Oncology 2022
Inhoudsopgave
Lesson 1 ........................................................................................................................................................... 3
Explain causes of cancer and cell injury ........................................................................................................ 3
Understand the terms: hyperplasia, metaplasia, neoplasia, malignant-, benign tumours ........................... 3
Basic knowledge of survival rates of different cancer types ......................................................................... 5
Recognize morphological features of tumour cells ....................................................................................... 6
Explain the 10 hallmarks of cancer ................................................................................................................ 8
Basic knowledge of the TNM system ............................................................................................................. 9
Different metastasis routes of different primary tumours .......................................................................... 10
Familiar with the nomenclature of tumours: carcinoma, sarcoma, etc. ..................................................... 12
Lesson 2 ......................................................................................................................................................... 13
Basic knowledge of different techniques addressed in this presentation .................................................. 13
Basic knowledge of different stages of tumour progression of colon cancer ............................................. 14
Understand the terms tumour promoter and tumour progression ............................................................ 17
Knows relation between adenomas and carcinomas .................................................................................. 18
Familiar with the apc gene as an example of a tumour suppressor gene and the relation to FAP ............. 18
Understand the terms tumour oncogenes and tumour suppressor genes ................................................. 18
Understand the terms Darwinian evolution of tumours ............................................................................. 19
Knows what tumour stem cells are and how they influence clonal expansion ........................................... 19
Familiar with the effect of chronic inflammation of tumour progression ................................................... 19
Notes ........................................................................................................................................................... 19
Lesson 3 ......................................................................................................................................................... 20
Basic knowledge of different stages of the cell cycle .................................................................................. 20
Knowledge of the cell cycle control system and checkpoints ..................................................................... 24
Knowledge on the mechanisms of CDK and cyclins .................................................................................... 25
Understand the effects and working of proteins involved in CDK activation and inhibition (e.g. RB and
p21).............................................................................................................................................................. 26
Understand how errors in activation of CDK and resulting cascades can contribute to carcinogenesis. ... 27
Know what telomeres are and understand it’s function ............................................................................. 31
Understand and be able to explain how telomeres become shorter every cell cycle................................. 31
Know what effects short telomeres can have in tumour development ...................................................... 32
Understand how tumour cells can become “immortal” by telomerase activation ..................................... 33
Understand the relation between telomerase activity and patient prognosis ........................................... 34
Notes ........................................................................................................................................................... 34
Lesson 4 ......................................................................................................................................................... 35
Knowing what tumour suppressor genes (TSGs) are ................................................................................... 35
Understanding how TSGs can be lost or inactivated ................................................................................... 36
Knowing and being able to describe how TSGs inactivation contributes to carcinogenesis ....................... 42
Knowing the difference between familial and sporadic cancers ................................................................. 42
Understanding what kind of genes can be considered TSGs ....................................................................... 42
Knowing and understanding what kind of processes can lead to different kinds of DNA damage ............. 43
Understanding the basics of different DNA repair systems ........................................................................ 44
• DNA Polymerase proofreading .......................................................................................................... 45
• Mismatch repair (Mut repair genes) .................................................................................................. 46
• Base Excision repair (BER) .................................................................................................................. 47
, • Nucleotide Excision Repair (NER) ....................................................................................................... 47
• Double strand break: Homologous Recombination ........................................................................... 48
• Double strand break: Non-homologous End Joining (NHEJ) .............................................................. 48
Understanding the consequences of impaired DNA repair systems ........................................................... 49
Understanding how DNA repair can lead to additional mutations ............................................................. 50
Notes ........................................................................................................................................................... 51
Lesson 5 ......................................................................................................................................................... 51
Knowing what oncogenes are ..................................................................................................................... 51
Understanding and knowing how oncogenes can rise from proto-oncogenes: .......................................... 52
• Mutation ............................................................................................................................................ 52
• Higher amounts of the protein by gene amplification ....................................................................... 53
• Translocation...................................................................................................................................... 54
Knowing how receptors can act as oncogenes ............................................................................................ 54
Lesson 6 ......................................................................................................................................................... 55
Knowing the different medial disciplines involved in cancer diagnosis and treatment .............................. 55
Perform calculations on sensitivity, specificity, PPV and NPP ..................................................................... 55
Understanding resection margins and their clinical value .......................................................................... 56
Understanding the basics of radiotherapy .................................................................................................. 56
Know the three classical types of chemotherapy: ....................................................................................... 56
• Antimetabolites.................................................................................................................................. 56
• Alkylating agents ................................................................................................................................ 56
• Organic drugs ..................................................................................................................................... 56
Understanding the different ways of immunotherapy................................................................................ 56
Familiar with additional therapeutic strategies such as kinase inhibitors .................................................. 57
Know the difficulties of cancer treatment and the future perspectives ..................................................... 57
Familiar with different phases of clinical trials ............................................................................................ 57
Escape room questions .................................................................................................................................. 57
,Lesson 1
Explain causes of cancer and cell injury
A tumour starts with cell injury
• Reversible injury: e.g., 10 to 15 minutes no oxygen for the heart, cells can recover
• Irreversible injury: cell damage leads to cell death (necrosis or apoptosis) e.g., 1 hour
of oxygen depletion for the heart
Figure 1 Apoptosis vs necrosis
Causes of cell injury
• Oxygen deprivation (hypoxia)
• Physical agents
o Mechanical trauma, extreme temperatures, changes in atmospheric pressure,
radiation, electric shock
• Chemical agents and drugs
• Infectious agents
• Immunologic reactions
• Genetic defects
• Nutritional imbalances
Understand the terms: hyperplasia, metaplasia, neoplasia, malignant-,
benign tumours
• Hyperplasia: increase in cell number
• Metaplasia: change in cell differentiation
• Neoplasia (tumour): abnormal and excessive growth of cells
• Dyplasia: presence of abnormal cells within tissue, can be pre-stage to cancer
• Atrophy: decrease in cell size and function
• Hypertrophy: increase in cell size
, Figure 2 neoplasia and dysplasia
Figure 3 Atrophy, hypertrophy, hyperplasia,
metaplasia and dysplasia
• Malignant tumours: is cancer (grows fast). Cells go through the basal lamina
• Benign tumours: is not cancer (slow growth). Cells do not go through the basal
lamina, stay within.
Figure 4 difference between a benign tumor and malignant tumor
• Benign tumors are only harmful if their size or location disrupts normal functioning.
Inhoudsopgave
Lesson 1 ........................................................................................................................................................... 3
Explain causes of cancer and cell injury ........................................................................................................ 3
Understand the terms: hyperplasia, metaplasia, neoplasia, malignant-, benign tumours ........................... 3
Basic knowledge of survival rates of different cancer types ......................................................................... 5
Recognize morphological features of tumour cells ....................................................................................... 6
Explain the 10 hallmarks of cancer ................................................................................................................ 8
Basic knowledge of the TNM system ............................................................................................................. 9
Different metastasis routes of different primary tumours .......................................................................... 10
Familiar with the nomenclature of tumours: carcinoma, sarcoma, etc. ..................................................... 12
Lesson 2 ......................................................................................................................................................... 13
Basic knowledge of different techniques addressed in this presentation .................................................. 13
Basic knowledge of different stages of tumour progression of colon cancer ............................................. 14
Understand the terms tumour promoter and tumour progression ............................................................ 17
Knows relation between adenomas and carcinomas .................................................................................. 18
Familiar with the apc gene as an example of a tumour suppressor gene and the relation to FAP ............. 18
Understand the terms tumour oncogenes and tumour suppressor genes ................................................. 18
Understand the terms Darwinian evolution of tumours ............................................................................. 19
Knows what tumour stem cells are and how they influence clonal expansion ........................................... 19
Familiar with the effect of chronic inflammation of tumour progression ................................................... 19
Notes ........................................................................................................................................................... 19
Lesson 3 ......................................................................................................................................................... 20
Basic knowledge of different stages of the cell cycle .................................................................................. 20
Knowledge of the cell cycle control system and checkpoints ..................................................................... 24
Knowledge on the mechanisms of CDK and cyclins .................................................................................... 25
Understand the effects and working of proteins involved in CDK activation and inhibition (e.g. RB and
p21).............................................................................................................................................................. 26
Understand how errors in activation of CDK and resulting cascades can contribute to carcinogenesis. ... 27
Know what telomeres are and understand it’s function ............................................................................. 31
Understand and be able to explain how telomeres become shorter every cell cycle................................. 31
Know what effects short telomeres can have in tumour development ...................................................... 32
Understand how tumour cells can become “immortal” by telomerase activation ..................................... 33
Understand the relation between telomerase activity and patient prognosis ........................................... 34
Notes ........................................................................................................................................................... 34
Lesson 4 ......................................................................................................................................................... 35
Knowing what tumour suppressor genes (TSGs) are ................................................................................... 35
Understanding how TSGs can be lost or inactivated ................................................................................... 36
Knowing and being able to describe how TSGs inactivation contributes to carcinogenesis ....................... 42
Knowing the difference between familial and sporadic cancers ................................................................. 42
Understanding what kind of genes can be considered TSGs ....................................................................... 42
Knowing and understanding what kind of processes can lead to different kinds of DNA damage ............. 43
Understanding the basics of different DNA repair systems ........................................................................ 44
• DNA Polymerase proofreading .......................................................................................................... 45
• Mismatch repair (Mut repair genes) .................................................................................................. 46
• Base Excision repair (BER) .................................................................................................................. 47
, • Nucleotide Excision Repair (NER) ....................................................................................................... 47
• Double strand break: Homologous Recombination ........................................................................... 48
• Double strand break: Non-homologous End Joining (NHEJ) .............................................................. 48
Understanding the consequences of impaired DNA repair systems ........................................................... 49
Understanding how DNA repair can lead to additional mutations ............................................................. 50
Notes ........................................................................................................................................................... 51
Lesson 5 ......................................................................................................................................................... 51
Knowing what oncogenes are ..................................................................................................................... 51
Understanding and knowing how oncogenes can rise from proto-oncogenes: .......................................... 52
• Mutation ............................................................................................................................................ 52
• Higher amounts of the protein by gene amplification ....................................................................... 53
• Translocation...................................................................................................................................... 54
Knowing how receptors can act as oncogenes ............................................................................................ 54
Lesson 6 ......................................................................................................................................................... 55
Knowing the different medial disciplines involved in cancer diagnosis and treatment .............................. 55
Perform calculations on sensitivity, specificity, PPV and NPP ..................................................................... 55
Understanding resection margins and their clinical value .......................................................................... 56
Understanding the basics of radiotherapy .................................................................................................. 56
Know the three classical types of chemotherapy: ....................................................................................... 56
• Antimetabolites.................................................................................................................................. 56
• Alkylating agents ................................................................................................................................ 56
• Organic drugs ..................................................................................................................................... 56
Understanding the different ways of immunotherapy................................................................................ 56
Familiar with additional therapeutic strategies such as kinase inhibitors .................................................. 57
Know the difficulties of cancer treatment and the future perspectives ..................................................... 57
Familiar with different phases of clinical trials ............................................................................................ 57
Escape room questions .................................................................................................................................. 57
,Lesson 1
Explain causes of cancer and cell injury
A tumour starts with cell injury
• Reversible injury: e.g., 10 to 15 minutes no oxygen for the heart, cells can recover
• Irreversible injury: cell damage leads to cell death (necrosis or apoptosis) e.g., 1 hour
of oxygen depletion for the heart
Figure 1 Apoptosis vs necrosis
Causes of cell injury
• Oxygen deprivation (hypoxia)
• Physical agents
o Mechanical trauma, extreme temperatures, changes in atmospheric pressure,
radiation, electric shock
• Chemical agents and drugs
• Infectious agents
• Immunologic reactions
• Genetic defects
• Nutritional imbalances
Understand the terms: hyperplasia, metaplasia, neoplasia, malignant-,
benign tumours
• Hyperplasia: increase in cell number
• Metaplasia: change in cell differentiation
• Neoplasia (tumour): abnormal and excessive growth of cells
• Dyplasia: presence of abnormal cells within tissue, can be pre-stage to cancer
• Atrophy: decrease in cell size and function
• Hypertrophy: increase in cell size
, Figure 2 neoplasia and dysplasia
Figure 3 Atrophy, hypertrophy, hyperplasia,
metaplasia and dysplasia
• Malignant tumours: is cancer (grows fast). Cells go through the basal lamina
• Benign tumours: is not cancer (slow growth). Cells do not go through the basal
lamina, stay within.
Figure 4 difference between a benign tumor and malignant tumor
• Benign tumors are only harmful if their size or location disrupts normal functioning.
