Cancer as a Complex Chronic Condition

Question 1

What are the three stages of cancer?

Answer 1

• Non - metastatic primary tumor
• Metastatic sub clones
• Metastases

Question 2

What is the progression of cancer in term of stages?

Answer 2

• tumour initiation (>10 years)
• Parental clone (~ 5 - 6 years)
• Metastatic seeds (~3 years)
• Patient’s death

Question 3

What is the process and goal of the clinical evolution of cancer?

Answer 3

• Risk assessment = cancer prevention
• Screening = early detection
• Classification, stage, grade, biomarker expression = guidance of local therapy or selection of systemic therapy and prediction of response
• Monitoring for recurrence = early intervention

Question 4

What are stages are included when cancer progresses?

Answer 4

• Initiation
• Promotion
• Late phase of promotion
• progression

Question 5

What happens during initiation?

Answer 5

• epidermal cell undergoes rapid, irreversible alteration or mutation of DNA
• Cells undergoes proliferation producing altered progeny or initiated cells

Question 6

What happens during promotion/ late phase of promotion

Answer 6

• Initiated cells undergo interrupted exposure to promoter; early reversible precancerous lesions
• Initiated cells undergo continuous exposure to promoter, causing malignant cell changes

Question 7

What happens during progression?

Answer 7

• Primary epidermal tumor - Invasion

- Metastasis

Question 8

What is the goals in cancer prevention approaches?

Answer 8

• Modify carcinogen activation by inhibiting enzymes
• Promotes scavenging of DNA - reactive electrophiles and (electron - donating) free radicals
• Scavenging of reactive oxygen species
• Alter the expression of genes involved in cell signaling, especially those in regulating cell proliferation, apoptosis and differentation
• Decrease inflammation

Question 9

What is the first and second hit of carcinogenesis?

Answer 9

• Carcinogen (1st hit) and promoter (2nd hit)

Question 10

What is a carcinogen?

Answer 10

Any substance that induces cancer in animals

Question 11

What is the process of carcinogen?

Answer 11

• Exposure to carcinogens
• Carcinogen attacks DNA
• Reaction with cellular targets, DNA damage, mutagenesis

Question 12

What is IARC classification of group 1?

Answer 12

The agent is carcinogenic to humans (Asbesto, solar radiation, tobacco)

Question 13

What is IARC classification of group 2A?

Answer 13

The agent is probably carcinogenic to humans (chemotherapy drugs, diesel engine exhaust, PCBs)

Question 14

What is IARC classification of group 2B?

Answer 14

The agent is possibly carcinogenic to humans (lead, mercury, gasoline engine exhaust)

Question 15

What is IARC classification of group 3?

Answer 15

The agent is not classifiable as to its carcinogenicity to humans

Question 16

What is IARC classification of group 4?

Answer 16

The agent is probably not carcinogenic to humans

Question 17

What are some agent examples of carcinogens?

Answer 17

• Aflatoxin
• Arsenic
• Asbestos
• Benzene
• Chlorambucil
• Epstein - Barr virus
• Hepatitis B virus
• Gamma radiation
• Solar radiation

Question 18

What are some mixture examples of carcinogens?

Answer 18

• Coal tar
• Soots
• Tobacco products

Question 19

What’s included in the stages of cancer

Answer 19

• Initiation (normal cell + First mutation)
• Promotion ( second mutation + third mutation)
• Progression (fourth mutation + cancer cells)

Question 20

What are some well established environmental factors ?

Answer 20

• Environmental tobacco smoke
• UV radiation
• Asbestos
• Rubber industry

Question 21

What are some controversial environmental factors?

Answer 21

• Electromagnetic fields
• Cell phones
• Air pollution

Question 22

What are some environmental carcinogens components?

Answer 22

• Physical
• Chemical
• Biological

Question 23

What are the two environmental cancer promoters?

Answer 23

• Chemical

- Biological

Question 24

What agents are environment and cancer issues of concern to community at large?

Answer 24

• Chemical (passive smoking, pesticides, plastic)

- physical (EMFs, cellular phones, UV)

Question 25

What environmental exposures are environment and cancer issues of concern to community at large?

Answer 25

• water (water chlorination)
• food (food pollutants)
• waste (cancer around waste landfills, health effects of dioxins, health effects of incinerators)
• nuclear (cancer around nuclear facilities)

Question 26

What human systems are environment and cancer issues of concern to community at large?

Answer 26

• reproduction ( male reproductive cancer, breast cancer, female & male reproduction)

Question 27

What is the primordial prevention applied to cancer?

Answer 27

• Creating economic, environmental and social conditions that are conducive to health and that minimize the likelihood of developing disease

Question 28

What is the primary prevention applied to cancer?

Answer 28

• addresses specific causal factors

Question 29

What is the secondary prevention applied to cancer?

Answer 29

• Targeting people with disease which is established but usually at an early stage, in order to limit the exacerbation of the disease and the development of complications

Question 30

What is the tertiary prevention applied to cancer?

Answer 30

• Concerned with patients with well established disease and its aim is to minimize suffering and complications

Question 31

What is the primordial prevention question in a person with cancer?

Answer 31

• Why me?

- Did something in my environment increased my risk of getting cancer?

Question 32

What is the primary prevention question in a person with cancer?

Answer 32

• Was it something I did?

- Is it my genes?

Question 33

What is the secondary prevention question in a person with cancer?

Answer 33

• Was it something I did not do?

Question 34

What is the tertiary prevention question in a person with cancer?

Answer 34

• Am I going to die from this cancer?