) or progesterone (PR). Plus, TNBC cells make very little or none of the protein called HER2 (human epidermal growth factor). That means all 3 biopsy tests to check for these hormones and the HER2 protein come back "negative." 

Tumor-based next-generation-sequencing (see next-generation sequencing )

Tumor microenvironment: If a tumor is a castle, the tumor’s microenvironment is everything immediately around the castle—like the moat, high walls, courtyard, and soldiers—that affects how easy it is to get to the castle. The immediate area surrounding a tumor includes blood vessels that provide nutrients to the tumor, immune cells that may protect the tumor, structural matter called the extracellular matrix, and other cells that support the tumor (like stromal cells) or that make space for it to get larger.

A tumor and its microenvironment constantly interact, which influences if and how the tumor grows. Cells in the microenvironment can perform both pro- and anti-tumor functions, controlling how the cancer progresses and spreads.

This relationship between the microenvironment and tumor means successful cancer treatments often need to target more than just the cancer cells. They may need to target cells in the microenvironment to cut off the tumor’s nutrients or weaken its protection. 

Tumorigenesis (see carcinogenesis )

Underrepresented minorities (URM) in health-related science : Racial and ethnic groups that are particularly underrepresented across many career stages: African American/Black, Hispanic/Latino, American Indian and Alaska Native, Native Hawaiian and other Pacific Islander groups. The ACS Diversity in Cancer Research (DICR) program focus on racial and ethnic underrepresented minorities.

Wnt gene (see Wnt signaling pathway )

Wnt protein (see Wnt signaling pathway )

Wnt signaling pathway: A complex and diverse communication channel in cells that has many signaling branches. Wnt genes code for a large family of Wnt proteins that “carry messages” across the Wnt pathway. These messages regulate many critical cell functions, including the beginning and end of cells.

In the tumor microenvironment, Wnt signaling can turn immune cells “on and off,” regulating the cell’s anticancer immune response, meaning the signals can help tumors grow or stop them from growing.

Defective, or disrupted, Wnt signaling is part of the cause of cancers in the breast (including triple-negative breast cancer), cervix, colon, lung, and skin, as well as some blood cancers. Multiple players along the pathway have been identified as targets for anticancer drugs to disrupt signals that let cancer cells grow.

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• Fact sheets /
• Cancer is a leading cause of death worldwide, accounting for nearly 10 million deaths in 2020, or nearly one in six deaths.
• The most common cancers are breast, lung, colon and rectum and prostate cancers.
• Around one-third of deaths from cancer are due to tobacco use, high body mass index, alcohol consumption, low fruit and vegetable intake, and lack of physical activity. In addition, air pollution is an important risk factor for lung cancer.
• Cancer-causing infections, such as human papillomavirus (HPV) and hepatitis, are responsible for approximately 30% of cancer cases in low- and lower-middle-income countries.
• Many cancers can be cured if detected early and treated effectively.

Cancer is a generic term for a large group of diseases that can affect any part of the body. Other terms used are malignant tumours and neoplasms. One defining feature of cancer is the rapid creation of abnormal cells that grow beyond their usual boundaries, and which can then invade adjoining parts of the body and spread to other organs; the latter process is referred to as metastasis. Widespread metastases are the primary cause of death from cancer.

The problem

Cancer is a leading cause of death worldwide, accounting for nearly 10 million deaths in 2020 (1). The most common in 2020 (in terms of new cases of cancer) were:

• breast (2.26 million cases);
• lung (2.21 million cases);
• colon and rectum (1.93 million cases);
• prostate (1.41 million cases);
• skin (non-melanoma) (1.20 million cases); and
• stomach (1.09 million cases).

The most common causes of cancer death in 2020 were:

• lung (1.80 million deaths);
• colon and rectum (916 000 deaths);
• liver (830 000 deaths);
• stomach (769 000 deaths); and
• breast (685 000 deaths).

Each year, approximately 400 000 children develop cancer. The most common cancers vary between countries. Cervical cancer is the most common in 23 countries. 

Cancer arises from the transformation of normal cells into tumour cells in a multi-stage process that generally progresses from a pre-cancerous lesion to a malignant tumour. These changes are the result of the interaction between a person's genetic factors and three categories of external agents, including:

• physical carcinogens, such as ultraviolet and ionizing radiation;
• chemical carcinogens, such as asbestos, components of tobacco smoke, alcohol, aflatoxin (a food contaminant), and arsenic (a drinking water contaminant); and
• biological carcinogens, such as infections from certain viruses, bacteria, or parasites.

WHO, through its cancer research agency, the International Agency for Research on Cancer (IARC), maintains a classification of cancer-causing agents.

The incidence of cancer rises dramatically with age, most likely due to a build-up of risks for specific cancers that increase with age. The overall risk accumulation is combined with the tendency for cellular repair mechanisms to be less effective as a person grows older.

Risk factors

Tobacco use, alcohol consumption, unhealthy diet, physical inactivity and air pollution are risk factors for cancer and other noncommunicable diseases.  

Some chronic infections are risk factors for cancer; this is a particular issue in low- and middle-income countries. Approximately 13% of cancers diagnosed in 2018 globally were attributed to carcinogenic infections, including Helicobacter pylori, human papillomavirus (HPV), hepatitis B virus, hepatitis C virus, and Epstein-Barr virus (2).

Hepatitis B and C viruses and some types of HPV increase the risk for liver and cervical cancer, respectively. Infection with HIV increases the risk of developing cervical cancer six-fold and substantially increases the risk of developing select other cancers such as Kaposi sarcoma.

Reducing the burden

Between 30 and 50% of cancers can currently be prevented by avoiding risk factors and implementing existing evidence-based prevention strategies. The cancer burden can also be reduced through early detection of cancer and appropriate treatment and care of patients who develop cancer. Many cancers have a high chance of cure if diagnosed early and treated appropriately. 

Cancer risk can be reduced by:

• not using tobacco;
• maintaining a healthy body weight;
• eating a healthy diet, including fruit and vegetables;
• doing physical activity on a regular basis;
• avoiding or reducing consumption of alcohol;
• getting vaccinated against HPV and hepatitis B if you belong to a group for which vaccination is recommended;
• avoiding ultraviolet radiation exposure (which primarily results from exposure to the sun and artificial tanning devices) and/or using sun protection measures;
• ensuring safe and appropriate use of radiation in health care (for diagnostic and therapeutic purposes);
• minimizing occupational exposure to ionizing radiation; and
• reducing exposure to outdoor air pollution and indoor air pollution, including radon (a radioactive gas produced from the natural decay of uranium, which can accumulate in buildings — homes, schools and workplaces).

Early detection

Cancer mortality is reduced when cases are detected and treated early. There are two components of early detection: early diagnosis and screening.

Early diagnosis

When identified early, cancer is more likely to respond to treatment and can result in a greater probability of survival with less morbidity, as well as less expensive treatment. Significant improvements can be made in the lives of cancer patients by detecting cancer early and avoiding delays in care.

Early diagnosis consists of three components:

• being aware of the symptoms of different forms of cancer and of the importance of seeking medical advice when abnormal findings are observed;
• access to clinical evaluation and diagnostic services; and
• timely referral to treatment services.

Early diagnosis of symptomatic cancers is relevant in all settings and the majority of cancers. Cancer programmes should be designed to reduce delays in, and barriers to, diagnosis, treatment and supportive care. 

Screening aims to identify individuals with findings suggestive of a specific cancer or pre-cancer before they have developed symptoms. When abnormalities are identified during screening, further tests to establish a definitive diagnosis should follow, as should referral for treatment if cancer is proven to be present.

Screening programmes are effective for some but not all cancer types and in general are far more complex and resource-intensive than early diagnosis as they require special equipment and dedicated personnel. Even when screening programmes are established, early diagnosis programmes are still necessary to identify those cancer cases occurring in people who do not meet the age or risk factor criteria for screening.

Patient selection for screening programmes is based on age and risk factors to avoid excessive false positive studies. Examples of screening methods are:

• HPV test (including HPV DNA and mRNA test), as preferred modality for cervical cancer screening; and
• mammography screening for breast cancer for women aged 50–69 residing in settings with strong or relatively strong health systems.

Quality assurance is required for both screening and early diagnosis programmes.

A correct cancer diagnosis is essential for appropriate and effective treatment because every cancer type requires a specific treatment regimen. Treatment usually includes surgery, radiotherapy, and/or systemic therapy (chemotherapy, hormonal treatments, targeted biological therapies). Proper selection of a treatment regimen takes into consideration both the cancer and the individual being treated. Completion of the treatment protocol in a defined period of time is important to achieve the predicted therapeutic result.

Determining the goals of treatment is an important first step. The primary goal is generally to cure cancer or to considerably prolong life. Improving the patient's quality of life is also an important goal. This can be achieved by support for the patient’s physical, psychosocial and spiritual well-being and palliative care in terminal stages of cancer.  

Some of the most common cancer types, such as breast cancer, cervical cancer, oral cancer, and colorectal cancer, have high cure probabilities when detected early and treated according to best practices.

Some cancer types, such as testicular seminoma and different types of leukaemia and lymphoma in children, also have high cure rates if appropriate treatment is provided, even when cancerous cells are present in other areas of the body.

There is, however, a significant variation in treatment availability between countries of different income levels; comprehensive treatment is reportedly available in more than 90% of high-income countries but less than 15% of low-income countries (3).

Palliative care

Palliative care is treatment to relieve, rather than cure, symptoms and suffering caused by cancer and to improve the quality of life of patients and their families. Palliative care can help people live more comfortably. It is particularly needed in places with a high proportion of patients in advanced stages of cancer where there is little chance of cure.

Relief from physical, psychosocial, and spiritual problems through palliative care is possible for more than 90% of patients with advanced stages of cancer.

Effective public health strategies, comprising community- and home-based care, are essential to provide pain relief and palliative care for patients and their families.

WHO response

In 2017, the World Health Assembly passed the Resolution Cancer prevention and control in the context of an integrated approach (WHA70.12) that urges governments and WHO to accelerate action to achieve the targets specified in the Global Action Plan for the prevention and control of NCDs 2013-2020 and the 2030 UN Agenda for Sustainable Development to reduce premature mortality from cancer.

WHO and IARC collaborate with other UN organizations, inlcuing the International Atomic Energy Agency, and partners to:

• increase political commitment for cancer prevention and control;
• coordinate and conduct research on the causes of human cancer and the mechanisms of carcinogenesis;
• monitor the cancer burden (as part of the work of the Global Initiative on Cancer Registries);
• identify “best buys” and other cost-effective, priority strategies for cancer prevention and control;
• develop standards and tools to guide the planning and implementation of interventions for prevention, early diagnosis, screening, treatment and palliative and survivorship care for both adult and child cancers;
• strengthen health systems at national and local levels to help them improve access to cancer treatments;
• set the agenda for cancer prevention and control in the 2020 WHO Report on Cancer;
• provide global leadership as well as technical assistance to support governments and their partners build and sustain high-quality cervical cancer control programmes as part of the Global Strategy to Accelerate the Elimination of Cervical Cancer;
• improve breast cancer control and reduce avoidable deaths from breast cancer, focusing on health promotion, timely diagnosis and access to care in order to accelerate coordinated implementation through the WHO Global Breast Cancer Initiative;
• support governments to improve survival for childhood cancer through directed country support, regional networks and global action as part of the WHO Global Initiative for Childhood Cancer using the Cure All approach;
• increase access to essential cancer medicines, particularly through the Global Platform for Access to Childhood Cancer Medicines; and
• provide technical assistance for rapid, effective transfer of best practice interventions to countries.

(1) Ferlay J, Ervik M, Lam F, Colombet M, Mery L, Piñeros M, et al. Global Cancer Observatory: Cancer Today. Lyon: International Agency for Research on Cancer; 2020 ( https://gco.iarc.fr/today , accessed February 2021).

(2) de Martel C, Georges D, Bray F, Ferlay J, Clifford GM. Global burden of cancer attributable to infections in 2018: a worldwide incidence analysis. Lancet Glob Health. 2020;8(2):e180-e190.  

(3) Assessing national capacity for the prevention and control of noncommunicable diseases: report of the 2019 global survey. Geneva: World Health Organization; 2020.

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• Types of cancer

This page is about the different types of cancer according to the type of cell they start from. You can read about

The main types of cancer

Our bodies are made up of billions of cells. The cells are so small that we can only see them under a microscope. 

Cells group together to make up the tissues and organs of our bodies. They are very similar. But vary in some ways because body organs do very different things. For example, nerves and muscles do different things, so the cells have different structures.

There are more than 200 types of cancer and we can classify cancers according to where they start in the body, such as breast cancer or lung cancer.  

We can also group cancer according to the type of cell they start in. There are 5 main groups. These are:

• carcinoma  – this cancer begins in the skin or in tissues that line or cover internal organs. There are different subtypes, including adenocarcinoma, basal cell carcinoma, squamous cell carcinoma and transitional cell carcinoma
• sarcoma  – this cancer begins in the connective or supportive tissues such as bone, cartilage, fat, muscle or blood vessels
• leukaemia  – this is cancer of the white blood cells. It starts in the tissues that make blood cells such as the bone marrow.  

• brain and spinal cord cancers  – these are known as central nervous system cancers

Carcinomas start in epithelial tissues. These tissues:

• cover the outside of the body such as the skin
• line the body cavities such as the inside of the chest cavity and the abdominal cavity

22_diagram_of_epithelial_cells.svg

Carcinomas are the most common type of cancer. They include many breast, lung, bowel and prostate cancers.

There are different types of epithelial cells and these can develop into different types of carcinoma. These include:

• squamous cell carcinoma
• adenocarcinoma
• transitional cell carcinoma
• basal cell carcinoma

Squamous cell carcinoma

Squamous cell carcinoma starts in squamous cells. These are the flat, surface covering cells found in areas such as the skin or the lining of the throat or food pipe (oesophagus).

26_diagram_of_squamous_cells.svg

Adenocarcinoma.

Adenocarcinomas start in glandular cells called adenomatous cells. Glandular cells produce fluids to keep tissues moist. 

24_diagram_of_glandular_cells.svg

Transitional cell carcinoma.

Transitional cells are cells that can stretch as an organ expands. They make up tissues called transitional epithelium. An example is the lining of the bladder. Cancers that start in these cells are called transitional cell carcinoma.

23_diagram_of_transitional_cells.svg

Basal cell carcinoma.

Basal cells line the deepest layer of skin cells. Cancers that start in these cells are called basal cell carcinomas. 

21_diagram_of_basal_cells.svg

Sarcomas start in connective tissues. These are the supporting tissues of the body. Connective tissues include the bones, cartilage, tendons and fibrous tissue that support organs. 

Sarcomas are much less common than carcinomas. There are 2 main types:

• bone sarcomas 
• soft tissue sarcomas

These make up less than 1 in every 100 cancers (1%) diagnosed every year.

Bone sarcomas

Sarcomas of bone start from bone cells.

20_diagram_of_an_osteocyte_-_a_type_of_bone_cell_kf.svg

Read about bone cancers .

Soft tissue sarcomas

Soft tissue sarcomas are rare but the most common types start in cartilage or muscle.

Cancer of the cartilage is called chondrosarcoma. 

32_diagram_showing_cartilage_cells_called_chondroblasts_kf.svg

C ancer of muscle cells is called rhabdomyosarcoma or leiomyosarcoma. 

25_diagram_of_muscle_cells.svg

Find out more about soft tissue sarcomas .

Leukaemias – cancers of blood cells

18_diagram_of_a_white_blood_cell.svg.

Leukaemias are uncommon. They make up only 3 out of 100 of all cancer cases (3%). But they are the most common type of cancer in children.

Find out more about the different types of leukaemia .

Lymphomas and myeloma

Read more about the lymphatic system and how cancer may affect it . 

It happens because some of the lymphatic system white blood cells (lymphocytes) start to divide in an abnormal way. And don't die as they should. These cells start to divide before they become fully grown (mature) so they can't fight infection. 

11_diagram_of_a_lymphocyte.svg

The abnormal lymphocytes start to collect in the lymph nodes or other places such as the bone marrow or spleen. They can then grow into tumours.

Lymphomas make up about 5 out of every 100 cancer cases (5%) in the UK. 

Find out about lymphomas .

Myeloma is a cancer that starts in plasma cells. Plasma cells are a type of white blood cell made in the bone marrow. They produce antibodies, also called immunoglobulins, to help fight infection.

12_diagram_of_a_plasma_cell.svg

Plasma cells can become abnormal and multiply out of control. They make a type of antibody that doesn't work properly to fight infection.

Myeloma makes up about 2 out of every 100 cases of cancer (2%) in the UK.

Find out more about myeloma .

Brain and spinal cord cancers

Cancer can start in the cells of the brain or spinal cord. The brain controls the body by sending electrical messages along nerve fibres. The fibres run out of the brain and join together to make the spinal cord, which also takes messages from the body to the brain.

The brain and spinal cord form the central nervous system. The brain is made up of billions of nerve cells called neurones. It also contains special connective tissue cells called glial cells that support the nerve cells.

The most common type of brain tumour develops from glial cells. It is called glioma. Some tumours that start in the brain or spinal cord are non cancerous (benign) and grow very slowly. Others are cancerous and tend to grow and spread.

19_diagram_of_an_astrocyte_-_a_type_of_glial_cell.svg

Brain and spinal cord tumours make up about 3 out of every 100 cases of cancer (3%) in the UK.

Read more about brain tumours and spinal cord tumours .

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What to know

This page describes U.S. Cancer Statistics and lists tools and databases that present these data.

The United States Cancer Statistics (USCS) are the official federal cancer statistics. They come from combined cancer registry data collected by CDC's National Program of Cancer Registries and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program. These data are used to understand cancer rates and trends, support cancer research, measure progress in cancer control and prevention efforts, focus action on eliminating disparities, and improve cancer outcomes for all.

Why Use U.S. Cancer Statistics?

This video highlights the features of U.S. Cancer Statistics, the official federal cancer statistics.

U.S. Cancer Statistics Data Visualizations tool

The Data Visualizations tool makes it easy for anyone to explore and use the latest official federal government cancer data from USCS. It includes the latest cancer data covering the U.S. population.

• Cancer Rates by US State: See rates of new cancers or cancer deaths for the entire United States and individual states for common cancers. Also, see the top 10 cancers for men and women.
• Demographics: See rates or numbers of new cancers or cancer deaths by race/ethnicity, sex, and age group for all cancers combined or for common cancers.
• Trends: See how the rates of new cancers or cancer deaths changed over time for the entire United States and individual states, for all cancers combined or for common cancers.

Other cancer statistics tools

• CDC WONDER lets you see age-adjusted and crude cancer rates in tabs, maps, and charts. It includes data on adult and childhood cancers by geographic region.
• State Cancer Profiles provides rates of new cancers at a county level, including a description of trends to see if rates are stable, falling, or rising in your area.
• Chronic Disease Indicators provides data for chronic diseases and risk factors that have a substantial impact on public health. In the Cancer category, it shows incidence and mortality for selected cancer types, and prevalence of screening test use. Data are presented by race/ethnicity and state.
• PLACES provides interactive maps for model-based estimates of chronic disease-related measures, including prevalence of cancer and cancer screening test use. PLACES provides model-based population-level analysis and community estimates for all counties, incorporated and census-designated places, census tracts, and ZIP Code Tabulation Areas across the United States.
• The Disability and Health Data System provides state-level health and demographic data about people with disabilities.
• Small Area Health Insurance Estimates provides data publications, interactive visualizations, and maps to help identify areas with high rates of uninsured and under-insured people so programs can help those in greatest need.

Databases available to researchers

• United States Cancer Statistics public use database: You can use SEER*Stat software to analyze population-based incidence data on the entire United States population.
• United States Cancer Statistics Restricted Access Data: This database includes variables that are not in the United States Cancer Statistics public use database, including county at diagnosis, site-specific factors, and prognostic measures. The database is available through CDC's National Center for Health Statistics Research Data Center.

Learn how to lower your cancer risk and what CDC is doing to prevent and control cancer.

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Immune to Cancer: The CRI Blog

Exploring the Different Types of Cancer and Treatment Options

Cancer is a formidable adversary, but our understanding of this disease has come a long way. Cancer comprises over 200 disease types characterized by uncontrolled cell division, each with its unique traits. Despite these distinctions, they share common underlying processes at the core of their development.

Over the last decade, cancer research has undergone a profound transformation. This evolution owes much to the advent and adoption of molecular biology techniques, which have empowered researchers to delve into the intricacies of individual cells in manners inconceivable a century ago. 

Today, our comprehension of cancer extends to the molecular and genetic levels. This expanding knowledge is opening doors to innovative approaches for preventing, delaying, and even rectifying the fundamental alterations that drive cancer.

Whether you’re seeking information on a specific type of cancer or want to expand your knowledge, we’re here to guide you through the labyrinth of cancer types, exploring their diversity and the impact that immunotherapy research has made on cancer patients worldwide. 

The Diverse Spectrum of Cancer Types

Cancer is a complex and multifaceted disease, with hundreds of different types identified to date. Some, like breast cancer and lung cancer, are named based on the specific part of the body where they begin, while others, like glioblastoma and squamous cell carcinoma, are classified according to the type of cell they originate from.

Each type of cancer presents a unique set of challenges. Factors like the location of the tumor, the stage at which it’s diagnosed, and the genetic makeup of the cancer cells all play a crucial role in determining the most effective treatment plan.

Understanding these nuances is essential for both patients and scientists. It’s the key to developing targeted therapies to combat specific cancer types more effectively.

How many types of cancer are there?

There are over 200 distinct types of cancer, each with varying subcategories and unique characteristics. As cancer research progresses, we continue to uncover new insights, expanding our knowledge of this complex disease. While these cancer types are well-documented, ongoing research may reveal additional variations and subtypes as we strive to understand and combat cancer comprehensively.

What are the most common types of cancer?

Breast, lung, bladder, prostate, and colorectal cancers collectively make up nearly half of all new cancer diagnoses in the United States. 

Lung Cancer  

Lung cancer affects approximately 2.1 million people and claims 1.7 million lives annually, ranking as the deadliest cancer worldwide. In the United States alone, 240,000 new cases and 130,000 deaths are estimated in 2023, surpassing the combined mortality of breast, prostate, and colon cancers.

Lung cancer is classified into two major types:

• Small cell lung cancer (SCLC) – 10-15% of cases.
• Non-small cell lung cancer (NSCLC) – 85-90% of cases, with subtypes:
• Adenocarcinoma (40%)
• Squamous cell carcinoma (25-30%)
• Large cell carcinoma (10-15%)

Unfortunately, most lung cancer diagnoses occur at advanced stages (3b/4 or beyond), limiting the effectiveness of traditional treatments like surgery, chemotherapy, and radiation. Advanced-stage patients need innovative treatments like immunotherapy, which has shown promise in clinical trials for extending survival rates.

In 2015, the first immunotherapy treatment received FDA approval for specific lung cancer subsets. Fast forward to today, where multiple immunotherapy options have earned FDA approval, even as first-line therapies, shifting the landscape of lung cancer treatment.

Breast Cancer

Breast cancer, affecting approximately 300,590 individuals in 2023, ranks among the most prevalent cancers in the United States. Shockingly, about 1 in 8 women and 1 in 1,000 men may confront invasive breast cancer at some point in their lives.

In the past, breast cancer posed unique challenges for immunotherapy due to its ‘cold’ immune profile—a term used to describe tumors that were less responsive to these treatments. However, groundbreaking research has unveiled a promising breakthrough.

These studies reveal that combining radiation therapy with two distinct immunotherapies—one designed to boost T cells and another aimed at enhancing dendritic cells—can effectively manage tumors in preclinical models of triple-negative breast cancer.

This particular type of breast cancer has long been resistant to immunotherapy alone, warranting the need for innovative treatments. This shift represents a remarkable advancement, as it taps into the body’s immune system to combat ‘cold’ tumors like never before, opening new avenues for enhancing breast cancer patient outcomes.

Prostate Cancer

Prostate cancer ranks as the world’s second most prevalent cancer among men, affecting approximately 1.3 million individuals and resulting in over 360,000 annual deaths, accounting for 4% of global cancer-related fatalities. In the United States, 2023 is expected to see around 290,000 new cases and over 35,000 deaths, impacting about 1 in 7 men during their lifetimes.

Early-stage prostate cancer exhibits a high degree of treatability, boasting nearly 100% five-year survival rates. This cancer type is typically characterized by its slow growth, often remaining confined within the prostate gland and necessitating minimal or no intervention. In certain instances, the progression of prostate cancer to other parts of the body, particularly the bones (metastasis), may take as long as eight years to manifest. However, for advanced-stage disease, the five-year survival rate diminishes to less than 30%, emphasizing the pressing need for more effective treatment options.

Immunotherapy represents a promising frontier in prostate cancer treatment, featuring two FDA-approved options and ongoing research, especially for metastatic cases. Notably, prostate cancer primarily affects men, but exceptionally rare cases have been reported in women due to specific genetic conditions.

Colorectal Cancer

In the United States, colorectal cancer ranks as the third most common form of cancer and the second most lethal. Globally, there are approximately 1.8 million cases of colorectal cancer diagnosed each year, resulting in over 900,000 deaths. In 2023, it is projected that there will be around 150,000 new cases of colorectal cancer diagnosed, leading to 53,000 colorectal cancer-related deaths in the United States alone.

Colorectal cancer, encompassing both colon and rectal cancer, initiates in the lining of the colon or rectum and can potentially metastasize to other organs and lymph nodes. The majority of colorectal cancers, over 95%, are adenocarcinomas, originating in the mucus-producing glands of the colon or rectum. Lynch syndrome, an inheritable genetic disorder, has been increasingly recognized for its role in the development of colorectal cancer, contributing to approximately 5,000 new cases in the United States annually.

Although both incidence and mortality rates have shown a decline in the past two decades, primarily due to effective screening tests that identify pre- and early-stage disease, the underutilization of these tests means that only 40% of colorectal cancers are detected at an early stage when the survival rate is exceptionally high, at 90%. Therefore, there is an urgent need for new treatments for colorectal cancer.

Melanoma 

Melanoma ranks as the fifth most common cancer among both men and women in the United States. Typically, melanoma is diagnosed around the age of 65, although before the age of 50, it affects more women than men. After turning 50, men experience higher rates of diagnosis.

In 2023, an estimated 97,610 adults in the United States will be diagnosed with invasive melanoma of the skin, with a nearly equal distribution between men (58,120 cases) and women (39,490 cases). Globally, around 324,635 people were diagnosed with melanoma in 2020.

While melanoma predominantly develops in older individuals, it is not limited to this age group. Younger people, including those under 30 years old, can also develop melanoma. In fact, it is one of the most frequently diagnosed cancers among young adults, especially in women. In 2020, an estimated 2,400 cases of melanoma were diagnosed in individuals aged 15 to 29.

While melanoma represents just 1% of all diagnosed skin cancers in the United States, it is responsible for the majority of skin cancer-related deaths. 

Melanoma treatment varies based on the disease’s stage at detection. Early-stage melanoma may be surgically removed, but advanced stages could require more complex treatments. Immunotherapy offers several FDA-approved options for melanoma. These include a range of targeted antibodies and immunomodulators. Each targets specific pathways or proteins to aid in treating advanced melanoma, with some approved for specific patient subsets, including post-surgical and tumor-agnostic cases.

Bladder Cancer

Bladder cancer, the sixth most common cancer in the U.S. and ninth worldwide, typically starts in the bladder’s inner lining cells. As it progresses, it may invade nearby tissues or metastasize to distant organs like the lungs or liver. In 2023, an estimated 82,000 new cases and around 17,000 deaths are anticipated in the U.S. Bladder cancer’s recurrence risk necessitates long-term patient surveillance. Better treatments, such as novel immunotherapies, might reduce recurrence rates and improve the survival of patients with bladder cancer.

The likelihood of developing bladder cancer varies between genders. Men face a higher risk, with approximately a 1 in 28 chance of developing this cancer during their lifetime, whereas women have a lower risk, around 1 in 91. Even though the disease mainly affects men, the underlying reasons for this gender disparity remain unclear. These statistics can be influenced by specific risk factors like smoking or weight, while others, such as age and family history, are beyond your control.

What are the deadliest cancers?

Lung cancer holds the distinction of being the primary cause of cancer-related fatalities in the United States, contributing to approximately 20% of all cancer deaths. Annually, the number of lives claimed by lung cancer surpasses the combined total of deaths from colon, breast, and prostate cancers.

• Deadliest Cancers in Men: The five most dangerous cancers in men are estimated to result in nearly 180,000 fatalities in the U.S. annually. Leading this grim tally is lung cancer, which accounts for approximately 67,160 male deaths. Prostate cancer follows, contributing to around 35,000 deaths. Colon and rectum cancers also pose a significant threat, with an estimated 28,000 male lives lost each year. Pancreatic cancer is not far behind, causing about 26,500 fatalities, while liver and intrahepatic bile duct cancer is responsible for roughly 19,000 male deaths annually. Together, these cancers represent some of the most significant health challenges faced by men today.
• Deadliest Cancers for Women: In women, the five deadliest cancers are projected to claim close to 160,500 lives annually. Lung and bronchus cancer tops the list, with an expected toll of about 60,000 female deaths. Breast cancer, a prevalent concern among women, accounts for approximately 43,00 fatalities. Colon and rectum cancers also have a significant impact, leading to around 24,000 deaths. Pancreatic cancer closely follows, with an estimated 24,000 female lives lost each year. Ovarian cancer, another major health concern, is responsible for roughly 13,300 female deaths. These statistics underscore the critical importance of awareness, research, and treatment advancements in these cancer types for women.

Understanding Rare Cancers

Rare cancers are those that affect fewer than 40,000 people annually in the United States. Collectively accounting for just over a quarter of all cancer cases, rare cancers affect a small number of individuals. 

Most common rare cancers: 

• Kidney Cancer
• Brain Cancer
• Non-Hodgkin lymphoma
• Pancreatic cancer

The journey towards accurately diagnosing rare cancers is often complex and challenging. The relative rarity of these cancers frequently results in delayed recognition by healthcare providers. This not only prolongs the diagnostic process but also impacts the effectiveness of timely treatment. Key factors contributing to this scenario include:

• Accelerating Diagnosis Through Specialized Networks : To combat this, the medical community is rallying around the need for more specialized diagnostic networks. These networks aim to connect primary care doctors with rare cancer specialists, utilizing telemedicine and cross-institution collaborations. By increasing the accessibility of expert opinions and specialized testing, the goal is to shorten the path to accurate diagnosis, allowing for quicker intervention.
• Innovative Treatments Following Early Detection: Post-diagnosis, the promise of immunotherapy stands as a beacon of hope. Groundbreaking immune-based therapies, such as immune checkpoint inhibitors, macrophage therapy, CAR T cell therapy, and neoantigen-based treatments, are emerging as game-changers. However, the true potential of these therapies is best realized when rare cancers are identified early, underscoring the importance of expedited diagnosis.
• Expanding Expertise and Education: To address the scarcity of knowledgeable medical professionals in rare cancer treatment, there’s a push to broaden the education and training of oncologists. This includes specialized fellowships, continuing medical education programs focused on rare cancers and the formation of expert consortia. By doing so, we can foster a generation of healthcare professionals who are not only aware of but also skilled in the nuances of rare cancer care.
• A Beacon of Hope Through Immunotherapy: Immunotherapy trials represent a beacon of hope for patients caught at the crossroads of differing medical opinions. By participating in these trials, patients gain access to cutting-edge treatments that may not yet have widespread consensus but show immense potential. This avenue allows patients to take an active role in exploring innovative clinical trials and therapeutic options.

Immunotherapy research and trials are not only pushing the boundaries of what’s possible in treating rare cancers but also addressing some of the unique challenges patients, doctors, and scientists face. 

The Critical Role of Immunotherapy Research

The landscape of cancer treatment is undergoing a revolution, and at the heart of this transformation is immunotherapy. This innovative approach harnesses the body’s immune system to fight cancer, offering hope for durable responses and even potential cures in cases where traditional treatments may fail. Unlike conventional therapies that indiscriminately attack rapidly dividing cells, immunotherapy targets the cancer more precisely, often resulting in fewer side effects and improved quality of life.

Research in this field is vital for several reasons. It propels the development of new treatments that can be tailored to individual patients, increasing the specificity and effectiveness of cancer care. Furthermore, immunotherapy research expands our understanding of the immune system’s role in cancer development and how it can be reprogrammed or boosted to recognize and combat cancer cells.

The Cancer Research Institute (CRI) leads the way in groundbreaking scientific discoveries, funding every stage of discovery research: basic, transitional, and clinical. This comprehensive approach has yielded major immunotherapy breakthroughs, including checkpoint inhibitors and revolutionizing outcomes for various cancer types. These accomplishments mark significant milestones in cancer treatment and provide a solid foundation for the advancement of novel immunotherapeutic strategies.

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IO-3 Assay Panel Offers Insights Into Immunotherapy Response

Cancer immunotherapies hold promise for inducing durable responses across cancer types, yet their effectiveness varies significantly among patients. In an effort to deepen our understanding of the mechanisms underlying response and resistance to immunotherapy, CPTAC researchers from the Fred Hutchinson Cancer Center (FHCC) and the Frederick National Laboratory for Cancer Research (FNLCR) have developed a novel multiplexed immuno-oncology assay panel known as IO-3. This assay panel, recently featured in Scientific Data , offers a comprehensive and precise method for analyzing immune response.

Study leader Dr. Jeff Whiteaker from the FHCC wrote, “MS has the benefit of being highly specific and multiplexable. Combining MS with immunoaffinity enrichment also improves sensitivity for low abundance analytes, greatly expanding the utility of this approach.”

The IO-3 panel was designed to target 43 peptides representing 39 immune- and inflammation-related proteins-of-interest. All viable peptides are unique to each protein-of-interest, and the final 43 peptides were selected based on a variety of factors including tryptic status, hydrophobicity, and certain post-translational modifications.

The panel was rigorously characterized and validated, with all the data available to the public . This includes features like antibody performance, mass spectrometer parameters, and reagent information. The researchers hope the availability of this data facilitates the widespread use of IO-3 assays in future research efforts. 

This IO-3 panel also builds upon previous work done by the FHCC lab, including their IO-1 and IO-2 assay panels. Used together, these three panels allow for analysis of 132 immuno-modulatory proteins from a given biospecimen. Taken individually or as a set, these assays have the potential to support the identification of new biomarkers, enable the prediction of adverse events, aid mechanistic studies aimed at tumor susceptibility, and more.

Looking forward at potential impacts, Dr. Whiteaker commented “these assays will provide highly robust protein measurements in clinical trials and exploratory studies, aiding our understanding of immunotherapy response and immune-related adverse events.”

All the antibodies were further characterized by the Antibody Characterization Laboratory at FNLCR to provide additional information about the antibodies and their potential use in other biological assays such as western blot, IHC, flow cytometry and Immunofluorescence, to name a few. All the resulting data, both positive and negative is made available on the NCI’s antibody portal . 

FNLCR’s ACL director, Dr. Simona Colantonio describes the ACLs role in the characterization of these antibodies. “Approximately 40% of the antibodies produced using peptides for the purpose of immunoaffinity enrichment in targeted MS assays, also recognize the corresponding full-length protein, which broadens its utility to the researcher, allowing it to be used in other biological assays.”  

Classification of Cancer Types Based on RNA HI-SEQ Data Using Dimensionality Reduction

• Conference paper
• First Online: 20 August 2024
• Cite this conference paper

• Zannatul Ferdous Tunny   ORCID: orcid.org/0000-0003-4632-8709 8 ,
• MD Abir Hasan Munna   ORCID: orcid.org/0000-0002-8208-3828 8 ,
• MD. Shahadat Hossain 8 ,
• Roksana Akter Raisa   ORCID: orcid.org/0000-0002-0256-5035 8 ,
• Muhammad Arifur Rahman   ORCID: orcid.org/0000-0002-6774-0041 9 &
• David J. Brown   ORCID: orcid.org/0000-0002-1677-7485 9  

Part of the book series: Communications in Computer and Information Science ((CCIS,volume 2065))

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• International Conference on Applied Intelligence and Informatics

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Many attempts have been made to enhance the accuracy of cancer classification through the use of gene expression data. However, the use of extensive data increases the potential for data overfitting, highlighting the need for more efficient approaches. This paper aims to find a more convenient method to classify the genome sequencing datasets. We have used three types of dimensionality reduction to reduce the feature number to make the dataset effective to use. We used the Pancan Hi-sequence dataset, which included 801 cases and 20531 genes for each case, resulting in fewer principle components using PCA, t-SNE, and UMAP. Initially, the data was transformed from a high-dimensional feature space to a lower-dimensional one through the reduction processes. Subsequently, the reduced features were assessed using both linear and non-linear SVM models with various kernels, resulting in an almost 99% accuracy rate.

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Zannatul Ferdous Tunny, MD Abir Hasan Munna, MD. Shahadat Hossain & Roksana Akter Raisa

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Tunny, Z.F., Munna, M.A.H., Hossain, M.S., Raisa, R.A., Rahman, M.A., Brown, D.J. (2024). Classification of Cancer Types Based on RNA HI-SEQ Data Using Dimensionality Reduction. In: Mahmud, M., Ben-Abdallah, H., Kaiser, M.S., Ahmed, M.R., Zhong, N. (eds) Applied Intelligence and Informatics. AII 2023. Communications in Computer and Information Science, vol 2065. Springer, Cham. https://doi.org/10.1007/978-3-031-68639-9_20

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Recent developments in cancer research: Expectations for a new remedy

1 Department of Surgery and Science, Kyushu University, Fukuoka Japan

Qingjiang Hu

Yuta kasagi, masaki mori.

Cancer research has made remarkable progress and new discoveries are beginning to be made. For example, the discovery of immune checkpoint inhibition mechanisms in cancer cells has led to the development of immune checkpoint inhibitors that have benefited many cancer patients. In this review, we will introduce and describe the latest novel areas of cancer research: exosomes, microbiome, immunotherapy. and organoids. Exosomes research will lead to further understanding of the mechanisms governing cancer proliferation, invasion, and metastasis, as well as the development of cancer detection and therapeutic methods. Microbiome are important in understanding the disease. Immunotherapy is the fourth treatment in cancer therapy. Organoid biology will further develop with a goal of translating the research into personalized therapy. These research areas may result in the creation of new cancer treatments in the future.

Cancer research has made remarkable progress and new discoveries are beginning to be made. In this review, we will introduce and describe the latest novel areas of cancer research: exosomes, microbiomes, immunotherapy, and organoids.

1. INTRODUCTION

The cancer research field has developed significantly through use of new equipment and technology. One example of new technology is Next‐Generation Sequencing (NGS). Also known as high‐throughput sequencing, NGS is the catch‐all term used to describe a number of different modern nucleic acid sequencing technologies. These methods allow for much quicker and cheaper sequencing of DNA and RNA compared with the previously used Sanger sequencing, and as such have revolutionized the study of genomics and molecular biology. NGS also allows for easier detection of mutations in cancer samples, leading to development of many new agents that can be used to treat patients. For example, if the RAS gene status is detected as wild type in a colorectal cancer patient, then an anti‐EGFR antibody, such as cetuximab or panitumumab, can be used for treatment.

A liquid biopsy, also known as fluid biopsy or fluid phase biopsy, is the sampling and analysis of non‐solid biological tissue, primarily blood. 1 It is being used as a novel way to detect cancer. Like a traditional biopsy, this type of technique is mainly used as a diagnostic and monitoring tool for diseases, and also has the added benefit of being largely noninvasive. Therefore, liquid biopsies can be performed more frequently, allowing for better tracking of tumors and mutations over a duration of time. This technique may also be used to validate the effectiveness of a cancer treatment drug by taking multiple liquid biopsy samples in the span of a few weeks. It may also prove to be beneficial for monitoring relapse in patients after treatment.

Novel devices and drugs have also been developed and used for cancer treatment. For surgery procedures, robotic‐assisted laparoscopic surgery has evolved and made it possible to visualize the fine movement of the forceps in three dimensions. This method is now used in esophageal, gastric, and rectal cancer surgeries in Japan. 2 , 3 , 4

Recently, immunotherapy became an additional method for treating cancer patients. The discovery of the immune checkpoint by Dr Honjo led to the development of immune checkpoint inhibitors. 5 Despite these developments, gastrointestinal cancers are still a major problem in need of new treatment methods. In this review, we introduce and describe four new areas of cancer research that may contribute to cancer treatment in the future: exosomes, microbiome, immunotherapy, and organoids.

2. AN APPLICATION OF EXOSOME RESEARCH IN CANCER THERAPY

An exosome is a small particle that is secreted by cells. Its size can range from 50 to 150 nm and has a surface consisting of proteins and lipids that originate from the cell membrane. Additionally, proteins and nucleic acids, such as DNA, microRNAs, and mRNAs, can be found inside the exosome as its “cargo.” 6 Recently, many researchers have discovered that exosomes are involved in the mechanisms of various diseases. As mentioned above, various functional compounds, such as microRNAs, mRNAs, and proteins, can be contained within exosomes. 7 , 8 Many cells use secretion of exosomes to communicate with one another, and these exosomes can even reach distant cells. Cancer cells can also secrete exosomes that contain molecules beneficial to cancer growth. For example, microRNAs found in cancer exosomes can modulate gene expression to induce angiogenesis in the tumor microenvironment, which supports metastasis. 9 Exosomes released from cancer cells can also reportedly break the blood‐brain barrier, which makes it contribute to brain metastasis. 10 , 11 Cancer cells themselves are similarly affected by the exosomes secreted by the surrounding normal cells. 12 In one case, the exosomes secreted by bone marrow‐delivered mesenchymal stem cells can force cancer cells into a dormant state. 13 These dormant cancer cells become resistant to chemotherapy and are involved in long‐term disease recurrence. Thus, exosomes are deeply involved in cancer proliferation, invasion, and metastasis, as well as in the formation of the tumor microenvironment and pre‐metastatic niche. 13 Further research on cancer‐related exosomes is ongoing.

Knowledge of exosomes can be applied to cancer treatment. If the secretion of exosomes from cancer cells can be prevented, then signal transduction supporting the formation of the tumor microenvironment and pre‐metastatic niche can be blocked. Work focusing on the removal of cancer exosomes is now ongoing. 14

Exosomes can also be utilized for cancer diagnosis. Exosomes secreted by many cell types are found in various body fluids, such as blood and urine. Capturing and analyzing exosomes from cancer cells can be used to detect the presence of disease. 15 Obtaining blood or urine from patients is not very invasive or painful. Since many molecules, such as various proteins, DNA, and microRNAs, can be found in exosomes from normal cells, it is important to distinguish them from cancer‐related ones. If exosomes are to be used for cancer diagnosis, then specific biomarkers need to be discovered. Additionally, the development of a method to detect these exosomes must be done. Currently, exosome detection methods for exosomes abundantly found in the serum of colorectal and pancreatic cancer patients, as well as exosomes found in the urine of bladder cancer patients, are being developed. 16 , 17 Thus, further understanding of the mechanisms governing cancer proliferation, invasion, and metastasis, as well as the development of cancer detection and therapeutic methods, is significantly affected by exosome research.

3. MICROBIOME IN CANCER RESEARCH

A large number of microorganisms inhabit the human body. These microorganisms include bacteria, viruses, and fungi. Among them, bacteria have the most important relationship with the human body. Bacteria can live anywhere within the human body, including the digestive tract, respiratory system, and oral cavity. 18 , 19 , 20 In particular, bacteria in the digestive tract are rich in type and number, 21 with possibly 1000 types and more than 100 trillion individual bacterial cells present. 22 , 23 The overall population of various bacteria found in the human intestine is referred to as the “intestinal flora.” Recently, the terms “microbiota” or “microbiome” have also been widely used.

Recent advancements with NGS have led to a much more precise understanding of the intestinal microbiome. 24 The bacteria in the human microbiome mainly belong to four phyla: Firmicutes, Bacteroidetes, Proteobacteria, and Actinobacteri. Of these, Firmicutes and Bacteroidetes are the most dominant species. It is reported that microbiome vary depending on age and race. 25 , 26 Dysbiosis is a condition in which the diversity of the microbiome is reduced. Dysbiosis is reportedly involved in various diseases such as inflammatory bowel disease, colorectal cancer, obesity, diabetes, and allergic diseases. 27 , 28 , 29 For example, bacteria such as Atopobium parvulum and Actinomyces odontolyticus increase in number during the early stages of colorectal cancer (adenomas or intramucosal cancers) and decrease in number during cancer progression. 30 This suggests that a specific microbiome is associated with early stages of colorectal cancer development, which may be useful knowledge for early cancer detection.

Various studies have also been conducted to elucidate the relationship between the microbiome and the human immune system. 31 The IgA antibody, which is one of the most important elements in the intestinal immune system, is believed to play a role in the elimination of pathogens and maintenance of the intestinal environment. The IgA antibody recognizes, eliminates, and neutralizes pathogenic bacteria and toxins. It also maintains a symbiotic relationship by recognizing and binding to the normal microbiome of the host. 32 Mice lacking a microbiome have reduced production of the IgA antibody. A microbiome is required for IgA antibody differentiation. Recent studies have identified W27IgA antibodies that have the ability to bind to various bacteria. 33 Oral administration of a W27IgA antibody to enteritis model mice suppressed enteritis by altering the microbiome. This W27IgA antibody can recognize a part of the amino acid sequence of serine hydroxymethyl transferase, which is a metabolic enzyme involved in bacterial growth. The W27IgA antibody can suppress the growth of E coli by binding to them. However, the W27IgA antibody does not bind to bacteria that suppress enteritis, such as bifidobacteria and lactic acid bacteria. 33 Thus, the microbiome is deeply involved in human intestinal immunity. Recently, it is having been established that the microbiome is not only involved in intestinal immunity, but also in the systemic immune system.

As the analysis of the microbiome progresses, the pathophysiology of various diseases, such as cancers, and its relationship with the regulatory function of the human immune system will be further elucidated. It has been demonstrated that F nucleatum plays a role in the development and progression of colon adenomas and colorectal cancer. It is also related to lymph node metastases and distant metastasis. 34 , 35 Also, microbiome is associated with hepatocellular carcinoma. 36 Studying microbiome will give us some clue in the development and remedy for gastrointestinal cancers (Table  1 ).

Gastrointestinal cancer and their related microbiome

4. THE RISE OF IMMUNOTHERAPY IN CANCER TREATMENT

For many years, surgery, chemotherapy, and radiation therapy were the main methods of cancer treatment. In addition to these therapies, immunotherapy has recently attracted great attention worldwide (Table  2 ). 37 , 38 Under normal circumstances, a cancer antigen will activate the patient's immune system to attack the cancer cells. However, sometimes the immune system does not recognize the cancer cells as non‐self, or it simply fails to attack them. This can result in the development and progression of cancer.

Immune checkpoint inhibitors

Although therapies that activate the immune system against cancer cells have been studied for a long time, the use of the patient's own immune system for cancer treatment was not established. Recently, the effectiveness of both immune checkpoint inhibition therapy and chimeric antigen receptor (CAR)‐T cell therapy has proved to be promising. 39 , 40 Immunotherapy has moved to the forefront of cancer treatment strategies.

There are two major reasons why proving the efficacy of cancer immunotherapies was difficult for some time. First, cancer immunity is strongly suppressed. Signal transduction from immune checkpoint compounds, such as PD‐1 and CTLA4, strongly inhibits cytotoxic T cells (CTLs). 38 This checkpoint mechanism can prevent the immune system from attacking cancer cells. The development of immune checkpoint inhibitors has arisen from the discovery of this mechanism. Inhibition of immune checkpoint molecules with neutralizing antibodies can release the suppression of cancer‐specific CTLs, activate immunity, and promote cancer elimination. The effectiveness of immune checkpoint antibodies has been confirmed and clinically applied to many solid cancers such as melanoma, 41 lung cancer, 42 urothelial cancer, 43 gastric cancer, 44 and esophageal cancer. 45 In addition to PD‐1 and CTLA4, new immune checkpoint molecules, such as LAG3, TIGIT, and SIRPA, are also being actively studied. 46 , 47 , 48 Although this therapy is promising, the cancer cases who respond to these therapies are limited. This is because use of this therapy requires the presence of cancer‐specific CTLs in the patient's body. To maximize the therapeutic effect, it is desirable to select appropriate cases and develop useful biomarkers.

The second difficulty for immunotherapy is that T cells do not recognize specific cancer cell antigens and immune accelerators are too weak. One goal of CAR‐T cell therapy is to strengthen the immune accelerator by administering CTLs to the patient's body that recognize specific cancer cell‐specific antigens. A CAR is prepared by fusing a single chain Fv (scFv), derived from a monoclonal antibody that recognizes a specific antigen expressed by cancer cells, with CD3z and costimulatory molecules (CD28, 4‐1BB, and others). Next, the CAR is introduced to the T cells obtained from a cancer patient and CAR‐T cells are made. CAR‐T cells recognize the specific antigen of the cancer cells and are activated to damage these cells. CAR‐T cells recognize cancer‐specific antigens with high antibody specificity and attack the respective cancer cells with strong cytotoxic activity and high proliferative activity. CAR‐T therapy is effective in blood cancers such as B‐cell acute lymphoblastic leukemia and myeloma. 49 , 50 While CAR‐T cell therapy has a high therapeutic effect, a frequent and serious adverse event called cytokine release syndrome has been observed in some patients. 51 , 52 The development of a technique for suppressing the occurrence of cytokine release syndrome is anticipated. In addition, the development of CAR‐T cell therapies for solid tumors is ongoing.

Recently, there was new progress made in treating gastrointestinal cancer patients. For MSI‐H colorectal cancer, the combination therapy with nivolumab and ipilimumab was approved. From the nivolumab plus ipilimumab cohort of CheckMate‐142, progression‐free survival rates were 76% (9 months) and 71% (12 months); respective overall survival rates were 87% and 85% which were quite high. This new treatment will benefit MSI‐H colorectal cancer patients. 53

Thus, it is expected that further understanding of cancer immune mechanisms and the development of various immunotherapies will contribute to great progress in cancer treatment.

One problem for immunotherapy is that there is no certain predictive biomarker. It was thought that the expression of PD‐1 or PD‐L1 would predict the effect. However, this was not the case. To find a new biomarker, we assessed the cytolytic activity (CYT) score. The CYT score is a new index of cancer immunity calculated from the mRNA expression levels of GZMA and PRF1. We are now evaluating CYT score in gastric cancer patients (data not published). The development in the biomarker search will benefit many gastrointestinal cancer patients.

5. ADVANTAGES FOR USING ORGANOIDS IN CANCER RESEARCH

The three‐dimensional (3D) organoid system is a cell culture‐based, novel, and physiologically relevant biologic platform. 54 An organoid is a miniaturized and simplified version of an organ that is produced in vitro in 3D and shows realistic microanatomy. With only one to a few cells isolated from tissue or cultured cells as the starting material, organoids are grown and passaged in a basement membrane matrix, which contributes to their self‐renewal and differentiation capacities. 54 , 55 The technique used for growing organoids has rapidly improved since the early 2010s with the advent of the field of stem cell biology. The characteristics of stem, embryonic stem cells (ES cells), or induced pluripotent stem cells (iPS cells) that allow them to form an organoid in vitro are also found in multiple types of carcinoma tissues and cells. Therefore, cancer researchers have applied ES cells or iPS cells in their field. 56 , 57 , 58

Organoid formation generally requires culturing stem cells or their progenitor cells in 3D. 54 , 55 The morphological and functional characteristics of various types of carcinoma tissue have been recapitulated in organoids that were generated from single‐cell suspensions or cell aggregates. These suspensions or aggregates were isolated from murine and human tissues or cultured cells, as well as from cancer stem cells propagated in culture. The structures of the organoids show the potential of cancer stem cell self‐renewal, proliferation, and differentiation abilities, and also provide insights into the roles of molecular pathways and niche factors that are essential in cancer tissues. 56 , 57 , 59 , 60 , 61 , 62 The organoid system also has been utilized for studying multiple biological processes, including motility, stress response, cell‐cell communications, and cellular interactions that involve a variety of cell types such as fibroblasts, endothelial cells, and inflammatory cells. These interactions are mediated via cell surface molecules, extracellular matrix proteins, and receptors in the microenvironment under homeostatic and pathologic conditions.

Although the organoid system is a complex and not effortless procedure that requires specific media, supplements, and many tricky techniques, 58 , 63 application of this system has been extended to a variety of cell types from different carcinomas (colorectal, pancreatic, prostate, breast, ovary, and esophageal cancers). 56 , 57 , 59 , 60 , 61 An organoid is generally induced within a few days to weeks, and is faster and less costly than the murine xenograft assay. Furthermore, applying novel genetic manipulations (e.g. CRISPR‐Cas9) can be carried out in the organoid system. 64 , 65

Kasagi et al modified keratinocyte serum‐free medium to grow 3D organoids from endoscopic esophageal biopsies, immortalized human esophageal epithelial cells, and murine esophagi. Esophageal 3D organoids serve as a novel platform to investigate regulatory mechanisms in squamous epithelial homeostasis in the context of esophageal cancers. 64

We anticipate that many experimental results that utilize the organoid system will be published in the future.

The 3D organoid system has emerged in the past several years as a robust tool in basic research with the potential to be used for personalized medicine. 66 By passaging dissociated primary structures to generate secondary 3D organoids, this system can be performed using live tissue pieces obtained from biopsies, operative‐resected specimens, or even frozen tissues. This method has the potential to transform personalized therapy. For example, in the case of cancer recurrence, an effective chemotherapy can be selected by testing the chemotherapeutic sensitivity of cancer‐derived organoids from an individual patient's tissue stocks. In many cases, a patient's organoid accumulation is helpful for testing the sensitivity of novel therapeutic agents for treating carcinoma. 66 Hence, it appears that organoid biology will further develop with a goal of translating the research into personalized therapy.

6. SUMMARY AND FUTURE DIRECTIONS

This review describes four new cancer‐related studies: exosomes, microbiome, immunotherapy, and organoids (Figure  1 ).

The summary of the four cancer research areas. In this figure the summary of the four cancer research areas is shown: exosome, microbiome, immunotherapy, and organoid research

Since exosomes are released in blood or urine, if the capturing system is established, it will be a less invasive test to diagnose cancer. In the present, the presence of circulating tumor DNA (ctDNA) is one of the tools to detect the minimal residual disease. However, since ctDNA is only DNA, it is difficult to spread to cancer research. In that respect, as exosomes include not only DNA but also other nucleic acids and proteins, this will be a new tool for cancer research such as the diagnosis of early cancer.

Microbiome may lead to improved cancer diagnosis and treatment. Detecting a specific microbiome in a gastrointestinal tract may predict a specific cancer. And changing microbiome in some way may result in preventing cancer development.

Organoids may help address the problem of drug resistance, and also lead to the development of personalized therapy. However, producing organoids takes time and testing the drug resistance may take more time. If we could overcome these problems, the research into organoids can contribute to overcoming cancer.

As shown in Table  3 , many new studies and findings are reported into this field of research. These four novel cancer research areas will make many contributions to the diagnosis and treatment of cancer.

Recent studies on exosome, microbiome, immunotherapy, and organoids

Conflict of Interest: All the authors have no conflict of interest to disclose.

ACKNOWLEDGMENTS

We thank Dr Hirofumi Hasuda and Dr Naomichi Koga for their help in preparing this manuscript. We also thank J. Iacona, PhD, from Edanz Group for editing a draft of this manuscript.

Ando K, Hu Q, Kasagi Y, Oki E, Mori M. Recent developments in cancer research: Expectations for a new remedy . Ann Gastroenterol Surg . 2021; 5 :419–426. 10.1002/ags3.12440 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]

Some types of HPV may affect men's fertility, new study suggests

Scientists have long considered that the world’s most common sexually transmitted infection, human papillomavirus, or HPV, may be a driver of infertility.

Most research about HPV’s potential impact on fertility has focused on women. But in recent years, researchers have increasingly expanded their focus to include the infection’s association with male fertility.

A new study from Argentinian researchers has found that the strains of HPV considered high risk because of their links to cancer were not only more common than low-risk strains in a small study population of men, they also appeared to pose a greater threat to sperm quality.

The study, published Friday in Frontiers in Cellular and Infection Microbiology, found that high-risk HPV appears to suppress key components of the immune system in the male genital tract. This could hamper the body’s ability to clear HPV , a process that typically takes about six months to a year after infection, while raising the risk of other infections that may also compromise male fertility.

“Individuals often have no symptoms or signs, yet still carry HPV in the male genital tract,” said the study’s senior author, Virginia Rivero, a professor of immunology at the National University of Córdoba in Argentina.

A 2020 systematic review of 50 studies found that 21% of infertile men had HPV-positive semen, compared with 8% in the general male population. Even after accounting for female infertility, men with HPV in their semen had three-fold greater odds of being infertile than those without the virus.

There are over 200 known strains of HPV. The riskiest handful can cause multiple cancers, including, in the U.S., about 26,000 diagnoses in women and 21,000 in men each year, according to the Centers for Disease Control and Prevention. The most common HPV-driven malignancy is cervical cancer, with about 13,800 invasive cases annually. Research suggests that most people are unaware that the virus can also cause vulval, anal, throat, vaginal and penile cancer .

A vaccine for HPV has been available since 2006 , when it was initially recommended just for girls; the recommendation was expanded to boys in 2011. The current version, which is given in a two- or three-dose series, prevents nine of the riskiest HPV strains, including those that cause genital warts.

The CDC recommends routine HPV vaccination for all boys and girls at 11 or 12 years old — children can receive it at as young as age 9 — and for those through age 26 who were not previously fully vaccinated. Experts consider the vaccine exceptionally safe .

A CDC study published Thursday found that for adolescents born in 2007, about 65% were fully vaccinated for HPV by age 15, compared with 60% of those born in 2008. The CDC attributes this statistically significant difference to disruptions from the Covid pandemic, beginning when the younger group turned 12.

Vaccination at older ages typically provides less benefit, since so many people contract at least one strain of HPV after becoming sexually active. But the CDC suggests that people up to age 45 may still discuss potential vaccination with their doctors. 

High-risk HPV lowers immune cells

In her new study, Rivero and her colleagues studied the ejaculate samples of 205 men, none of whom were vaccinated for HPV. The men, who had a median age of 35, sought a fertility assessment or treatment for urinary-tract problems from 2018 to 2021 at a urology clinic in Argentina.

Thirty-nine, or 19%, of the men tested positive for HPV. Researchers were able to identify 20 men among them who had high-risk strains and seven men with low-risk HPV.  

On the surface, the investigators didn’t find any notable differences in the semen quality between the men with either type of HPV and a group of 43 men who tested negative for the virus. When they examined the semen more closely with highly sensitive tools, they found clues suggesting how high-risk HPV strains might be influencing male infertility.

The men with high-risk HPV had a lower level of certain immune cells in their semen, suggesting the virus had hampered the body’s ability to fight it off. This suppression of immune cells might also have raised the men’s risk of other infections that could further compromise their ability to conceive.

There was also evidence that the sperm of the men with high-risk HPV were sustaining damage from what’s known as oxidative stress. This could explain why these men had a higher level of dead sperm compared with those who didn’t have the virus.

Dr. Eugenio Ventimiglia, a urologist at the Università Vita-Salute San Raffaele in Milan, Italy, said the new study, which he was not involved in, “provides insight into the biological mechanisms potentially linking HPV to male reproductive health issues.” 

Nevertheless, he said its findings should be “interpreted cautiously.”

“Instead of conclusively proving a cause-effect relationship between HPV and male factor infertility, the study’s findings are more appropriately seen as generating hypotheses for further research,” Ventimiglia said.

Can vaccination protect men's fertility?

Men’s HPV might also affect fertility in part by transmitting the virus into the woman’s reproductive tract; the virus might then harm the pregnancy at various stages, including before the fertilized egg implants in the womb. Couples receiving assisted reproductive technology have a greater chance of miscarriage if the man has HPV in his semen, researchers have found .

Research indicates that providing the HPV vaccine to men who are having trouble conceiving and who have an active HPV infection might help them clear the virus faster and potentially improve their chances of conceiving.

“Whatever other changes are thought to be associated with HPV, it should be noted that HPV infection is usually brief, as is the sperm lifespan,” said Dr. Marie-Hélène Mayrand, an epidemiologist and the chair of the obstetrics and gynecology department of University of Montreal. “This is reassuring that any effect, if found, would be brief and self-limited.” Mayrand was not involved in the new research.

Rivero advises that men struggling with fertility receive testing for HPV and other sexually transmitted infections that could affect their fertility. If positive for HPV, additional testing may be needed to identify specific strains. 

The test results, Rivero said, could help men identify a potential driver of their infertility. 

HPV vaccination rates among adolescent boys and men have been rising over the last decade. Recent research suggested that the HPV vaccine was linked to a drastically lower rate of head and neck cancers in men and adolescent boys. 

It’s not yet known if the vaccine could protect men’s fertility. 

“When a critical mass of boys and girls are vaccinated, it is likely that the transmission of the HPV genotypes covered by the vaccines will decrease.” Rivero said. “But the broader impact on fertility remains uncertain.”

Rivero said she hoped to see a larger study in the future that could lend more statistical heft to her findings. Her own lab plans to further study how simultaneous infections with HPV and other STIs might influence male fertility.

CORRECTION: (Aug. 23, 2024 10:50 a.m. ET)  A previous version of this article misidentified Dr. Eugenio Ventimiglia. He is a urologist at the Università Vita-Salute San Raffaele, not an oncologist in the urology unit.

Benjamin Ryan is independent journalist specializing in science and LGBTQ coverage. He contributes to NBC News, The New York Times, The Guardian and Thomson Reuters Foundation and has also written for The Washington Post, The Nation, The Atlantic and New York.

• Open access
• Published: 23 August 2024

Chemotherapy delays among cancer patients in Iran during COVID-19 pandemic

• Moein Rast 1 ,
• Pedram Fadavi 2 ,
• Marzieh Nojomi 1 ,
• Donya Hatami 1 ,
• Kiarash Ansari 1 ,
• Seyyed Amir Yasin Ahmadi 1 &
• Arash Tehrani-Banihashemi 1  

BMC Public Health volume  24 , Article number:  2299 ( 2024 ) Cite this article

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Background and objectives

Following the outbreak of COVID-19, a set of restrictions, health advice, and limitations were put in place to reduce the spread of the virus. These restrictions, together with fear and anxiety of the population, limited people’s access to public services such as health care services. Cancer patients during this era are a significant concern due to being at high risk for COVID-19 infection and also being exposed to delays in their diagnosis, treatment, and follow-ups. Delays in the treatment of cancer could lead to a poorer prognosis. In this study, we attempted to determine the magnitude of delays in chemotherapy and factors associated with delays during the COVID-19 pandemic.

All patients diagnosed with colorectal, lung, gastric cancer, and lymphoma who had chemotherapy at teaching hospitals of Iran University of Medical Sciences (IUMS) between February 20, 2020, and March 20, 2022, were included. Age, gender, cancer type, having metastatic cancer, and date of each chemotherapy session were included for each patient individually. Every session with delays longer than two days was recorded. A three to six-day delay was considered a moderate delay, and a seven-day or longer delay was considered a severe delay in receiving each chemotherapy session. Additionally, each patient’s total number of delays in the entire course was calculated. Logistic regression was used to examine the impact of pandemic waves on delays. On the other hand, Poisson regression was used to evaluate the number of delays in the entire course of chemotherapy.

The research findings indicated an association between the male gender and having metastasis with a higher likelihood of a moderate delay in the treatment regimen. Regarding cancer type, colorectal cancer was associated with higher rates of moderate delays (IRR = 1.88, P  < 0.001), but gastric (IRR = 0.75, P  = 0.001) and lung cancer (IRR = 0.59, P  = 0.002) were associated with reduced rates of severe and moderate delays, respectively. Compared to the COVID-19 pandemic plateau periods, the first (OR = 2.08, P  < 0.001), third, and fifth waves of the pandemic were associated with increased delays.

We found an association between the male gender, colorectal cancer, metastatic disease and higher rates of moderate delays. The initial COVID-19 pandemic wave was associated with increased severe delays in the chemotherapy course. According to the findings of this study, male cancer patients and those with metastatic cancer are at risk of poorer prognosis due to lower adherence to treatment. These findings can assist policymakers in developing targeted strategies to lessen the delay rates in the more vulnerable population.

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The outbreak of the COVID-19 virus started in late December 2019, and the WHO declared it a pandemic on 11 March 2020 [ 1 ]. Respiratory disease caused by COVID-19 had a high transmissibility and mortality. Various limitations, guidelines, and health recommendations, including mask wear and social distancing, were implemented during the pandemic to lower the disease’s prevalence [ 2 ]. Limited public transportation, limited working hours, and complete lockdowns in severe circumstances, together with people’s fear of the COVID-19 virus, restricted people’s access to any public services and, on top of that, health care services. On the other hand, the high number of COVID-19 patients and the large burden of the COVID-19 pandemic on hospitals deregulated the routine delivery of healthcare services, which led to poorer overall performance of healthcare systems in different aspects [ 3 , 4 ].

The severity of COVID-19 infection varies in different populations. Having an underlying illness, in particular cancer, or being immunocompromised is one of the risk factors for higher infection rates and severe COVID-19 respiratory disease [ 5 ]. During the pandemic, cancer patients experienced a high degree of anxiety, which may have led to poorer treatment compliance, delay in cancer treatment, and therefore worsening of overall prognosis [ 6 , 7 ]. Early diagnosis, treatment and regular follow-up after treatment can lead to better overall outcomes and prognosis of cancer [ 8 ]. Cancer patients are a major reason for concern due to their underlying disease and the significance of their scheduled treatment plan. Any delay or interruption in cancer treatment would impact the overall prognosis and survival [ 9 ]. According to the World Bank, during the COVID-19 pandemic, Iran was classified as a Lower-Middle-Income Country (LMIC) [ 10 ]. During the pandemic, low- and middle-income countries faced significant challenges in treating cancer patients due to increased pressure on hospitals, disrupted supply chains, and exacerbated financial issues [ 11 , 12 ].

Using the findings of this study, healthcare systems can create more effective treatment plans and general preventative measures, especially for high-priority patients who are more likely to have a delay during similar circumstances. In this study, we attempted to determine the magnitude of treatment delay caused by the COVID-19 pandemic in three teaching hospitals in Tehran, Iran, which is an LMIC and the parameters associated with treatment delay.

Study design

This retrospective observational study using universal sampling included all patients undergoing chemotherapy for cancers such as lung, lymphomas, gastric, and colorectal from February 20, 2020, to March 20, 2022, at 3 teaching hospitals of Iran University of Medical Sciences (IUMS) in Tehran, Iran. All patients below 18 and over 80 years old were excluded. Due to inadequate data about the duration of their cycle and incomplete patient information, patients who underwent chemotherapy for two or fewer sessions were also excluded. Data regarding each patient’s cancer type, chemotherapy cycle length, and demographic features (such as age and gender) were gathered using patient records from the hospitals. Metastasis of the underlying cancer to another organ (referred to as “metastatic cancer” in this study) was used as one of the indicators of the disease stage.

COVID-19 waves in Iran

This study included COVID-19 waves in Iran to measure the association of the COVID-19 pandemic with chemotherapy delays among cancer patients. According to the Coronavirus Control Operations Headquarters in Iran, the country experienced six waves of COVID-19 during the pandemic [ 13 ] (Table  1 ). Also, in this study, each scheduled session of chemotherapy was determined in the aspect of being during each wave of COVID-19.

Measured delays

Based on chemotherapy cycle length, scheduled chemotherapy session dates were defined. A latency period was determined by calculating the number of days between the actual dates that the patient received chemotherapy and its relative scheduled date; a latency period of two days or less was disregarded, and a latency period of 3 days or more was generally considered as a delay in each chemotherapy session. In this study, 3 to 6 days of delay in each session was considered a moderate delay and a delay of 7 days or more was considered a severe delay. Before the pandemic, median delays of 7 days were common, and any delays longer than that are not recommended and might be associated with lower survival rates [ 14 ].

The number of delayed sessions for each patient (moderate and severe separately) was also counted to measure the effect of age, gender, metastasis, and cancer type on the number of times a patient experienced delays in their entire course of chemotherapy.

All data was analyzed using STATA version 17 (Stata Corp). To evaluate the effect of age, gender, metastasis, and cancer type on experiencing at least one delay throughout the entire course of chemotherapy (compared to not experiencing any delays in the whole course (a dichotomous outcome)), t-tests and chi squire were used. Also, to evaluate the association of said variables with the quantitative number of delayed sessions for each patient (moderate and severe separately) the Poisson regression model and Incidence Rate Ratio (IRR) were used.

A random-effect multiple logistic regression was performed to evaluate the effect of COVID-19 pandemic waves on the incidence of delay in each session. A chemotherapy session was defined during the COVID-19 waves if the scheduled date of the chemotherapy session was during one of the COVID-19 waves. As a result, if the scheduled date of the chemotherapy session was between two waves, the chemotherapy session was included in the COVID-19 pandemic plateau. For that model, panel data was defined from grouping sessions by their unique patient ID code. Also, age, gender, metastasis, and type of cancer were used as covariates in that model.

After data collection, 670 patients were selected, of which 16 met the exclusion criteria. In this article, 654 patients underwent chemotherapy sessions. Of this total, 246 patients (37.61%) were female. The average age of cancer patients was 57.05 years (SD = 12.73). In this study, 79 patients (12.08%) had metastatic cancer. Regarding cancer type, 260 patients (39.76%) had colorectal cancer, 221 patients (33.79%) had gastric cancer, 54 patients (8.26%) had lung cancer, and 119 patients (18.20%) had lymphoma (Table  2 ).

Overall, there were 2407 delayed sessions (53.08%). The median days of delay was 3 days. In this study, 588 patients (89.91%) encountered at least one delay in chemotherapy session during their entire course, while 66 patients (10.09%) did not suffer any delays at all. The average age of patients with at least one delay during their entire course and without a delay wasn’t different. Also, gender, metastasis, and type of cancer didn’t have a significant association with having a delay in the entire course of chemotherapy (Table  2 ).

Number of delayed sessions for each patient

A Poisson model was used to count the number of moderate and severe delays during patients’ entire chemotherapy course. Being male (IRR = 1.20, P  = 0.002) and having metastatic cancer (IRR = 1.20, P  = 0.01) were associated with higher rates of moderate delay. In an aspect of cancer type, lymphoma was set as the baseline group. Colorectal cancer had a significant association with higher rates of moderate delay (IRR = 1.88, P  < 0.001), and lung cancer had an association with lower rates of moderate delays (IRR = 0.59 P  = 0.002) in the entire course of chemotherapy (Table  3 ). Regarding the number of severe delays, gastric cancer had an association with lower rates of delay when compared to lymphoma as a baseline group. (IRR = 0.75, P  = 0.001) (Table  4 ).

In this study, out of 4535 chemotherapy sessions, 2407 sessions (53.08%) were delayed. Moreover, 2545 sessions (56.12%) occurred during 6 waves of the pandemic, and 1990 sessions (43.88%) were not during any wave of the pandemic (Table  5 ).

A logistic regression model showed a significant association between delay and the first (OR = 2.08, P  < 0.001), third (OR = 1.33 P  = 0.02), and fifth (OR = 1.61 and P  < 0.001) waves of the COVID-19 in Iran. The results remained consistently significant in the first and fifth waves, even in severe delays (Table  6 ). On the contrary, the fourth wave of COVID-19 was negatively associated with delays (OR = 0.74 and P  = 0.04) (Table  7 ).

This study found a significant association between gender and moderate delays in the course of chemotherapy. Similar findings regarding male patients experiencing more delays in cancer treatment were also noted before the pandemic [ 15 ]. Although the exact cause requires further studies, this might be due to the larger social support females receive, which decreases patient delay [ 16 ]. Also, historically, men have consistently underused healthcare services and have generally shown less interest in health compared to women [ 17 , 18 ].

Age was not associated with a moderate or severe delay during chemotherapy, which is consistent with previous literature [ 15 , 19 ]. Metastatic cancer was associated with higher rates of moderate delays in an entire course of chemotherapy. The exact cause of this increase needs further study. However, it might be due to a longer hospitalization, for which patients encountered difficulties receiving the treatment in a timely manner. Similar observations were also noted in other literature [ 20 ].

Colorectal cancer was associated with higher rates of moderate delays compared to other types of cancer. The same association between GI tract cancer and higher rates of delay was observed in similar studies [ 20 ]. On the other hand, lung cancer was associated with a decreased rate of moderate delays and gastric cancer was associated with a reduced rate of severe delays in the course of chemotherapy. The exact cause of these findings requires further studies. However, in the case of lung cancer, which is the most lethal cancer, the cause of stricter adherence to chemotherapy may be due to the fact that the fear of these patients from their disease was higher than the fear of the COVID-19 pandemic [ 21 ].

To our knowledge, this is the first study that analyzed the effect of the COVID-19 pandemic waves on the treatment of cancer patients. The initial wave of the COVID-19 pandemic was significantly linked to increased delays, including severe delays. This finding has been caused by the high rates of fear and anxiety among the population at first, as well as the nearly complete lockdown and quarantine that were imposed during the early stages of the pandemic [ 22 , 23 ]. The fifth pandemic wave was also associated with increased delays(beyond two days in each session ). It can be due to the prolongation of the fifth wave in Iran and the higher number of chemotherapy sessions during this wave, the exact cause for higher delay during this wave requires further studies.

Overall, a reducing trend was observed in the number of delays during the pandemic, specifically in the last six months of this study. This reducing trend can be explained by the discovery of vaccines, less restriction throughout the pandemic, and decreased overall fear of the disease over time [ 22 ](Fig.  1 ).

Managing cancer during a crisis like the COVID-19 pandemic in lower-middle-income countries (LMIC) poses a complex challenge. It involves protecting patients from COVID-19 while ensuring the continuity of cancer treatment with limited resources. Healthcare-related services such as chemotherapy, radiotherapy, and life-saving interventions experienced more severe shortages in these countries compared to high-income countries (HIC) [ 11 ]. During the pandemic, previous treatment challenges in LMIC are exacerbated by disrupted global supply chains and financial constraints [ 24 ]. These elements require identifying vulnerable patients and preparedness to prioritize such patients, creating a stepwise approach for better delivery of health services to cancer patients in these regions [ 12 ].

The study’s strengths include its duration, sample size, and consideration of pandemic waves, which can highlight the pandemic’s impact on healthcare services. However, there are limitations to this study. First, the entire study took place during the COVID-19 pandemic. Further studies should include a comparison with the pre and post-pandemic periods. Second, the exact cause of these delays is unknown and can be studied in the future.

Delays between treatment options( such as surgery and chemotherapy), assessing vaccinations and the effects of policies implemented during this period on the continuity of chemotherapy and assessing the impact of these delays on outcomes and the survival of patients can also be future topics for further studies.

This study revealed a significant correlation between gender and moderate delays in chemotherapy, with males experiencing more delays. However, age did not show a similar association. Having metastatic disease and colorectal cancer were linked with increased moderate delays, while lung cancer was associated with fewer delays. The COVID-19 pandemic’s initial wave significantly increased delays, with a reducing trend observed over time, possibly due to vaccine discovery and reduced fear of the disease. Exploring the exact causes of these delays, the impact of vaccinations, implemented policies, and telemedicine on chemotherapy continuity, as well as the effects of these delays on patient outcomes and survival, could provide a more comprehensive understanding of the pandemic’s impact on cancer patients.

Monthly Average of number of delays in entire course of chemotherapy

Data availability

Data of this study is available upon reasonable request from corresponding author.

Abbreviations

Iran University of Medical sciences

Confidence interval

Incidence Rate Ratio

Lower-middle-income countries

High-income countries

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Acknowledgements

The Authors would like to appreciate to the Vice-Chancellor of Research and Technology at Iran University of Medical Sciences for Financial supports of this study. We appreciate “Quillbot” which has been used to improve readability of the text.

This work was supported by Iran University of Medical Sciences (Grant number: 22177).

Author information

Authors and affiliations.

Preventive Medicine and Public Health Research Center, Department of Community and Family Medicine, School of Medicine, Psychosocial Health Research Institute, Iran University of Medical Sciences, Shahid Hemmat Highway, P.O Box: 14665-354, Tehran, 1449614535, Iran

Moein Rast, Marzieh Nojomi, Donya Hatami, Kiarash Ansari, Seyyed Amir Yasin Ahmadi & Arash Tehrani-Banihashemi

Department of Radiation Oncology, School of Medicine, Iran University of Medical Sciences, Tehran, 1445613131, Iran

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Contributions

A.TB. and M.R. designed the study and its topic. P.F., K.A. collected the data and conducted data analysis.M.R., D.H, SAY.A. participated in data analysis and drafting manuscript. M.N., A.TB. and P.F. provided expert opinions regarding data analysis, critical revision of the study and supervised the project. All authors take full responsibility for their contributions to this study. Also, all authors reviewed and approved the final manuscript.

Corresponding author

Correspondence to Arash Tehrani-Banihashemi .

Ethics declarations

Ethics approval and consent to participate.

This study was approved by the Research Ethics Committee of the Iran University of Medical Sciences, Tehran, Iran (IR.IUMS.REC.1400.1201). In this study, the need for informed consent was waived by the Research Ethics Committee of the Iran University of Medical Sciences, Tehran, Iran.

Consent for publication

Not applicable.

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Rast, M., Fadavi, P., Nojomi, M. et al. Chemotherapy delays among cancer patients in Iran during COVID-19 pandemic. BMC Public Health 24 , 2299 (2024). https://doi.org/10.1186/s12889-024-19780-4

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Received : 23 January 2024

Accepted : 13 August 2024

Published : 23 August 2024

DOI : https://doi.org/10.1186/s12889-024-19780-4

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FDA label information for this drug is available at DailyMed.

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