Intro Flashcards
Terminology:
1. Incidence
2. Incidence rate
3. Mortality Rate
4. Case fatality rate
5. Prevalence
6. Survival Rate
- Incidence: number of new cases identified in a specified population within a time period (e.g., 1 year)
- Incidence rate: number developing cancer per 100,000 population per year
- Mortality rate: number dying per 100,000/year (e.g., 2.6 per 100,000/year)
- Case fatality rate: percentage of people with specific cancer diagnosis that die from that cancer (e.g., 40% fatality rate)
- Prevalence: number of cases per population at a specific point in time (e.g., 50,234 documented cases in the United States)
- Survival rate: the percentage of people who are alive at certain stages after their diagnosis or the start of treatment, usually described as a five-year survival rate.
Cancer Age Ranges
<20
-brain/CNS/nerves (neuroblastoma = nerves)
-Eye - retinoblastotma
-blood/lymph (leukemia, lymphoma (hodgkin/nonhodgkin)
-Bone (Ewing sarcoma and osteosarcoma)
-skeletal muscles (rhabdomyosarcoma)
Age + Cancer: 21-49
-breast, cervix, uterine, ovarian
-testes (20-35)
-kidney
-bowel
lymph nodes (non-hodgkin)
-skin (melanoma)
Age + Cancer: 50-64
-lung
-Breast, cervix, uterine, ovarian
prostate
-kidney
-bowel + liver + Pancreas
-Skin
Age + Cancer > 65
-Oral cavity/pharynx/larynx/ lung
-GI: Esophagus, stomach, colorectal/rectal, pancreas
-breast, ovarian
-prostate
-bladder
-skin
Modifiable risk factors for cancer
-Tobacco + Alcohol
-High fat/low-fiber dietst
-High-risk occupations
-Sunscreen usage
-Sedentary life styles
-Cancer-related infecttions
Cancer-related infetions
-Helicopactor Hylori
-Hepatitis B and C
-Herpes
-HIV + HPV
Non-modifiable risk factors for cancer
-age, sex, race/etthnicity, genetics/family history
Healthcare disparities
-low income
-low health literacy
-rural
-lack of healthcare coverage
Occupational Cancer Hazards
- ABC - aspestos, biological agents, cleaning agents
- Radiation exposure
- Other (manufacturers, dry cleaners, jewlers, miners, etc
Cancer screening -
Skin
Yearly physical for everyon
Colorectal CA screening
- Colonoscopy Q10 yrs ≥ 45
- CT colonography or sigmoidoscopy Q5 years if NO colonoscopy
- Fecal Occult Blood or immunochemical test- yearly after 50
Cervical CA screenings
Pap smear 25-65 Q 3 years OR every 5 years with HPV screening concurrently
Breast
-Mammogram - yearly for average risk women >40 (30 for high risk)
-Clinical breast exam Q3 years 20-30, yearly for 40+
-MRI of breast for high-risk only
Endometrial cancer screening
-Yearly for high-risk only, no screening otherwise
Prostate cancer screening
-PSA: men over 50, discuss with provider. High-risk men (African American or with family hx) testing should occur at age 45. Further testing depends on PSA level (biopsy or Digital Rectal Exam
Lung cancer screening
Annual Low-dose CT scan (LDCT): for at-risk adults ages 50 to 80 years old. Must be in fairly good health and currently smoke or have quit smoking in the past 15 years and have at least a 20 pack-year smoking history.
Carcinogenesis
-process of cancer formation
-failure of cell repair and replication of cells with damage that no longer die
what causes carcinogenesis
-Mutations in regulatory cells (proto-oncogenes, tumor suppressor genes, DNA repair genes)
-genomic instabilty
-inflammation
oncogenes
stimulate or suppress normal apoptosis of cells
P53 suppressor gene
produces a protein that detects DNA lesions and prevents cells from entering S phase to either induce rapirs or cell death
-most frequently mutated gene seen in cancer
Cytogenetics
The structure and function of the chromosomes
-abnormalities are used to diagnose solid tumor and heme malignancies
Common hereditary genes associated with cancer (6)
WT1: Wilms tumor
APC: familial colon polyposis, osteomas, thyroid cancer, hepatoblastoma
CDKN20: familial melanoma
BRCA-1/BRCA-2: familial breast and ovarian cancers
TP53 mutant: hereditary Li-Fraumeni syndrome
MLH1/MSH2/PMS1: hereditary Lynch Syndrome, which can cause colon, rectal, stomach, biliary, brain, endometrium, uterine and renal pelvis cancers
Molecular testing and Genetics
BRAF, EGFR, ER receptor, PR receptor, KRAS, HER2/neu, Philadelphia chromosome (Ph+), CD-30
What must studies have before participant enrollment?
-IRB approval or IEC approval (independent ethics committee)
-informed consent
-protection of vulnerable populations
Clinical trial phase I and II
Phase Ia: studies how a drug acts in humans (FiH trial)
Phase Ib: studies interactions with other drugs (combination therapy)
Phase IIa: studies how a drug functions in disease types
Phase IIb: pivotal trials to evaluate safety and efficacy in humans
Clinical trial Phase III and IV
Phase IIIa: trials to generate additional data for specific populations (e.g., patients with renal failure). Data assist in package insert and labeling of a drug.
Phase IIIb: trials done after submission of a New Drug Application (NDA) but before approval and launch
Phase IV: trials done after market launch; may include different formulations, dosages, age groups, and patient groups (aka: “post-marketing surveillance”)
