Is Cancer Infectious? EBV

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Overview

As an oncologist, you treat patients with cancer everyday, but you never get used to having to deliver this kind of bad news. As you prepare for your next appointment, you review the case and know that the patient’s cancer can be linked to a virus. What will you report during your up-coming conference on cancer be:  Is cancer infectious?


Scenario-EBV

Part I

Will you ever get used to this? You don’t think so.Female doctor looking at x-rays As an oncologist, you treat patients with cancer everyday—it’s what you do. But, each case seems to hit you a little bit differently and this one is no exception.

You continue to review the case history and the most recent test results for Samira Mocci. Ms. Mocci is your next appointment and you don’t have good news for her.

Samira Mocci is a 32 year-old female with no history of cancer in her family. Yet, she has cancer. Samira first went to her doctor because she noticed she had swollen lymph glands. The glands weren’t painful, but they got more swollen very quickly. She started to have fevers and unexplained weight loss.

As a mother of three small children, Samira was concerned that something was very wrong. Given the symptoms, her doctor ordered some blood tests and a biopsy of the lymph glands. Unfortunately, the tests showed Burkitt’s lymphoma.  Now, she needs a full assessment of her condition, treatment options, and prognosis.

You wonder how she will react when she hears the latest report from the lymph gland biopsy. In addition to cancer cells, the microscopic examination also showed the presence of a virus—EBV. You are sure she will have a lot of questions.

The Epstein-Barr Virus (EBV) is a common viral infection in humans. About 19 of every 20 adults have the virus in their bodies. EBV was discovered over 40 years ago in a lymph gland biopsy in a Burkitt’s lymphoma (cancer of cells of the immune system) case. EBV has two very different life cycles:  a lytic phase during which new virions are actively produced and a latent phase in which

microscope view of Epstein-Barr virus (bright spheres)
An image of a microscope slide showing the Epstein-Barr virus under fluorescent antibody (FA) staining techniques. Credit: CDC/Dr. P. Feorino. https://phil.cdc.gov/phil/details.asp

the virus is dormant, usually for the host’s lifetime. The virus can infect lymphocytes (infection-fighting white blood cells of the immune system) and cause   certain types of cancer.

Recently, there has been an increase in cases of Burkitt’s lymphoma, especially in the sub-Saharan region of Africa. Ms. Mocci, originally from Ethiopia, is afflicted with this type of cancer.

You have an up-coming national conference on viruses linked to cancer and you are considering presenting Samira’s case at the conference. But first, you have to prepare for the appointment with Samira and prepare her for what comes next.

 

Your task:

Be prepared to discuss her diagnosis, treatment options, and prognosis with Samira. Be prepared to answer her questions concerning each phase of her care.

Guiding questions:

  1. How do cells become cancerous? What is the difference between a normal cell and a cancer cell? What is the difference between a tumor and cancer?
  2. How can infectious agents cause cancer?
  3. What other factors besides viruses can cause cancer? Name the other factors and describe how they cause cancers.
  4. How does cancer spread from one part of the body to other parts?
  5. This cancer is fairly rare in someone this young. How did Samira develop this cancer?
  6. What are Samira’s treatment options? As her oncologist, what are your recommendations?
  7. What is Samira’s prognosis? What specific issues are of concern in this type of cancer that may affect Samira’s outcome? Does this type of cancer usually spread to other parts of the body?
  8. What part does the body’s immune system play in fighting off infectious disease and cancer?
  9. Is cancer an infectious disease?

Part II: The Conference

You are well-prepared for your presentation at a National Institutes of Health (NIH) National Cancer Institute conference. You are part of a panel of respected oncologists discussing patient cases involving virus-linked cancers. You are presenting Samira Mocci’s case and expect your colleagues will have interesting patient cases as well.

Professional medical conferences like these always provide new information and discoveries as colleagues discuss treatments that may have worked more effectively in specific cases, new innovations in diagnostic tests, and trends in cancer statistics.

A major segment of this year’s conference concerns recommendations from the national oncology associations for public health statements about virus-linked cancers.

In addition to presenting Samira Mocci’s case, you will also be contributing to the recommendations gathered at this conference. This is an important issue. EBV infections cause an estimated 200,000 new cancer cases each year and more than 140,000 deaths worldwide.

Your Task:

Provide public health recommendations for the diagnosis, treatment options, care, and prevention of virus-associated cancer.  Work with your colleagues to draft a public health alert concerning virus-linked cancers.

Different types of cancers may have different recommendations, but some may have recommendations in common.  Work with your colleagues to issue all appropriate public health advisories.

 

© WHEELING JESUIT UNIVERSITY 2018