Using Biomarkers to Identify Lung Cancer Subtypes

Using Biomarkers to Identify Lung Cancer Subtypes is an activity developed by Learning Undefeated as part of Generation Health: How Science Powers Us.  Generation Health is a partnership between Learning Undefeated, AstraZeneca, and Discovery Education that aims to make science personal through a focus on healthy living messaging.    Using Biomarkers to Identify Lung Cancer Subtypes can be used after the Oncology Digital Lesson Bundle to explore how biomarkers are used in diagnoses to help provide targeted cancer treatments.

Cancer is a disease in which abnormal cells divide uncontrollably and destroy body tissue. The two major subtypes of lung cancer are small-cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC).  Like its name indicates, small cell lung cancer has smaller cells than non-small cell lung cancer.  The small cells make the disease spread faster, metastasizing quickly to other body parts.

Cancer cells, like all cells, have protein and lipid markers on the outside of their cells.  These molecules, called biomarkers, help the body to identify the different types of cells that are nearby.  Because we have identified biomarkers that are unique to SCLC and NSCLC, we can use that information to help diagnose a patient.  By getting a subtype diagnosis of SCLC or NSCLC instead of the broad lung cancer diagnosis, a patient can receive targeted treatment.

Learning objectives
  • Students will understand the role of biomarkers in cancer diagnoses
  • Students will understand the antibody/antigen relationship and how it can be used for diagnosis
  • Students will be able to run an ELISA (enzyme-linked immunosorbent assay) to diagnose a patient with a subtype of lung cancer.
  • Students will be able to explain false-positive results
Background Information

Explore the basics of cancer- what it is and what can cause it.  Discover details of two subtypes of lung cancer and the biomarkers uniquely found on each.

Cancer is a disease in which abnormal cells divide uncontrollably and destroy body tissue.  Once the cells start growing into large masses, also known as tumors, the cells can start to move to other parts of the body, a process called metastasis.  These cancer cells grow uncontrollably because there has been a change, or mutation, in the genes that regulate division.

Genes and Cancer

Every time a cell has to divide to make more cells, the DNA must be copied.  This allows each cell at the end to have the appropriate DNA to keep functioning.  As the DNA is copied, mistakes can sometimes be made, these are called mutations.  Some mutations don’t change anything but others might prevent an important part of the cell from being made or functioning.  Often times, one mutation doesn’t have much effect because humans have 2 copies of most genes, one from each chromosome in a pair.  When there are multiple mutations in both copies, the gene stops working. Mutations happen in our cells very often, but the cell can usually detect the change and repair it.  Though our cells are very good at catching these mistakes, some slip through the cracks.

Environmental Mutations

Even if your cells never mutated through replication, they may still mutate based on your environment.  Things like cigarette smoke, radiation, and UV light can cause the DNA to change.  Because of their ability to affect the DNA, these are called carcinogens, meaning that they can cause cancer.  The more a person is exposed to these carcinogens, the more likely they are to develop cancer.

cancer.org

Humans have two sponge-like organs in the chest to help us breathe.  To breathe, air comes in through the nose and mouth and travels down the trachea (windpipe).  The trachea divides into tubes called bronchi which enter the lungs and divide into smaller tubes until the air reaches a tiny sac known as alveoli.  The alveoli are very thin covered in blood vessels to help get oxygen into the blood stream and carbon dioxide out.

Lung Cancer Causes

Smoking tobacco is the leading cause of lung cancer.  This includes secondhand exposure to smoke.  Other risk factors for lung cancer include radon, asbestos, diesel exhaust, and air pollution.

Lung Cancer Biomarkers

Lung cancers typically start in the cells lining of the bronchi and can spread to other parts of the lungs or body depending on the subtype.

All lung cancers have a protein on the outside of the cells called carcinoembryonic antigen (CEA).  CEA is an important protein in fetus development but is usually found at low levels in adults.  Both lung cancer subtypes, SCLC and NSCLC, have CEA present on the outside of their cells.  CEA will be used to help diagnose that a patient has lung cancer before trying to determine its subtype.

cancer.org

Small cell lung cancer (SCLC) accounts for 10-15% of all lung cancer cases.  Small cell lung cancer cases generally start in the large breathing tubes of the lungs, the bronchi.  Like it’s name indicates, small cell lung cancer has smaller cells than non-small cell lung cancer.  The small cells make the disease spread faster, metastasizing quickly to other body parts.

SCLC Biomarkers

Pro-gastrin releasing peptide (proGRP), is a biomarker that is found on the exterior of only small cell lung cancer cells. proGRP is usually expressed in the nervous system and digestive tract but is seen at high levels when a patient has SCLC.

cancer.org

 Non-small cell lung cancer (NSCLC) is more common, accounting for 80-85% of lung cancer cases.  Non-small cell lung cancer starts in the center of the lungs and sometimes the peripheral edges of the lungs.  This cancer is also more common amongst people who smoke or have smoked in the past.  We also see that women are diagnosed with non-small cell lung cancer more than men and that younger people are diagnosed with it more than those that are older.

NSCLC Biomarkers

The marker neuron specific enolase (NSE) is a biomarker that is found on the exterior of only non-small cell lung cancer cells.  

cancer.org

Pre-Laboratory Engagement

The Best Defense Against Lung Cancer is a Good Offense

Use Generation Health’s digital lesson bundle to investigate facts and misconceptions about the causes of lung cancer (including what happens at the cellular level).  In this activity, students will explore a rising epidemic impacting their generation: vaping (or the use of e-cigarettes).

Download Digital Lesson Bundle

Includes:

  • One Student-Facing Presentation PPT
  • One Teacher Guide PDF

Student Objectives

Students will:

  • Differentiate between normal cell growth and cancerous cells.
  • Investigate the causes of lung cancer and address misconceptions.
  • Explore the chemical substances found in e-cigarettes.
  • Understand the stages and types of lung cancer and explore treatments for different forms of lung cancer.
  • Analyze evidence-based approaches for lowering lung cancer risk.
Laboratory Activity

Cancer is a disease in which abnormal cells divide uncontrollably and destroy body tissue.  Once the cells start growing into large masses, also known as tumors, the cells can start to move to other parts of the body, a process called metastasis.  These cancer cells grow uncontrollably because there has been a change, or mutation, in the genes that regulate division.

Lung cancer can be caused by factors like smoking, radon exposure, and air pollution. Lung cancer shows symptoms like a cough that doesn’t go away or gets worse, coughing up blood, and chest pain that gets worse with deep breathing, coughing, or laughing.  Patients with these symptoms have a computed tomography (CT) scan performed in order to confirm that the patient does have lung cancer.  The CT scan can show the soft tissue of the lungs and identify masses that look out of place.  Once a CT scan shows an unidentified mass, serum samples are sent for further testing to identify the specific type of lung cancer.

Dr. Bryant is a doctor at the Discovery Clinic. The clinic is located in one of the many hot zones for radon in the state of Maryland. Some of her older patients have started to demonstrate some symptoms associated with lung disease and she has used computed tomography (CT) scans to confirm that they have lung cancer. She has sent over serum samples from three different patients to your laboratory to determine which type of lung cancer the patients have so she can propose treatment. She knows that your biomedical research facility has the tools readily available for a quick turnaround.

Specifications

  • Skill level: Intermediate
  • Grade level(s):  6 – 8
  • Focus: Health, Biology
  • Time: 45-60 minutes

NGSS Alignment

MS-LS3 Heredity: Inheritance and Variation of Traits

Key Words

lung cancer, biomarkers, ELISA, antibodies, antigens

Additional Resources

Lung Cancer Types Learn about the types of lung cancers, their unique features, and their treatments.

Biomarker Testing Learn about biomarkers and the role they play in delivering targeted therapies.