Cancer: Difference between revisions

Normal cells typically generate only about 30% of energy from [[glycolysis]],<ref name="pmid23226794">{{cite journal | vauthors = Zheng J | title=Energy metabolism of cancer: Glycolysis versus oxidative phosphorylation (Review) | journal=[[Oncology Letters]] | volume=4 | issue=6 | pages=1151–1157 | year=2012  | doi = 10.3892/ol.2012.928 | pmc= 3506713 | pmid=23226794}}</ref> whereas most cancers rely on glycolysis for energy production ([[Warburg effect (oncology)|Warburg effect]]).<ref name="pmid20181022">{{cite journal | vauthors = Seyfried TN, Shelton LM | title=Cancer as a metabolic disease | journal=[[Nutrition & Metabolism]] | volume=7 | pages=7 | year=2010  | doi = 10.1186/1743-7075-7-7 | pmc= 2845135 | pmid=20181022 | doi-access=free }}</ref><ref name="pmid31781842">{{cite journal | vauthors = Weiss JM | title=The promise and peril of targeting cell metabolism for cancer therapy | journal=[[Cancer Immunology, Immunotherapy]] | volume=69 | issue=2 | pages=255–261 | year=2020  | doi = 10.1007/s00262-019-02432-7 | pmc= 7004869 | pmid=31781842}}</ref><ref name="pmid32523242">{{cite journal | vauthors = Al-Azzam N | title=Sirtuin 6 and metabolic genes interplay in Warburg effect in cancers| journal=[[Journal of Clinical Biochemistry and Nutrition]] | volume=66 | issue=3 | pages=169–175 | year=2020 | url=https://www.jbc.org/content/295/32/11021.long | doi = 10.3164/jcbn.19-110 | pmc= 7263929 | pmid=32523242}}</ref> But a minority of cancer types rely on [[oxidative phosphorylation]] as the primary energy source, including [[lymphoma]], [[leukemia]], and [[endometrial cancer]].<ref name="pmid33028168">{{cite journal | vauthors = Farhadi P, Yarani R, Dokaneheifard S, Mansouri K  | title = The emerging role of targeting cancer metabolism for cancer therapy | journal = [[Tumor Biology]] | volume = 42 | issue = 10 | pages = 1010428320965284 | year = 2020 | doi = 10.1177/1010428320965284 | pmid = 33028168 | s2cid = 222214285 | doi-access = free }}</ref> Even in these cases, however, the use of glycolysis as an energy source rarely exceeds 60%.<ref name="pmid23226794" /> A few cancers use [[glutamine]] as the major energy source, partly because it provides nitrogen required for [[nucleotide]] (DNA, RNA) synthesis.<ref name="pmid26771115">{{cite journal | vauthors=Pavlova NN, Thompson CB | title=The Emerging Hallmarks of Cancer Metabolism | journal=[[Cell Metabolism]] | volume=23 | issue=1 | pages=27–47 | year=2016  | doi = 10.1016/j.cmet.2015.12.006 | pmc= 4715268 | pmid=26771115}}</ref><ref name="pmid23226794" /> [[Cancer stem cell]]s often use oxidative phosphorylation or glutamine as a primary energy source.<ref name="pmid32670883">{{cite journal | vauthors=Yadav UP, Singh T, Kumar P, Mehta K | title=Metabolic Adaptations in Cancer Stem Cells | journal=[[Frontiers in Oncology]] | volume=10 | pages=1010 | year=2020  | doi = 10.3389/fonc.2020.01010 | pmc= 7330710 | pmid=32670883| doi-access=free }}</ref>

The total health care expenditure on cancer in the US was estimated to be $80.2&nbsp;billion in 2015.<ref>{{cite web |title=Economic Impact of Cancer |url=https://www.cancer.org/cancer/cancer-basics/economic-impact-of-cancer.html |website=American Cancer Society |date=3 January 2018 |access-date=5 July 2018}}</ref> Even though cancer-related health care expenditure have increased in absolute terms during recent decades, the share of health expenditure devoted to cancer treatment has remained close to 5% between the 1960s and 2004.<ref>{{cite journal |vauthors=Bosanquet N, Sikora K |title=The economics of cancer care in the UK |journal=Lancet Oncology |volume=5 |issue=9 |pages=568–74 |year=2004 |pmid=15337487 |doi=10.1016/S1470-2045(04)01569-4}}</ref><ref>{{cite journal |vauthors=Mariotto AB, Yabroff KR, Shao Y, Feuer EJ, Brown ML |title=Projections of the cost of cancer care in the United States: 2010–2020 |journal=Journal of the National Cancer Institute |volume=103 |issue=2 |pages=117–28 |year=2011 |pmid=21228314 |pmc=3107566 |doi=10.1093/jnci/djq495}}</ref> A similar pattern has been observed in Europe where about 6% of all health care expenditure are spent on cancer treatment.<ref>{{cite journal |vauthors=Jönsson B, Hofmarcher T, Lindgren P, Wilking N |title=The cost and burden of cancer in the European Union 1995–2014 |journal=European Journal of Cancer |volume=66 |issue=Oct |pages=162–70 |year=2016 |pmid=27589247 |doi=10.1016/j.ejca.2016.06.022}}</ref><ref name=EJC2018>{{cite journal |vauthors=Hofmarcher T, Lindgren P, Wilking N, Jönsson B |title=The cost of cancer in Europe 2018 |journal=European Journal of Cancer |volume=129 |issue=Apr |pages=41–49 |year=2020 |pmid=32120274 |doi=10.1016/j.ejca.2020.01.011|doi-access=free }}</ref> In addition to health care expenditure and [[financial toxicity]], cancer causes indirect costs in the form of productivity losses due to sick days, permanent incapacity and disability as well as premature death during working age. Cancer causes also costs for informal care. Indirect costs and informal care costs are typically estimated to exceed or equal the health care costs of cancer.<ref>{{cite journal |vauthors=Luengo-Fernandez R, Leal J, Gray A, Sullivan R |title=Economic burden of cancer across the European Union: a population-based cost analysis |journal=Lancet Oncology |volume=14 |issue=12 |pages=1165–74 |year=2013 |pmid=24131614 |doi=10.1016/S1470-2045(13)70442-X}}</ref><ref name=EJC2018 />