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But I'm Too Young!

A Case Study of Ovarian Cancer



Co Authors:

Nancy A. Rice
Department of Biology
Western Kentucky University
nancy.rice@wku.edu

Bruno Borsari
Biology Department
Winona State University
bborsari@winona.edu

Abstract:

In this “clicker case,” students are introduced to Abby, a college student who has been diagnosed with ovarian cancer. As they follow Abby’s plight, students learn about basic cellular and genetic mechanisms that are responsible for cancer formation, gaining a general understanding of how cells become cancerous through genetic mutations, how cancers can spread throughout the body by metastasizing, and how modern medicine is currently treating patients diagnosed with cancer through surgery, radiation, and chemotherapy. Developed for use in a large introductory biology course, the case consists of a PowerPoint (~2MB) presented in class that is punctuated by multiple-choice questions the students answer using “clickers.” The case can be adapted for use without these technologies.

Objectives:
  • Define cancer and differentiate between benign and malignant tumors.
  • Explain that cancers result from mutations in genes that control the cell cycle.
  • Understand how cancerous cells move around the body.
  • Know the difference between tumor suppressor genes and oncogenes, and understand how these genes contribute to cancer formation.
Keywords: Ovarian cancer; genetic mutation; benign tumor; malignant tumor; BRCA1; BRCA2; tumor suppressor genes; oncogenes
Topical Area: N/A
Educational Level: High school, Undergraduate lower division
Formats: PDF, PowerPoint
Type/Method: Clicker, Interrupted
Language: English
Subject Headings: Biology (General)   Cell Biology   Medicine (General)   Genetics / Heredity  
Date Posted: 08/12/08
Date Modified: N/A
Copyright: Copyright held by the National Center for Case Study Teaching in Science, University at Buffalo, State University of New York. Please see our usage guidelines, which outline our policy concerning permissible reproduction of this work.

Teaching Notes


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Answer Key


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1. Regarding the use of CA-125, it should be strongly emphasized that this “marker” measures inflammation, not cancer per se. There is no specific blood test for ovarian cancer like the PSA test for prostate cancer. This is important because students need to understand that many lives could be saved (perhaps 15,000/year) if there were a way to screen women for ovarian cancer. This would mean diagnosis at stages I or II when the cure rates are much higher than for stages III or IV when cure rates are dismal. Students could be asked to look up survival for these stages.

Students should be asked to explain why we don’t have a specific test. Are there biological reasons? There are also political/economic questions that students should consider since they may well affect their lives. What issues are involved with insurance companies having to pay for screening mammograms? What is the reason for the new idea that the PSA need not be done on men over the age of 70? Why is the CA-125 not used for screening, even if there are some false positives?

2. Why do we use the term "remission"? Who invented that word? Was it oncologists? Certainly they use it and so does every one else! What does it mean? To me it means that there’s no sign of that cancer, BUT we’re waiting for it to return, for the other shoe to drop, so to speak. If a person has a heart attack or a stroke, and they’ve recovered, there’s a reasonable probability of a repeat. Have students look these numbers up. BUT we don’t say that these patients are "in remission."

How does the term "remission" affect the patient? Does it instill a bit of unnecessary fear? (The doctor must think it’s coming back!) Does this term remove hope that the patient might be cured?


Victoria Finnerty, Ph.D.
Department of Biology
Emory University
Atlanta, GA 30322
victoria.finnerty@emory.edu
8/21/2008

I enjoyed the case presentation on ovarian cancer from the National Center for Case Study Teaching in Science. However, I would like to make a correction to a comment that was submitted by a reader on 08/21/2008 in response to this case.

The commenter wrote: “Regarding the use of CA-125, it should be strongly emphasized that this ‘marker’ measures inflammation, not cancer per se. There is no specific blood test for ovarian cancer like the PSA test for prostate cancer.”

I disagree. Inflammation can also elevate PSA levels in serum, such as prostatitis (inflammation of the prostate) and benign prostatic hyperplasia (BPH) (enlargement of the prostate). (Ref - NCI website - http://www.cancer.gov/cancertopics/factsheet/detection/PSA).

I think these cases are very instructive and well-done. My correction is only meant to preserve the great value they already contain.


Jose A Hernandez, MD
Pathology
Mercy Hospital
Miami, FL
elcubano@aol.com
6/6/2011

I am writing with a suggestion for this case. I have used this case for several years now in my Pathophysiology course. This is a course for health majors at a community college. I use the website www.polleverywhere.com to make the case a clicker case and my students enjoy seeing the “clicker” case come to life. Before the case study today, I used the following link: http://www.nbcnews.com/health/health-news/nih-finally-makes-good-henrietta-lacks-family-its-about-time-f6C10867941 to discuss the New York Times bestseller, The Immortal Life of Henrietta Lacks. Henrietta Lacks died of ovarian cancer and her cells were collected and used in research without her knowledge. The HeLa cells have been used for 60 years and just recently the entire genome of the cells was originally published by a European lab but then retracted. This led to the most recent decision by the Lacks family and the NIH about who can have access to the genome of the HeLa cells. Raises some nice ethical issues and awareness of the issues around tissue donation, etc.


Alisa J. Petree, MHSM, MT(ASCP), Associate Professor & Clinical Coordinator
Medical Laboratory Technician Program
McLennan Community College
Waco, TX 76708
apetree@mclennan.edu
2/9/2014



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