The case of Kevin, an individual, who had been working in a uranium mine for 10 years and developed small cell lung cancer 25 years later, is the case of radiation-induced carcinogenesis. Scholars describe this process as a sequence of the accumulated changes in the DNA and other cells of the human body as a result of different aggressive external factors such as chemical, biological, and other types of damage (Weaver et al., 2014). Kevin’s case is an example of correlation between the influence of ionizing radiation and the accumulated damage of lung cells. In this respect, scholars argue that Hmga2 competing RNA activity as the consequence of radiation impact significantly promotes lung cancer formation (Kumar et al., 2013). Consequently, while working in the uranium mine, Kevin’s body accumulated the critical number of changes in DNA and RNA, which gradually induced small cell lung cancer. During the period of 25 years, Kevin’s body has passed through the three main stages of carcinogenesis, which include cancer initiation, promotion, and progression. Each of these changes requires separate discussion as they play a critical role in cancer formation whereas some of them allow the process of cancer formation to be reversed.
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Initiation
Cancer initiation is a comparatively silent period during which a sequence of genetic changes in a patient’s body occurs. The primary source of these changes is an external influence of different factors such as radiation, consumption of carcinogenic food and exposure to other carcinogenic factors such as ultraviolet radiation. During this stage, mutations in DNA of different cells occur and such mutations are accumulated by cells increasing the risk to turn malignant. Experts indicate that cancer initiation is always a two-way process that combines the influence of external carcinogenic factors and the presence of host biology, which modifies the type of cancer and the time of its initiation (Barcellos-Hoff, Lyden & Wang, 2013). Therefore, the cells predisposed to cancer development remain “latent” until they face the impact of a promoter (Barcellos-Hoff et al., 2013). In the case of Kevin, the promoter was ionizing radiation whereas it is possible to presume that this individual has a strong biology that has been resisting cancer formation for almost 25 years.
Kevin’s case is a manifestation of the fact that uranium radiation triggered the initiation of small cell lung cancer due to the damage of DNA and RNA in the vulnerable cells due to a biological factor. Scholars indicate that although ionizing radiation is widely used as a standard method to treat cancer it promotes cancer malignancy (Cui et al., 2015). The academic studies of the harmful effect of ionizing radiation on the human body revealed that it plays a critical impact in triggering small cell lung cancer (Cui et al., 2015). Therefore, Kevin’s lungs have accumulated a critical number of genetic alterations in DNA and RNA levels that triggered the process of cancer formation.
Promotion
Promotion is the second stage of carcinogenesis during which the damaged cells mutate and reproduce themselves generating a type of tissue that is different from other kinds of body tissue. Experts identify that radiation promotes invasiveness of non-small-cell lung cancer cells inducing specific DNA changes and promotes cell growth rate as well as cell migratory and mutation rate (Cui et al., 2015). The cells that accumulate the critical number of negative changes and lose the ability to restore their DNA form a tumor that can be seen using screening tools (Weaver et al., 2014). In this sense, radiation is a specific type of carcinogen, which promotes tumor formation, whereas there are other cancer promoters such as smoking and ultraviolet exposure among the others.
During the stage of cancer promotion, it is possible to reverse the process of carcinogenesis by excluding the adverse factors affecting the body. One of the adverse impacts of radiation is the increase of cancer frequency through the impact on the stroma, which is partially mediated by TGFβ (Barcellos-Hoff et al., 2013). For this reason, Kevin should have quit his job in order to avoid exposure to uranium. This step was important from a genetic perspective, as cancer requires a range of specific genetic alterations to occur before it evolves. Apparently, radiation brought these genetic changes leading to tumor progression in a long-term perspective (Barcellos-Hoff et al., 2013). However, due to non-disclosed factors or lack of awareness of the effect of exposure to uranium, the man had been working in the mine for 10 years, which possibly caused cancer progression 25 years later.
Progression
Progression is the final stage of cancer formation during which the tumor cells grow and expand transforming healthy tissues into malignant ones. A significant role in this process is devoted to cell mutation, which makes it unable to reverse the process of carcinogenesis due to the damage of DNA segments responsible for the cell restoration (Weaver et al., 2014). An additional condition that aggravates the process of carcinogenesis is the evolvement of metastasis that expands it to other tissues and organs. During the stage of cancer progression, a patient develops a range of symptoms that make it possible to presume the active stage of carcinogenesis as they become visible.
One of the most relevant visual manifestations of cancer progression is muscle loss and overall weight loss. Experts characterize this process as cachexia or tumor-induced energy wasting, which interferes with treatment and deteriorates the quality of patients’ lives (Kir & Spiegelman, 2016). One of the most critical negative impacts of cachexia is its ability to induce cancer-associated morbidity and mortality due to the decrease of anabolic activity within a body and loss of appetite (Garcia et al., 2015). The details presented in Kevin’s case approve that the patient developed cachexia, which manifests itself as the overall weight loss and loss of muscle volume in particular. In addition, muscle degradation has seriously restricted the patient`s autonomy due to the loss of ability to move without external assistance. Moreover, cachexia explains the reason why Kevin loses body weight and muscle volume disregarding the fact that he consumes a considerable amount of food on a daily basis. This can be explained by the fact that energy wasting is associated with the tumor that stimulates energy hypermetabolism leading to excessive energy wasting (Kir & Spiegelman, 2016). At the same time, anorexia and cachexia may be caused by another factor that requires consideration and verification.
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The second factor that can explain the patient’s progressing weight and muscle volume loss is the activity of onconeural antigens, which is the outcome of metabolic reactions in his body induced by cancer. According to various experts the production of onconeural antibodies can lead to cachexia, encephalopathy, and neuromuscular disorders (Mitchell, Bakhos & Zimmerman, 2015). This process can be characterized as autoimmune as the agents produced by the immune system to protect the body from cancer deteriorate its functions. It is likely that the antibody, which is produced in Kevin’s case, is Anti-Ri anti-neuronal nuclear antibody type 2 (ANNA-2) as it strongly associated with small cell lung cancer (Mitchell et al., 2015). At the same time, visual evidence associated with the activity of onconeural antigens, which include neuromuscular disorders (Weaver et al., 2014), was not discussed in the case. For this reason, the patient should undergo a testing procedure aimed at revealing the presence of onconeural antigens of a specific type. In order to confirm onconeural antigen-associated cachexia, Kevin has to undergo Anti-Ri antibodies test (Mitchell et al., 2015). In case the level of Anti-Ri antibodies is high, the second suggestion is correct and should be considered by the clinical personnel responsible for Kevin’s treatment.
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Conclusion
The analysis of Kevin’s case demonstrates that the patient has developed small cell lung cancer induced by ionizing radiation, which achieved the progression stage. One of the outcomes of this state is the growth and expansion of the previously formed tumor and a range of metabolic changes. One of these changes is cachexia, which is the loss of body weight and muscle volume due to the waste of energy stimulated by the tumor. The evidence brought by Kevin’s wife approves that he developed cancer-associated cachexia, which can be visually observed as anorexia and loss of appetite. Due to the fact that such a condition endangers Kevin’s life, he requires a supportive anti-carcinogenic treatment program that takes into account the result of Anti-Ri antibodies test.
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