Introduction to oncology and cancer prevention

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What are the five most common types of cancer?

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What are the five most common types of cancer?



Lung and Bronchus

Colon and Rectum

Melanoma of the skin

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What is cancer?

A disease in which some of the body's cell grow uncontrollably and spread to other parts of the body

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What is a tumor?

A abnormal cell growth

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What can cancer cells do inside the body?

§  Grow in the absence of signals telling them to grow.

§  Ignore signals that normally tell cells to stop dividing or to die.

§  Invade into nearby areas and spread to other areas of the body.

§  Tell blood vessels to grow toward tumors.

§  Hide from the immune system.

§  Trick the immune system into helping cancer cells stay alive and grow,

§  Accumulate multiple changes in their chromosomes, such as duplications and deletions of chromosome parts.

§  Rely on different kinds of nutrients than normal cells.

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How can cancer be genetic?

§  It is caused by genes that control how cells function, grow and divide.

§  Genetic changes cause cancer because of errors that occur as cells divide, damage to DNA caused by harmful substances in the environment (carcinogens), inherited from parents ( germline).

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True/false: with increase in age the bodies ability to repair or eliminate damage DNA before they turn cancerous decreases.


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These cancer genes are considered accelerators that push cells to divide:


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These cells are the normal cells that once activated turn into



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What are two examples of oncogenes?

ALK (lung cancer)

BCR-ABL ( chronic myeloid leukemia)

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These genes are considered like car brakes:

Tumor suppressor genes

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What is the normal function of tumor suppressor genes?

They are supposed to inhibit inappropriate cellular growth and proliferation.

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What is the mechanism behind tumor suppression genes causing cancer?

There are alterations that can lead to loss of control over normal growth.

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What are examples of tumor suppressor genes that can cause cancer?

BRCA( breast, ovarian)


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What is the normal function of DNA repair genes?

They help to repair the DNA that is damaged due to carcinogens.

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How do DNA repair genes cause cancer?

Deficiency in these genes allow for accumulation of genetic alterations

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What happens if DNA repair genes does not correct the problem?

The error is not corrected and this leads to alterations that activates oncogenes or inactivates tumor suppressor genes.

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What are examples of DNA repair genes?



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What are risk factors for developing cancer?

§  Older age

§  Smoking, high-fat diet , certain occupations/working with toxic chemicals.

§  Family history: Inheritance and genetics

§  Genetic disorders: wisott-aldrich, Beckwith Wiedemann syndrome

§  Viral infections:  No vaccine: EBV, HIV, polyomavirus. Vaccine: Hepatitis B, HPV

§  Environmental exposure: pesticides, fertilizers, coal, benzene, radiation

§  Cancer therapy: alkylating agents, radiation

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What ways can you prevent cancer?

§  Medications ( breast and colon have medications that can help reduce risk)

§  Avoid things that are known to cause cancer.

§  Screening tests

§  Treatment for infections that  are known to increase the risk of cancer ( hepatitis C, HIV, H. Pylori)

§  Surgery

§  Vaccines

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What are some risk reducing medical interventions for cancer?

§  Colorectal cancer  chemoprevention: low dose aspirin

§  Breast cancer chemoprevention: tamoxifen, raloxifene, exemestane, anastrozole

§  Breast, ovarian, uterine cancer surgical prevention: mastectomy, saplingo-oophrorectomy

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What lifestyle things can a person do in order to help lower risk of getting cancer?

§  Do not smoke.

§  Have a healthy weight.

§  Exercise

§  Eat healthy.

§  Limit alcohol intake

§  Protect skin from harmful UV rays.

§  Assess cancer risk, family history, individual history.

§  Have regular check0ups and cancer screening tests.

§  Get vaccinated ( HPV, HepB)

§  Use sunscreen.

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Warring signs of Cancer:

§  C: Change in bowel or bladder habits.

§  A: a sore that does not heal.

§  U: unusual bleeding or discharge.

§  T: thickening or lump in breast or elsewhere.

§  I: indigestion or difficulty swallowing.

§  O: obvious change in wart or mole.

§  N: nagging cough or hoarseness.

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Breast cancer screening: females

Age 40 - 44: yearly mammograms are optional

Age45- 54: begin yearly mammograms

Age greater than or equal to 55: mammograms every 2 years or continue yearly

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Prostate cancer: males

Age greater than or equal 50

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Colon Cancer Screening: Males and Females

Age > 45:

Stool based tests ( if positive follow up with colonoscopy): fecal occult blood test or fecal immunochemical test ( yearly) , stool DNA test ( 3 years)

Visual exams of colon/rectum: Colonoscopy ( gold standard: every 10 years) , sigmoidoscopy ( 5 years) , CT colonography ( 5 years)

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Lung Cancer Screening: Males and Females

Age 50-80

Low dose CT scan of chest if all of the following:

  • > 20 pack year smoking history

  • still smoking or quit smoking < 15 years.

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Cervical Cancer Screening: Females

Age 25-65

Pap smear ever 3 years or Pap Smear + HPV DNA test every 5 years

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What is the journey of a cancer patient?

-they get diagnosed and worked up

-their cancer gets put into the stage it is in

-they start undergoing treatment

-their response to treatment is evaluated

-the patient is monitored for side effects or adverse events

-if the patient is not responding they may have a relapse or cancer is progressing

- some patient may be getting better/cured.

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How does a patient get diagnosed with cancer?

-The doctor will take a biopsy of the tissue

-After biopsy is taking than there is a pathological assessment to help report a definitive diagnosis to identify drug targets

-Imaging happens in order to help determine the extent of the disease

-extended lab panel helps to prepare for treatment, risk stratify patient

-rule out other diseases that may look like cancer

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What is grading in regards to cancer?

`-it is the description of a tumor based on how abnormal the tumor cells and the tissues look under the microscope

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What is staging in regards to cancer?

-it helps to define the extent of the disease

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What are the methods used to help a doctor stage a patients cancer?


-CT scan


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What are the types of staging?

-Stage 0: abnormal cells are present but have not spread to nearby tissue

-Stage I-III: cancer is present. The higher the number the larger the cancer tumor and the more it has spread into nearby tissue.

-Stage IV: The cancer has spread to distant parts of the body

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Solid tumor staging:


  • size and extent of primary tumor

  • T0: main tumor cannot be found

  • T1-4: higher the number= larger tumor or more it has grown into nearby tissues


  • Number of nearby lymph nodes that have cancer.

  • N0: no cancer in the nearby lymph nodes

  • N1-3: higher number= more lymph nodes that contain cancer


  • Whether the cancer was metastasized or spread

  • M0: cancer has not spread to other parts of the body

  • M1: cancer has spread to other parts of the body

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What are the goals for cancer treatment?

§  Curative intent: for patient administered to patients with local or regional disease. Administered to cure the patient.

§  Life extending extent: administered to patients with metastatic disease to slow progression of cancer and prolong survival by months to years.

§  Palliative intent: given to patients with the goal of reducing symptoms.

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Performance Status

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What are some treatments that are used to treat cancer?

o   Surgery:

§  Remove the tumor.

§  Debulk a tumor

§  Ease cancer symptoms.

o   Radiation:

§  Use of high doses of radiation to kill cancer cells and shrink tumors by damaging their DNA.

§  Takes days or weeks of treatment before DNA is damaged enough for cancer cells to die.

o   Antineoplastic agents

o   Stem cell transplant

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What is the treatment plan for treating solid tumors?

o   Neoadjuvant

o   Surgery

o   Adjuvant

o   Maintenance

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What is the treatment plan for treating hematologic malignancy?

o   Induction

o   Consolidation

o   Maintenance

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What is considered complete response/remission?

-complete disappearance of all cancer without evidence of new disease for at least 1 month after treatment

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What is considered partial response to cancer treatment?

-25%-30% or greater decrease in tumor size from baseline and no evidence of any disease for at least 1 month.

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What is considered stable disease?

-no change in tumor size

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What would be considered progression in disease?

-20-25% increase in size or development of new lesions while receiving treatment

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What is considered relapse, recurrent or refractory in cancer treatment?

-return of disease or the signs and symptoms of disease after a period of improvement

-recurs after eradicated

-refractory to treatment ( no response to treatment)

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This is when a high dose combination is giving initial to induce a complete response:


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This happens after successful induction to kill undetectable disease and prolong remission:


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This type of treatment happens before a person receives surgery in order to shrink tumor to allow for complete surgical resection:


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This type of treatment happens after surgery to help destroy residual cells and prevent recurrence:


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What happens during maintenance period?

-treatment is continued for a long period of time after response.

-Prevent relapse and prolong PFS

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What happens in the salvage stage of cancer treatment?

-treatment after the cancer has not responded to convential therapies to induce a response.

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What happens in palliative care for cancer patients?

-Provides relief from cancer burden patients.

-Help to increase the quality of life

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What is the role of an oncology pharmacist?

o   Prescribe anticancer treatment and supportive care.

o   Counsel patients in clinic on their anti-cancer treatments and supportive care regimens.

o   Review labs, allergies, drug-to drug interactions, and review clinic guidelines.

o   Monitor patients on active therapy and make recommendations to adjust treatment and/or add supportive care treatments for treatment-related adverse effects.

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