Oncology Exam Summary, NWI-BM015C KW2, 2023-2024
Lecture 1
Intro:
• Disturbed growth/ invasive growth (endo) is not only/ always cancer
• Focus mostly on solid cancers
• Often occurs in fast dividing tissue
Cancer epidemiology
Descriptive cancer epidemiology
• Why is it important?
• Key epidemiological concepts
• Differences by country, cancer type, cancer stage
Etiologic cancer epidemiology (Risk factors)
• Age
• How to identify causes of cancer
• Lifestyle-related risk factors for cancer
• Other risk factors for cancer
Cancer epidemiology in Nijmegen – examples of bladder cancer research
• Life-time risk (85 yrs) of cancer in females? 38% (more than 1 in 3 females)
• Life-time risk (85 yrs) of cancer in males? 45% (almost 1 in 2 males)
• How many persons are diagnosed with (invasive) cancer every year in the Netherlands? ±
124,000 → the numbers increase over time, higher numbers are expected
• The sharp increase is due to aging – we need more focus on prevention, it has an enormous
burden on the health care system
Why is it important?
• Knowledge about trends in incidence and survival/ mortality after cancer
• Can be used to develop, implement and evaluate effective policies for cancer control
(e.g. cancer screening, preventive measures, education health care personnel, planning care
facilities)
Key epidemiological concepts
1. Prevalence
2. Incidence
3. Mortality
4. Relative survival
,e.g. 5-year prevalence at 1 January 2019 in the NL: all living cancer patients who have been
diagnosed in the previous 5 years in the NL
e.g. incidence in 2018 in the NL: number of newly diagnosed cancer cases in 2018 in the NL
• Number: absolute number of new cases in a certain period
• CR (crude rate): number of new cases per 100,000 persons per year
• ESR (European standardized rate): number of new cases per 100,000 persons per year,
standardized for the age composition of Europe
• WSR (World standardized rate): number of new cases per 100,000 persons per year,
standardized for the age composition of the world
e.g. mortality in 2018 in the NL: number of cases that died from cancer in 2018 in the NL
Also expressed as number, CR, ESR, WSR (similar to incidence)
The percentage of cancer cases alive at a certain time period after diagnosis (not including those who
died from other diseases)
e.g. 5-year relative survival: Percentage of cancer cases who survived 5 years
Worldwide differences in cancer incidence
• More prevalent in the western world (might be related to age – people grow older in e.g., the
Netherlands than in Africa, the western world might also be better at diagnosing it)
• Men: especially lung and prostate cancer
• Women: mainly breast cancer and colorectum cancer
• Stomach cancer more prevalent in Russia and south America compared to the western world –
due to food conservation and helicobacter pylori (more common)
• Liver cancer more common in Asian in African countries – due to Hepatitis B and Aflatoxin (mold)
• Cervix cancer more common in African countries – due to Human Papillomavirus
,• Standardized incidence lung cancer in women in NL – due to an increase in smoking in women,
while men quit smoking
• Mortality total cancer in NL increases over time
• The most common types are not always the deadliest (lung cancer causes the most deaths, while
skin is more prevalent, for example)
• Testicular cancer leads to little deaths, while pancreatic cancer has a very low survival rate
what is the most important risk factor for cancer in general? Age
Time needed for accumulation of damage to daughter cells
Mutations in regulatory genes:
• ‘Spontaneous’
• Chemical substances
• Radiation
• Viruses
Protective tools
• Repair of blueprint (DNA repair)
• Clean suicide (apoptosis)
• Mitosis stops (senescence)
Cancer at older age
• Accumulation of damage / mutations in regulatory genes
• More damage to repair tools / repair tools less effective
• Less control by micro-environment
• Life expectancy has increased
• Grey pressure: the number of people ages above 65 has increased
•
• Consequence for number of new cancer diagnoses per year: +25%
• Survival is improved
• Consequence for number of cancer deaths per year: +13%
• Consequence for number of patients alive per year: +49% (due to increased survival)
Enormous public health problem:
• Double ageing phenomenon
• Better survival because of
o Early detection
o Improved treatment
• More expensive health care
o Diagnosis
o Treatment
• Conclusion: Focus on prevention !!
, How do you identify causes of cancer
1. Accidental finding / keep alert
2. Systematic counting / trends
3. Focussed research
human observational studies experimental studies
4. Exploration
Accidental:
• Nuns have a higher risk of breast cancer (hormone exposure due to having children is not
present)
• CT scan: doctors have a higher chance of skin abnormalities since the doctors are constantly
exposed
• Painting watches with radium: constant exposure for women workers – high incidence in
Martland
• Recent examples: bridges painted with certain paint, TATA steel (lung cancer)
Systematic:
• Retina cancer: compare the development in one eye and compare to patients who have it in two
eyes – might be one hit or two hit theory (two eye patients were affected from birth on, higher
risk)
• Cumulative risk (%) stomach cancer up to 74 y
• Migrant studies – people who lived in Japan and moved to the US, look at breast and stomach
cancer incidence (breast cancer more uncommon in Japan, increases when moving to the US,
stomach incidence also decreases for the next generation)
• Trend in melanoma (increased exposure to sun)
Focused research:
• Design of a case-control study
• Number of cases compared to control without diseases – ask about exposure – can identify risk
factors:
•
• Same type of vaginal cancer in 8 women – 7/8 had a miscarriage and took oestrogen to prevent
miscarriages
• Design of a prospective cohort study:
Lecture 1
Intro:
• Disturbed growth/ invasive growth (endo) is not only/ always cancer
• Focus mostly on solid cancers
• Often occurs in fast dividing tissue
Cancer epidemiology
Descriptive cancer epidemiology
• Why is it important?
• Key epidemiological concepts
• Differences by country, cancer type, cancer stage
Etiologic cancer epidemiology (Risk factors)
• Age
• How to identify causes of cancer
• Lifestyle-related risk factors for cancer
• Other risk factors for cancer
Cancer epidemiology in Nijmegen – examples of bladder cancer research
• Life-time risk (85 yrs) of cancer in females? 38% (more than 1 in 3 females)
• Life-time risk (85 yrs) of cancer in males? 45% (almost 1 in 2 males)
• How many persons are diagnosed with (invasive) cancer every year in the Netherlands? ±
124,000 → the numbers increase over time, higher numbers are expected
• The sharp increase is due to aging – we need more focus on prevention, it has an enormous
burden on the health care system
Why is it important?
• Knowledge about trends in incidence and survival/ mortality after cancer
• Can be used to develop, implement and evaluate effective policies for cancer control
(e.g. cancer screening, preventive measures, education health care personnel, planning care
facilities)
Key epidemiological concepts
1. Prevalence
2. Incidence
3. Mortality
4. Relative survival
,e.g. 5-year prevalence at 1 January 2019 in the NL: all living cancer patients who have been
diagnosed in the previous 5 years in the NL
e.g. incidence in 2018 in the NL: number of newly diagnosed cancer cases in 2018 in the NL
• Number: absolute number of new cases in a certain period
• CR (crude rate): number of new cases per 100,000 persons per year
• ESR (European standardized rate): number of new cases per 100,000 persons per year,
standardized for the age composition of Europe
• WSR (World standardized rate): number of new cases per 100,000 persons per year,
standardized for the age composition of the world
e.g. mortality in 2018 in the NL: number of cases that died from cancer in 2018 in the NL
Also expressed as number, CR, ESR, WSR (similar to incidence)
The percentage of cancer cases alive at a certain time period after diagnosis (not including those who
died from other diseases)
e.g. 5-year relative survival: Percentage of cancer cases who survived 5 years
Worldwide differences in cancer incidence
• More prevalent in the western world (might be related to age – people grow older in e.g., the
Netherlands than in Africa, the western world might also be better at diagnosing it)
• Men: especially lung and prostate cancer
• Women: mainly breast cancer and colorectum cancer
• Stomach cancer more prevalent in Russia and south America compared to the western world –
due to food conservation and helicobacter pylori (more common)
• Liver cancer more common in Asian in African countries – due to Hepatitis B and Aflatoxin (mold)
• Cervix cancer more common in African countries – due to Human Papillomavirus
,• Standardized incidence lung cancer in women in NL – due to an increase in smoking in women,
while men quit smoking
• Mortality total cancer in NL increases over time
• The most common types are not always the deadliest (lung cancer causes the most deaths, while
skin is more prevalent, for example)
• Testicular cancer leads to little deaths, while pancreatic cancer has a very low survival rate
what is the most important risk factor for cancer in general? Age
Time needed for accumulation of damage to daughter cells
Mutations in regulatory genes:
• ‘Spontaneous’
• Chemical substances
• Radiation
• Viruses
Protective tools
• Repair of blueprint (DNA repair)
• Clean suicide (apoptosis)
• Mitosis stops (senescence)
Cancer at older age
• Accumulation of damage / mutations in regulatory genes
• More damage to repair tools / repair tools less effective
• Less control by micro-environment
• Life expectancy has increased
• Grey pressure: the number of people ages above 65 has increased
•
• Consequence for number of new cancer diagnoses per year: +25%
• Survival is improved
• Consequence for number of cancer deaths per year: +13%
• Consequence for number of patients alive per year: +49% (due to increased survival)
Enormous public health problem:
• Double ageing phenomenon
• Better survival because of
o Early detection
o Improved treatment
• More expensive health care
o Diagnosis
o Treatment
• Conclusion: Focus on prevention !!
, How do you identify causes of cancer
1. Accidental finding / keep alert
2. Systematic counting / trends
3. Focussed research
human observational studies experimental studies
4. Exploration
Accidental:
• Nuns have a higher risk of breast cancer (hormone exposure due to having children is not
present)
• CT scan: doctors have a higher chance of skin abnormalities since the doctors are constantly
exposed
• Painting watches with radium: constant exposure for women workers – high incidence in
Martland
• Recent examples: bridges painted with certain paint, TATA steel (lung cancer)
Systematic:
• Retina cancer: compare the development in one eye and compare to patients who have it in two
eyes – might be one hit or two hit theory (two eye patients were affected from birth on, higher
risk)
• Cumulative risk (%) stomach cancer up to 74 y
• Migrant studies – people who lived in Japan and moved to the US, look at breast and stomach
cancer incidence (breast cancer more uncommon in Japan, increases when moving to the US,
stomach incidence also decreases for the next generation)
• Trend in melanoma (increased exposure to sun)
Focused research:
• Design of a case-control study
• Number of cases compared to control without diseases – ask about exposure – can identify risk
factors:
•
• Same type of vaginal cancer in 8 women – 7/8 had a miscarriage and took oestrogen to prevent
miscarriages
• Design of a prospective cohort study:
