Infectious causes of cancer

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Worldwide approximately 18% of cancers are related to infectious diseases.[1] This proportion varies in different regions of the world from high of 25% in Africa to less than 10% in the developed world.[1] Viruses are usual infectious agents that cause cancer but Mycobacterium, some other bacteria and parasites may also have an effect.

A virus that can cause cancer is called an oncovirus. These include human papillomavirus (cervical carcinoma), Epstein-Barr virus (B-cell lymphoproliferative disease and nasopharyngeal carcinoma), Kaposi's sarcoma herpesvirus (Kaposi's Sarcoma and primary effusion lymphomas), hepatitis B and hepatitis C viruses (hepatocellular carcinoma), and Human T-cell leukemia virus-1 (T-cell leukemias). Bacterial infection may also increase the risk of cancer, as seen in Helicobacter pylori-induced gastric carcinoma.[2] Parasitic infections strongly associated with cancer include Schistosoma haematobium (squamous cell carcinoma of the bladder) and the liver flukes, Opisthorchis viverrini and Clonorchis sinensis (cholangiocarcinoma).[3]

Mycobacterium[edit]

Perhaps the oldest cause of cancer (tuberculoma) known today. The 'tuberculoma' is a clinical manifestation of the tuberculosis which happens to conglomerate tubercles and radiologically simulating a cancer.[4][5][6] Since these are evolutions of primary complex, the tuberculomas may contain within caseum or calcifications. With the passage of time, in fact, for degeneration, Mycobacterium tuberculosis (also called Bacillus Koch) is transformed into crystals of calcium. Can affect every organ such as the brain,[7][8][9] intestine,[10] ovaries,[improper synthesis?][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62] breast,[63][64][65][66][67][68][69][70][71][72] lungs,[73][74][75][76][77][78][79][80][81][82][83][84][85][86][87] esophagus,[88][89][90][91] intestine,[92][93][94][95] liver,[96] pancreas,[97][98][99][100] bones [101][102][103][104] and more others.

Although the histologic, clinical, and tumor markers such as the CA-125 are similar, therefore it is often difficult to differentiate tuberculoma from cancer.

For these reasons, the hypothesis mycobacterial should always be considered in the differential diagnosis of cancer.

Viruses[edit]

According to some authors, viruses are one of the most important risks factor for cancer development in humans, second only to tobacco use.[105]

There are two types of cancers caused by viruses: acutely transforming or slowly transforming cancers. In acutely transforming viruses, the virus carries an overactive oncogene, and the infected cell becomes cancerous as soon as the overactive viral gene is expressed. In contrast, in slowly transforming viruses, the virus genome is inserted near a previously existing proto-oncogene in the genome of the infected cell. The virus causes overexpression of that proto-oncogene, which typically induces uncontrolled cell division. Because the virus' genes might not insert near enough to a proto-oncogene to trigger the cancerous changes[citation needed] and, even if optimally located, it might take some time to become activated, slowly transforming viruses usually cause tumors much longer after infection than the acutely transforming viruses, if at all.

Infection by some hepatitis viruses, especially hepatitis B and hepatitis C, can induce a chronic viral infection that leads to liver cancer in about 1 in 200 of people infected with hepatitis B each year (more in Asia, fewer in North America), and in about 1 in 45 of people infected with hepatitis C each year.[106] People with chronic hepatitis B infection are more than 200 times more likely to develop liver cancer than uninfected people.[106] Liver cirrhosis, whether from chronic viral hepatitis infection or alcohol abuse or some other cause, is independently associated with the development of liver cancer, and the combination of cirrhosis and viral hepatitis presents the highest risk of liver cancer development. Because chronic viral hepatitis is so common, and liver cancer so deadly, liver cancer is one of the most common causes of cancer-related deaths in the world, and is especially common in East Asia and parts of sub-Sarahan Africa.

Human papillomaviruses (HPV) are another particularly common cancer-causing virus. HPV is well known for causing genital warts and essentially all cases of cervical cancer, but it can also infect and cause cancer in several other parts of the body, including the larynx, lining of the mouth, nose, and throat, anus, and esophagus. The Papanicolaou smear ("Pap" smear) is a widely used cancer screening test for cervical cancer. DNA-based tests to identify the virus are also available.[107]

Herpesviruses are a third group of common cancer-causing viruses. Two types of herpesviruses have been associated with cancer: the Epstein-Barr virus (EBV) and human herpesvirus 8 (HHV-8).[108] EBV appears to cause all nonkeratinizing nasopharyngeal carcinomas and some cases of lymphoma, including Burkitt’s lymphoma—the association is especially strong in Africa—and Hodgkin’s disease.[108] EBV has also been found in a variety of other types of cancer cells, although its role in causing these other cancers is not well established. HHV-8 causes all cases of Kaposi’s sarcoma, and has been found in some cases of a cancer-related condition called Castleman's disease.[108] Studies involving other kinds of cancer, particularly prostate cancer, have been inconsistent.[108] Both of these herpesviruses are commonly found in cancerous cells of primary effusion lymphoma.[108] Herpesviruses also cause cancer in animals, especially leukemias and lymphomas.[108]

HIV does not directly cause cancer, but it is associated with a number of malignancies, especially Kaposi's sarcoma, non-Hodgkin's lymphoma, anal cancer and cervical cancer. Kaposi's sarcoma is caused by human herpesvirus 8. AIDS-related cases of anal cancer and cervical cancer are commonly caused by human papillomavirus. After HIV destroys the immune system, the body is no longer able to control these viruses, and the infections manifest as cancer.[109] Certain other immune deficiency states (e.g. common variable immunodeficiency and IgA deficiency) are also associated with increased risk of malignancy.[110]

Bacteria[edit]

In addition to viruses, certain kinds of bacteria can cause some cancers. The most prominent example is the link between chronic infection of the wall of the stomach with Helicobacter pylori and gastric cancer.[111][112] Although only a minority of those infected with Helicobacter go on to develop cancer, since this bacterial infection is quite common, it may be responsible for most of these cancers.[113] The mechanism by which H. pylori causes cancer may involve chronic inflammation, or the direct action of some of its virulence factors, for example, CagA has been implicated in carcinogenesis.[114]

Parasites[edit]

The parasites that cause schistosomiasis (bilharzia), especially S. haematobium, can cause bladder cancer and cancer at other sites.[115] Inflammation triggered by the worm's eggs appears to be the mechanism by which squamous cell carcinoma of the bladder is caused. In Asia, infection by S. japonicum is associated with colorectal cancer.[115]

Distomiasis, caused by parasitic liver flukes, is associated with cholangiocarcinoma (cancer of the bile duct) in East Asia.[115]

Malaria is associated with Burkitt's lymphoma in Africa, especially when present in combination with Epstein-Barr virus, although it is unclear whether it is causative.[115]

Parasites are also a significant cause of cancer in animals. Cysticercus fasciolaris, the larval form of the common tapeworm of the cat, Taenia taeniaformis, causes cancer in rats.[115] Spirocerca lupi is associated with esophageal cancer in dogs, at least within the southern United States.[115]

See also[edit]

References[edit]

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