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Oncology > Chapter 1: Introduction (Lecture) > Flashcards

Chapter 1: Introduction (Lecture) Flashcards

1
Q

What is the definition of the incidence of cancer?

A

The number of new cases that is registered within a certain period (mostly 1 year). The incidence is mostly expressed as the number of new cases per 100.000 persons each year (crude incidence rate).

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2
Q

What is the definition of the prevalence of cancer?

A

All persons who somewhere in time have been diagnosed with cancer and are still living at a certain date.

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3
Q

What is the definition of the mortality of cancer?

A

The number of patients who died as a result of cancer within a certain period (mostly 1 year).

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4
Q

What is the definition of the survival of cancer?

A

The percentage of patients still living at a certain period after diagnosing.

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5
Q

What is meant by the cancer-specific survival?

A

The relative survival observed is corrected for the expected death within the Dutch population comparable with respect to gender, age and calender year.

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6
Q

How many patients were diagnosed with cancer in the Netherlands in 2020?

A. 27.000

B. 58.000

C. 115.000

D. 195.000

A

B. 115.000

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7
Q

How many patients have been diagnosed with cancer in the past 5 years (till 2020 (5-year prevalence) in the Netherlands?

A

>380.000

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8
Q

What was the mortality rate of cancer in 2019 in the Netherlands?

A

46.000

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9
Q

What type of cancer has the highest incidence in male? And which type in female?

A

In male -> lung cancer In female -> breast cancer

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10
Q

Look at this figure closely and remember which types of cancer are most common/most fatal/least fatal. But also look at the left and right side of both graphs, where it’s displayed what cancers are most common in high or low incomes (high/low HDI) (for illustration).

A

Okay

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11
Q

This figure displays mortality trends of 2010 vs 2000 of some cancer in women and men. One thing is strikingly different. Name this difference and explain it.

A

The mortality of lung cancer in men has gone down, while the mortality of lung cancer in woman has gone up.

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12
Q

What’s the result of better treatment, prevention, diagnosing?

A

An increasing survival in time.

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13
Q

True or false: Cancer is a group of diseases.

A

True

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14
Q

What are two characteristics of cancer?

A

Uncontrolled cell growth and invasive and forming metastases.

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15
Q

Does a patient with a tumor always have cancer?

A

No, because a tumor is (only) a mass of cells. Not every tumor is invasive and metastasing. And thus, benign tumors are not cancer, only malignant (invading) tumors are.

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16
Q

What are reasons why a malignant tumor is life threatening?

A
  • Invasion of organs disturbs organ function.
  • Cancer cells compete with normal cells for nutrient and oxygen.
  • Growing tumors can cause obstructions.
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17
Q

From what tissues do carcinomas, adenocarcinomas, sarcomas and lymphomas arise?

A
  • Carcinomas arise from epithelia (85% of all cancers).
  • Adenocarcinomas arise from glandular tissues (e.g. breast).
  • Sarcomas arise from mesodermal tissues (e.g. bone, muscle).
  • Lymphomas arise from (progenitors) of white blood cells.
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18
Q

Why is the incidence of carcinomas much higher than of other cancers?

A. Epithelial cells are the most abundant cells in our body

B. Epithelial cells are highly proliferating cells

C. Epithelial cells are the most metabolically active cells

D. Epithelial cells are more exposed to carcinogens

A

D. Epithelial cells are more exposed to carcinogens (but they al do contribute to oncogenesis)

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19
Q

What is a carcinogen?

A

An agent causing cancer by causing alterations in the DNA of a cell.

20
Q

From normal epithelium to lymph node and distant metastases. Name the (simple) steps of cancer development (oncogenesis).

A

Normal epithelium -> hyperplasia -> dysplasia -> carcinoma in situ -> invasive carcinoma -> lymph node and distant metastases.

21
Q

What is meant by the fact that cancer is clonal but at the same time tumors are heterogeneous?

A

A tumor originates from one (single gene-mutated) cell (clonal). But during oncogenesis every dividing cancer cell can develop new mutations. This results in a heterogeneous cancer population, with cancer cells that have different mutations.

22
Q

Is cancer inheritable?

A

No, almost all of the mutations develop in somatic cells and will not be passed to the next generation of offspring. However, some inheritant germline mutations can increase the chance to develop cancer and can be passed on to the next generation of offspring. These mutations are rarely involved in causing cancer immediately.

23
Q

Why does the risk to develop cancer increase at older age?

A

Cancer is a matter of chance and time (exposure to carcinogens) and with that the incidence of cancer is increasing due to longer life expectancy.

24
Q

What are the six hallmarks of cancer?

A
  1. Sustaining proliferative signaling
  2. Resisting cell death
  3. Inducing angiogenesis
  4. Enabling replicative immortality
  5. Activating invasion and metastases
  6. Evading growth suppressors.
25
Q

What are two emerging hallmarks of cancer?

A

Deregulating cellular energetics and avoiding immune destruction.

26
Q

What are two enabling characteristics of cancer?

A

Tumor-promoting inflammation and genome instability and mutations.

27
Q

Statement: a tumor is more than just tumor cells.

  • From a reductionist point of view: what is cancer?
  • From a heterotypic cell biology view: what is cancer?
A
  • Reductionist: a tumor consists of cancer cells.
  • Heterotypic cell biology: a tumor consist of cancer cells, but also immune cells, endothelial cells and fibroblasts.
28
Q

What is disturbed and what is stimulated during the growth of a tumor?

A

The balance between proliferation, cell death and differentiation is disturbed. Here, proliferation is stimulated and apoptosis and differentiation are halted.

29
Q

Fill in (differentiation, apoptosis or proliferation):

Oncogenes stimulate … (1), while tumor suppressor genes stimulate … (2) and … (3).

A
  1. Proliferation 2. Differentiation 3. Apoptosis
30
Q

Fill in: Oncogenes are … (1) genes that are mutated and induced for … (2). They can sometimes arise from … (3). The wild type genes are called … (4).

A
  1. normal 2. expression 3. viruses 4. proto-oncogenes
31
Q

What happens when a tumor suppressor loses its functions?

A

Loss of growth inhibition -> tumor development.

32
Q

What happens when a mutation of an oncogene is dominant? What happens when it’s recessive?

A
  • When the mutation is dominant -> 1 mutation is sufficient to have a protein product produced at higher quantities or increased activity.
  • When the mutation is recessive -> most of the time both alleles have to be mutated (except for haploinsufficiency).
33
Q

Is it possible to recognize cancer cells in tissue culture? How?

A

Cancer cells have different morphology, can grow at low serum in culture media, show no/decreased contact inhibiton and cancer cells can grow without a substrate.

34
Q

How can oncogenes be identified in a laboratory?

A
  1. Isolate the gene from tumor cells.
  2. Transfection of DNA into immortalized mouse fibroblasts.
  3. Evaluation whether transfected cells obtain altered growth characteristics (transformation assay).
35
Q

What are risk factors for cancer?

A

Environment, diet, alcohol, smoking, reproduction, viruses, own metabolism.

36
Q

What are conventional treatments of cancer?

A

Surgery, radiotherapy, chemotherapy, prevention of cell division (cytostatic effect), killing of cancer cells (cytotoxic effect).

37
Q

What is the defenition of a cytostatic and cytotoxic effect?

A

Cytostatic effect: prevention of cell division. Cytotoxic effect: killing of cancer cells.

38
Q

What are the limitations of conventional chemotherapy?

A
  • Adverse events/toxicity on normal tissues
  • The therapeutic index (TI) of most chemotherapeutics is relatively small.
39
Q

What is the therapeutic index (TI)?

A

The difference between maximum tolerated dose (MTD) and the minimum dose needed to exert anti-cancer activity.

40
Q

What is the aim of cancer treatment development?

A

To develop novel anti-cancer agents with selective acitivity against cancer cells, thus causing less toxicity.

41
Q

What patients are used in clinical trial with novel anticancer agents?

A

Patients without any further treatment options.

42
Q

Describe the first three phases of a clinical trial.

A

Phase I: assessment of safety in a limited number of patients.

Phase II: assesment of efficacy at a safe dose.

Phase III: extensive trials. Assessment of added value. Comparison with current standard treatment.

43
Q

What are the most important characteristics of a phase III trial?

A
  • Clear definition of patient groups (inclusion criteria).
  • Randomisation
  • Blind or double-blind research trial
  • Placebo
44
Q

Just know that only a small proportion of patients benefit from treatment with current drugs. See and click for figure.

A

Okay

45
Q

What is the reason that a majority of current cancer drugs have such a low efficacy?

A

Tumors differ from eachother. Genomics have shown that every tumor has its own unique genetic profile. Hence, the importance of personalized medicine.

46
Q

How do you know whether a patient might be a suitable candidate for treatment with a particular targeted drug?

A

Performing diagnostic tests, like genetics, imaging, immunohistochemistry.

47
Q

The development of cancer is usually associated with a combination of:

A. Mutation of one copy of a proto-oncogene and loss of one copy of a tumor-suppressor gene.

B. Mutation of both copies of a proto-oncogene and loss of one copy of a tumor- suppressor gene

C. Mutation of one copy of a proto-oncogene and loss of both copies of a tumor- suppressor gene

D. Mutation of both copies of a proto-oncogene and loss of both copies of a tumor- suppressor gene

A

C. Mutation of one copy of a proto-oncogene and loss of both copies of a tumor- suppressor gene

Oncology (18 decks)

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