A 63 year old male with a strong history of Type II Diabetes Mellitus (last hemoglobin A1c of 9.8), alcohol
abuse (status-post rehab), basal cell carcinoma of the skin on his forehead (status-post cryotherapy), and heart
failure with reduced ejection fraction (last ejection fraction of 35%), presents to his primary doctor for a yearly
routine checkup by his family doctor. He initially felt annoyed by the fact that his insurance was mandating that
he go to the doctor once per year, as he has never felt as if anything was wrong with him; his wife, whom he
also considered to be bothersome, also felt that he needed to see a doctor as he had suddenly become less
hungry for her cooking (which he blamed on the fact that she had changed seasoning and had started cooking
more vegetables for his heart issues, which he dislikes strongly). He feels that his health issues, though
numerous, are very well controlled and that he needs no interventions. In fact, he adamantly told his family
doctor, “I’m taking 6 medications for this darned heart condition, and I will not take anything else. So you are
wasting your time seeing me.”
The visit initially was the “routine,” as the first 15 minutes of the interaction was fairly similar to his previous
ones. As usual, he denied any acute issues and stated that he felt great. Upon further questioning, however, he
gradually began to notice that his ability to mow his yard without becoming winded has mildly diminished; in
addition to this, he began to realize that, retrospectively, he has eaten significantly less than he used to (even
when it’s not his wife’s cooking that he is eating). He vehemently denied any other symptoms, however.
He was then taken to the scale and weighed; to his dismay, he realized that he had lost about 70 pounds since
his visit to his endocrinologist 6 months ago. Concerned about this rapid weight loss, his family doctor ordered
a simple complete blood count (CBC), which revealed a white blood cell count of 60,000 (normal 4-12k), a
hemoglobin of 8.3 (normal 12-16 in males), and platelets of 675,000 (normal 150k-400k). Given these findings,
the patient was set up for a bone marrow biopsy at a local hospital in 1 month.
Unfortunately, the patient experienced a severe myocardial infarction (inferolateral STEMI secondary to direct
occlusion of the left anterior descending artery) 2 weeks after the appointment with his family doctor and died
at 3:00 am on a Sunday night. An autopsy was performed at the hospital 3 days after the patient succumbed;
serological testing revealed a positive test for a Robertsonian translocation from chromosome 9à22 (BCR-ABL
fusion), also known as the “Philadelphia Chromosome,” and bone marrow biopsy results were revealing of
multiple immature, multi-nucleated neutrophils and basophils, consistent with a post-mortem diagnosis of
Chronic Myeloid Leukemia (CML).
Please answer the following questions:
What are the intrinsic immunologic mechanisms by which the immune system targets and destroys potentially
What are the mechanisms as to how cells can become cancerous?
What are some cellular mechanisms by which cancer cells can “dodge” the immune system?