ONCOLOGIE
Inleiding ....................................................................................................................................... 5
Epidemiologie ............................................................................................................................ 5
Definitie kanker .......................................................................................................................... 5
Oorzaken kanker (!) ..................................................................................................................... 5
Classificatie – TNM classificatie ................................................................................................... 7
Terminologie .............................................................................................................................. 7
Anamnese en diagnose ............................................................................................................... 8
Klinische studies .........................................................................................................................10
Theorie van klinische studies ......................................................................................................10
Organiseren van een academische klinische studie .......................................................................13
Hallmarks van kanker ..................................................................................................................14
Wat is kanker? ...........................................................................................................................14
Hallmarks of cancer ...................................................................................................................16
Epidemiologie en screening .........................................................................................................22
Concepten secundaire preventie .................................................................................................22
Besluitvorming ..........................................................................................................................23
Doelgroep .................................................................................................................................23
Concepten................................................................................................................................23
Borstkankerscreening in Vlaanderen ............................................................................................25
Dikkedarmkankerscreening in Vlaanderen ....................................................................................26
Diagnostiek oncologie: beeldvorming ...........................................................................................27
Algemeen .................................................................................................................................27
Screening .................................................................................................................................27
Diagnose en stadiëring ...............................................................................................................28
Beoordeling van behandelingsrespons .........................................................................................29
Beeldvormingsgeleide behandeling .............................................................................................31
Lange termijn surveillantie ..........................................................................................................32
Toekomst – AI ............................................................................................................................32
Diagnostiek oncologie: pathologie ...............................................................................................33
Introductie ................................................................................................................................33
Histologische karakteristieken van maligne tumoren .....................................................................34
Predictieve biomarkers in oncologie ............................................................................................36
Oncologische chirurgie ................................................................................................................41
Introductie ................................................................................................................................41
Doelen van chirurgische oncologie ..............................................................................................41
1
, Non-resectie lokale behandeling – curatief intent! .........................................................................46
Navigatie – tumor targeting .........................................................................................................48
Chemotherapie en targeted therapie ............................................................................................49
Algemeen .................................................................................................................................49
Chemotherapie .........................................................................................................................49
Targeted therapie ......................................................................................................................52
Immunotherapie..........................................................................................................................56
Algemeen .................................................................................................................................56
Kanker immmunotherapie ..........................................................................................................56
Klinische studies: dendrietcel vaccins..........................................................................................60
Toekomst .................................................................................................................................60
Kankergenetica ...........................................................................................................................62
Inleiding ...................................................................................................................................62
Tumor predispositie syndromen: diagnose ...................................................................................63
Tumor predispositie syndromen: voorbeelden ..............................................................................64
Leerdoelen ...............................................................................................................................67
Coping ........................................................................................................................................68
Inleiding ...................................................................................................................................68
Copingmechanismen .................................................................................................................68
Coping toegepast op oncologie ...................................................................................................69
Rol van de arts...........................................................................................................................70
Zelfzorg ....................................................................................................................................72
Take home message ..................................................................................................................72
Straling en stralingsbescherming .................................................................................................73
Ioniserende straling ...................................................................................................................73
Definitie van straling...................................................................................................................73
ICRP en stralingsbelasting ..........................................................................................................74
Gray en Sievert ..........................................................................................................................75
Stralingseffecten .......................................................................................................................76
Achtergrondstraling ...................................................................................................................77
Radiotherapie..............................................................................................................................78
Biologische aspecten van radiotherapie .......................................................................................78
Klinische aspecten van radiotherapie ...........................................................................................80
Oncorevalidatie...........................................................................................................................85
Inleiding: oncorevalidatie in België ...............................................................................................85
Kankerbehandeling gerelateerde nevenwerkingen: wanneer revalidatie? .........................................85
Kankergerelateerde vermoeidheid ...............................................................................................87
2
, Verschillende momenten van revalidatie ......................................................................................88
Belang van beweging bij kanker ...................................................................................................88
Rol van de kiné in een notendop ..................................................................................................89
Take home messages .................................................................................................................89
Palliatieve zorg ............................................................................................................................90
Wat? ........................................................................................................................................90
Wie? ........................................................................................................................................90
Consultatie palliatief arts............................................................................................................90
Casus 1 ....................................................................................................................................91
Prognosticeren ............................................................................................................................93
Definitie ....................................................................................................................................93
Waarom? ..................................................................................................................................93
Hoe? ........................................................................................................................................94
Multidisciplinair: rectumcarcinoom .............................................................................................95
Inleiding ...................................................................................................................................95
Epidemiologie ...........................................................................................................................95
Risicofactoren ...........................................................................................................................95
Pathogenese .............................................................................................................................95
Klinische presentatie .................................................................................................................95
Onderzoeken ............................................................................................................................96
Stadiëring en TNM classificatie ....................................................................................................96
Behandeling ..............................................................................................................................97
Post-behandeling surveillantie ....................................................................................................98
Take home messages .................................................................................................................98
Multidisciplinair: borstkanker ......................................................................................................99
Epidemiologie ...........................................................................................................................99
Pathologie ................................................................................................................................99
Stadiëring ............................................................................................................................... 100
Diagnose ................................................................................................................................ 100
Casussen ............................................................................................................................... 100
Kinderoncologie ........................................................................................................................ 101
Epidemiologie ......................................................................................................................... 101
Biologie van childhood kanker ................................................................................................... 101
Basis van diagnose en behandeling ........................................................................................... 102
Meest prevalente pediatrische maligniteiten ............................................................................... 105
Predispositie in pediatrische oncologie ...................................................................................... 115
Langetermijn overlevers en late effecten .................................................................................... 115
3
, Pediatrische oncologie wereldwijd ............................................................................................ 116
Wetenschappelijk onderzoek ..................................................................................................... 117
Inleiding: research design ......................................................................................................... 117
Klinisch onderzoek in oncologie ................................................................................................ 117
Preklinisch onderzoek in oncologie ............................................................................................ 118
Preklinisch onderzoek ............................................................................................................... 121
Te kennen ............................................................................................................................... 121
Voeding en kanker ..................................................................................................................... 122
Preventie ................................................................................................................................ 122
Malnutritie .............................................................................................................................. 122
Screening ............................................................................................................................... 122
Nutritionele interventie ............................................................................................................. 123
Nucleaire geneeskunde ............................................................................................................. 125
Inleiding ................................................................................................................................. 125
Diagnostische onderzoeken ...................................................................................................... 125
Radionuclide therapie .............................................................................................................. 129
Zelfzorg in de oncologie ............................................................................................................. 130
Slecht nieuws brengen ............................................................................................................. 130
Impact op jou als hulpverlener .................................................................................................. 131
Zelfzorg .................................................................................................................................. 132
4
Inleiding ....................................................................................................................................... 5
Epidemiologie ............................................................................................................................ 5
Definitie kanker .......................................................................................................................... 5
Oorzaken kanker (!) ..................................................................................................................... 5
Classificatie – TNM classificatie ................................................................................................... 7
Terminologie .............................................................................................................................. 7
Anamnese en diagnose ............................................................................................................... 8
Klinische studies .........................................................................................................................10
Theorie van klinische studies ......................................................................................................10
Organiseren van een academische klinische studie .......................................................................13
Hallmarks van kanker ..................................................................................................................14
Wat is kanker? ...........................................................................................................................14
Hallmarks of cancer ...................................................................................................................16
Epidemiologie en screening .........................................................................................................22
Concepten secundaire preventie .................................................................................................22
Besluitvorming ..........................................................................................................................23
Doelgroep .................................................................................................................................23
Concepten................................................................................................................................23
Borstkankerscreening in Vlaanderen ............................................................................................25
Dikkedarmkankerscreening in Vlaanderen ....................................................................................26
Diagnostiek oncologie: beeldvorming ...........................................................................................27
Algemeen .................................................................................................................................27
Screening .................................................................................................................................27
Diagnose en stadiëring ...............................................................................................................28
Beoordeling van behandelingsrespons .........................................................................................29
Beeldvormingsgeleide behandeling .............................................................................................31
Lange termijn surveillantie ..........................................................................................................32
Toekomst – AI ............................................................................................................................32
Diagnostiek oncologie: pathologie ...............................................................................................33
Introductie ................................................................................................................................33
Histologische karakteristieken van maligne tumoren .....................................................................34
Predictieve biomarkers in oncologie ............................................................................................36
Oncologische chirurgie ................................................................................................................41
Introductie ................................................................................................................................41
Doelen van chirurgische oncologie ..............................................................................................41
1
, Non-resectie lokale behandeling – curatief intent! .........................................................................46
Navigatie – tumor targeting .........................................................................................................48
Chemotherapie en targeted therapie ............................................................................................49
Algemeen .................................................................................................................................49
Chemotherapie .........................................................................................................................49
Targeted therapie ......................................................................................................................52
Immunotherapie..........................................................................................................................56
Algemeen .................................................................................................................................56
Kanker immmunotherapie ..........................................................................................................56
Klinische studies: dendrietcel vaccins..........................................................................................60
Toekomst .................................................................................................................................60
Kankergenetica ...........................................................................................................................62
Inleiding ...................................................................................................................................62
Tumor predispositie syndromen: diagnose ...................................................................................63
Tumor predispositie syndromen: voorbeelden ..............................................................................64
Leerdoelen ...............................................................................................................................67
Coping ........................................................................................................................................68
Inleiding ...................................................................................................................................68
Copingmechanismen .................................................................................................................68
Coping toegepast op oncologie ...................................................................................................69
Rol van de arts...........................................................................................................................70
Zelfzorg ....................................................................................................................................72
Take home message ..................................................................................................................72
Straling en stralingsbescherming .................................................................................................73
Ioniserende straling ...................................................................................................................73
Definitie van straling...................................................................................................................73
ICRP en stralingsbelasting ..........................................................................................................74
Gray en Sievert ..........................................................................................................................75
Stralingseffecten .......................................................................................................................76
Achtergrondstraling ...................................................................................................................77
Radiotherapie..............................................................................................................................78
Biologische aspecten van radiotherapie .......................................................................................78
Klinische aspecten van radiotherapie ...........................................................................................80
Oncorevalidatie...........................................................................................................................85
Inleiding: oncorevalidatie in België ...............................................................................................85
Kankerbehandeling gerelateerde nevenwerkingen: wanneer revalidatie? .........................................85
Kankergerelateerde vermoeidheid ...............................................................................................87
2
, Verschillende momenten van revalidatie ......................................................................................88
Belang van beweging bij kanker ...................................................................................................88
Rol van de kiné in een notendop ..................................................................................................89
Take home messages .................................................................................................................89
Palliatieve zorg ............................................................................................................................90
Wat? ........................................................................................................................................90
Wie? ........................................................................................................................................90
Consultatie palliatief arts............................................................................................................90
Casus 1 ....................................................................................................................................91
Prognosticeren ............................................................................................................................93
Definitie ....................................................................................................................................93
Waarom? ..................................................................................................................................93
Hoe? ........................................................................................................................................94
Multidisciplinair: rectumcarcinoom .............................................................................................95
Inleiding ...................................................................................................................................95
Epidemiologie ...........................................................................................................................95
Risicofactoren ...........................................................................................................................95
Pathogenese .............................................................................................................................95
Klinische presentatie .................................................................................................................95
Onderzoeken ............................................................................................................................96
Stadiëring en TNM classificatie ....................................................................................................96
Behandeling ..............................................................................................................................97
Post-behandeling surveillantie ....................................................................................................98
Take home messages .................................................................................................................98
Multidisciplinair: borstkanker ......................................................................................................99
Epidemiologie ...........................................................................................................................99
Pathologie ................................................................................................................................99
Stadiëring ............................................................................................................................... 100
Diagnose ................................................................................................................................ 100
Casussen ............................................................................................................................... 100
Kinderoncologie ........................................................................................................................ 101
Epidemiologie ......................................................................................................................... 101
Biologie van childhood kanker ................................................................................................... 101
Basis van diagnose en behandeling ........................................................................................... 102
Meest prevalente pediatrische maligniteiten ............................................................................... 105
Predispositie in pediatrische oncologie ...................................................................................... 115
Langetermijn overlevers en late effecten .................................................................................... 115
3
, Pediatrische oncologie wereldwijd ............................................................................................ 116
Wetenschappelijk onderzoek ..................................................................................................... 117
Inleiding: research design ......................................................................................................... 117
Klinisch onderzoek in oncologie ................................................................................................ 117
Preklinisch onderzoek in oncologie ............................................................................................ 118
Preklinisch onderzoek ............................................................................................................... 121
Te kennen ............................................................................................................................... 121
Voeding en kanker ..................................................................................................................... 122
Preventie ................................................................................................................................ 122
Malnutritie .............................................................................................................................. 122
Screening ............................................................................................................................... 122
Nutritionele interventie ............................................................................................................. 123
Nucleaire geneeskunde ............................................................................................................. 125
Inleiding ................................................................................................................................. 125
Diagnostische onderzoeken ...................................................................................................... 125
Radionuclide therapie .............................................................................................................. 129
Zelfzorg in de oncologie ............................................................................................................. 130
Slecht nieuws brengen ............................................................................................................. 130
Impact op jou als hulpverlener .................................................................................................. 131
Zelfzorg .................................................................................................................................. 132
4
